Cough Desensitization Treatment: Combination of Desensitization and Cough Suppression

Chronic cough (CC) is a cough that persists longer than 8 weeks. CC impacts 11% of Americans and 20% of those do not respond to standard medical treatment and are diagnosed with refractory chronic cough (RCC). Research shows that most of these patients suffer from RCC due to hypersensitivity of airway sensory nerves. The purpose of the current study is to gradually desensitize the nerves that regulate the cough reflex in patients with RCC through cough desensitization treatment (CDT). CDT combines repeated exposure to aerosolized capsaicin, a known cough stimulant found within chili peppers, in increasing doses while actively suppressing cough. This study is a randomized, placebo-controlled clinical trial. Participants attend up to 12 treatment sessions where they are exposed to the active treatment or placebo. The treatment group receives progressive doses of aerosolized capsaicin, while actively suppressing their cough. The placebo group receives aerosolized saline and isn’t coached to suppress their cough. Outcome measures include (1) Leicester Cough Questionnaire (a validated patient-report measure), (2) urge-to-cough (UTC) testing (cough frequency and perceived UTC following exposure to various cough stimulants), (3) a visual-analogue scale of overall cough severity from 0 (no cough) to 100 (maximum cough), and (4) cough-reflex sensory testing. Seventeen participants (eight placebo, nine treatment) have completed the study. We anticipate an additional 1-3 participants will complete the study by UMCUR. Our data thus far looks encouraging with the treatment group showing greater improvement than the placebo group on every measure. The 1-week posttest mean change in LCQ was 5.53 and 3.28 in the treatment and placebo groups, respectively. Mean reduction in VAS was 32.67 points and 8.75, respectively. Mean change in cough-reflex threshold was 1.12 and .12, respectively. Statistical analysis will be included in the final presentation

Cough desensitization treatment for patients with refractory chronic cough: results of a second pilot randomized control trial

Abstract Objective The purpose of this study was to collect pilot efficacy data on a novel treatment for refractory chronic cough (RCC), which we call cough desensitization treatment (CDT). Design and methods In this parallel cohort, sham-controlled, randomized controlled trial, 21 adults with RCC were randomly assigned to 12 sessions of either CDT (progressive doses of aerosolized capsaicin while behaviorally suppressing cough; n = 11) or a sham treatment (repeated exposure to aerosolized saline; n = 9). The Leicester Cough Questionnaire (LCQ) was the primary outcome measure. Perceived cough severity with a visual analogue scale and cough challenge testing (for measuring cough-reflex sensitivity) were secondary outcome measures. Data were analyzed with mixed effects linear regression and follow-up contrasts. Results Results on all measures favored CDT. Excluding one sham participant, whose baseline LCQ scores were deemed unreliable, mean change in LCQ at 3-weeks post treatment was 6.35 and 2.17 in the CDT and sham groups, respectively. There was moderate to strong evidence of a greater improvement in the CDT group in total LCQ score (p = .058) and LCQ Psychological domain (p = .026) and Physical domain (p = .045) scores. Strong evidence was found for a greater reduction in urge-to-cough during CCT in the CDT group (p = .037) and marginal for a reduction in the capsaicin cough-reflex sensitivity (p = .094). There was weak evidence of a greater reduction in cough severity in the CDT group (p = .103). Discussion Although the study is limited due to the small sample size, the data provide additional evidence supporting further research on CDT. CDT resulted in a greater change in the primary efficacy measure (LCQ) than both pharmaceutical and behavioral treatments currently found in the literature. Trial Registration This trial (NCT05226299) was registered on Clinicaltrials.gov on 07/02/2022

Prevalence, determinants and knowledge of antibacterial self-medication: A cross sectional study in North-eastern Tanzania.

Self-medication is very common especially in developing countries and is documented to be associated with many health risks including antibiotic resistance. This study investigated the prevalence, determinants and knowledge of self-medication among residents of Siha District in Tanzania. A cross-sectional study was conducted among 300 residents in a rural District of Kilimanjaro region, North-eastern Tanzania from 1st to 28th April 2017. A semi-structured questionnaire was used to collect information regarding drugs used, knowledge, history and reasons for antibiotic self-medication. Log-binomial regression analysis was done using STATA 13 to examine factors associated with self-medication. A slightly majority of the respondents (58%) admitted to self-medication. Antibiotics most commonly utilized were amoxycillin (43%) and an antiprotozoal drug metronidazole (10%). The most common symptoms that led to self-medication were cough (51.17%), headache/ fever/ malaria (25.57%) and diarrhoea (21.59%). The most common reasons for self-medication were emergency illness (24.00%), health facility charges (20.33%), proximity of pharmacy to home (17.00%) and no reason (16.66%). Almost all reported that self-medication is not better than seeking medical consultation, 98% can result into harmful effects and 96% can result to drug resistance. The level of self-medication in this study is comparable with findings from other studies in developing countries. Pharmacies were commonly used as the first point of medical care. There is therefore a need for educative antibiotic legislative intervention to mitigate the adverse effects of antibiotic self-medication in Siha district in Tanzania