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Cough Reflex (cough + reflex)
Selected AbstractsAssociation of angiotensin-I converting enzyme DD genotype with influenza pneumonia in the elderlyGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 1 2002Miyuki Onishi Background: Although angiotensin-I converting enzyme (ACE) is known to associate with cough reflex and inflammatory conditions, and both may participate in influenza pneumonia in the elderly, no study has been carried out on the association between influenza pneumonia and the insertion/deletion (I/D) polymorphism of the ACE gene (ACE). Methods: The subjects were 934 elderly inpatients (mean ± SD age of 82 ± 8 years) in a long-term care hospital. The association between ACE I/D and the incidence of influenza-pneumonia events was assessed over a winter season. Data were analyzed by multiple logistic regression analysis, with adjustment for age, gender, already known clinical risk factors, and ACE-inhibitor use. Results: During the follow-up period, 330 patients developed influenza (Directigen FLU-A) and 89 developed influenza pneumonia (Center for Disease Control and Prevention (CDC) criteria with chest X-ray required), 16 fatal and 73 non-fatal. Compared to non-influenza subjects (n = 604) and influenza patients without pneumonia (n = 241), ACE DD genotype (vs ID + II) resulted in a significant risk for all pneumonia (relative risk 2.32 [95% CI: 1.30,4.14] and 2.76 [1.39,4.04]), non-fatal pneumonia (1.91 [1.01,3.63] and 2.57 [1.23,5.39]) and fatal pneumonia (6.27 [1.68,23.3] and 5.15 [1.29,20.5]). Conclusion:ACE I/D polymorphism is a strong and independent risk indicator of influenza pneumonia events in elderly inpatients. [source] Capsaicin Troche for Swallowing Dysfunction in Older PeopleJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2005Takae Ebihara MD Objectives: To determine whether oral capsaicin troche supplementation with every meal upregulates the impairment of upper respiratory protective reflexes such as the swallowing reflex and the cough reflex. Design: Randomized, controlled study with recruitment through nursing homes. Setting: Sendai, Japan, from September 2002 through December 2003. Participants: Sixty-four participants in nursing homes with a mean age±standard deviation of 81.9±1.0 with stable physical status. Intervention: Participants were randomly assigned to the program for the supplementation of capsaicin trochisci or placebo trochisci before every meal for 4 weeks. Measurements: Assessment of individual latency time of the swallowing reflex (LTSR) and cough reflex sensitivity. Results: Before the commencement of this study, there were no significant baseline differences in multiple parameters between the intervention group and control group. LTSR in participants in the intervention group was significantly shorter than in the control group (P<.05). The odds ratio (OR) of the shortening of the LTSR of more than 1 minute in the intervention group was 3.4 (95% confidence interval (CI)=1.1,10.4), compared with the control group (P=.03). In particular, daily capsaicin supplementation significantly increased the ratio of LTSR reduction at 4 weeks after the study to baseline LTSR in the high-risk group (baseline LTSR >6.0 seconds) compared with the low-risk group (baseline LTSR <3.0 seconds) and the intermediate group (3.0 seconds Malpositioning of fine bore feeding tube: A serious complicationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2005R. Kawati Feeding tubes are used frequently in the intensive care unit to provide enteral nutrition. For critically ill patients, enteral nutrition is preferable to parenteral in terms of cost, complication and gut mucosal maintenance. Fine bore feeding tubes are always preferred because their soft, flexible construction and narrow diameter enables these tubes to be well tolerated by patients and they rarely contribute to sinus infections or obstruction of breathing. On the other hand it is not uncommon that these tubes are misplaced in the tracheobronchial tree or the pleural cavity, especially in high-risk patients, i.e. sedated patients, patients with weak cough reflex, endotracheally intubated patients and agitated patients (1,3). Malpositioning in the peritoneal cavity or the mediastinum through gastric or esophageal perforation is also possible (1, 4,7); even intravascular (8, 9) and intracranial misplacement have been reported (10,13). The incidence of misplacement of a feeding tube is difficult to estimate because few studies have been performed. The largest study of 1100 such tubes revealed an overall malposition rate of 1.3% (1), but it should be mentioned that this study included only radiographically detected misplacements. Other researchers estimate the occurrence of accidental misplacement and migration out of position as high as 13% to 20% in high-risk patients (14, 15). [source] Synergistic interactions between airway afferent nerve subtypes regulating the cough reflex in guinea-pigsTHE JOURNAL OF PHYSIOLOGY, Issue 2 2005Stuart B. Mazzone Cough initiated from the trachea and larynx in anaesthetized guinea-pigs is mediated by capsaicin-insensitive, mechanically sensitive vagal afferent neurones. Tachykinin-containing, capsaicin-sensitive C-fibres also innervate the airways and have been implicated in the cough reflex. Capsaicin-sensitive nerves act centrally and synergistically to modify reflex bronchospasm initiated by airway mechanoreceptor stimulation. The hypothesis that polymodal mechanoreceptors and capsaicin-sensitive afferent nerves similarly interact centrally to regulate coughing was addressed in this study. Cough was evoked from the tracheal mucosa either electrically (16 Hz, 10 s trains, 1,10 V) or by citric acid (0.001,2 m). Neither capsaicin nor bradykinin evoked a cough when applied to the trachea of anaesthetized guinea-pigs, but they substantially reduced the electrical threshold for initiating the cough reflex. The TRPV1 receptor antagonist capsazepine prevented the increased cough sensitivity induced by capsaicin. These effects of topically applied capsaicin and bradykinin were not due to interactions between afferent nerve subtypes within the tracheal wall or a direct effect on the cough receptors, as they were mimicked by nebulizing 1 mg ml,1 bradykinin into the lower airways and by microinjecting 0.5 nmol capsaicin into nucleus of the solitary tract (nTS). Citric acid-induced coughing was also potentiated by inhalation of bradykinin. The effects of tracheal capsaicin challenge on cough were mimicked by microinjecting substance P (0.5,5 nmol) into the nTS and prevented by intracerebroventricular administration (20 nmol h,1) of the neurokinin receptor antagonists CP99994 or SB223412. Tracheal application of these antagonists was without effect. C-fibre activation may thus sensitize the cough reflex via central mechanisms. [source] H+/K+ -ATPase (proton pump) inhibitors dampen increased cough reflex: more than gastric acid suppressionCLINICAL & EXPERIMENTAL ALLERGY, Issue 3 2005K. F. Chung No abstract is available for this article. [source]
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