Clinical observation on moxibustion at Baihui (GV20) plus Tuina for children with postnasal drip syndrome / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of moxibustion at Baihui (GV20) plus Tuina (Chinese therapeutic massage) for children with postnasal drip syndrome (PNDS).Methods: A total of 60 cases were divided into an observation group and a control group according to the random number table method, with 30 cases in each group. Cases in the control group received mometasone furoate nasal spray and nasal irrigation with 0.9％ normal saline. Cases in the observation group received additional moxibustion at Baihui (GV20) plus Tuina at the head and face. All the cases were treated for four consecutive weeks. The clinical efficacy and traditional Chinese medicine (TCM) symptoms score were compared between the two groups. Results: The total effective rate of the observation group was 93.3％ while that of the control group was 70.0％. The difference between the two groups was statistically significant (P<0.05). After treatment, the TCM symptom scores in both groups declined significantly, showing a statistical difference from that before treatment (P<0.05), and the score of the observation group was notably lower than that of the control group (P<0.05). Conclusion: The clinical efficacy of moxibustion at Baihui (GV20) plus Tuina at the head and face on the basis of nasal spray with Western medicine is more significant than that of Western medicine alone for PNDS in children.

Cough related to swallowing in asthma patients

BACKGROUND: Occurrence of cough during swallowing is common among asthma patients, but has not been investigated in detail. OBJECTIVE: We conducted an observational study to determine the prevalence of swallowing-related cough (SRC) and its characteristics in asthma patients. METHODS: Asthma patients attending our outpatient department between May 2005 and April 2007 were interviewed to investigate if they had ever experienced SRC, as well as postnasal drip or heartburn and cough related to these conditions. RESULTS: Among 417 patients who completed the questionnaire, 121 patients (29.0%) had experienced SRC. Spicy and sour foods were the most frequent tussigenic foods, causing cough in 76.0% and 53.7% of the 121 patients, respectively. In patients without SRC, the prevalence rates of postnasal drip and postnasal drip-induced cough were 35.8% (106 of 296) and 7.8% (23 of 296), respectively. The corresponding prevalence rates in patients with SRC were 50.4% (61 of 121) and 37.2% (45 of 121), which were both significantly higher than in patients without cough (p = 0.006 and p < 0.001 respectively). In patients without SRC, the prevalence rates of heartburn and heartburn-induced cough were 22.2% (66 of 296) and 2.4% (7 of 296), respectively. The corresponding prevalence rates in patients with SRC were 45.5% (55 of 121) and 16.5% (20 of 121), with both being significantly higher than in patients without cough (p = 0.002 and p < 0.001, respectively). CONCLUSION: SRC was frequent in asthma patients, and was closely related to postnasal drip and heartburn. Irritable larynx is one of the possible underlying mechanisms of SRC. This study was registered with the University Hospital Medical Information Network clinical trials registry (registration number: UMIN000017426).

Diagnosis and Management of Dry Cough: Focus on Upper Airway Cough Syndrome and Postinfectious Cough.

Cough is an important complaint of respiratory disease and normal defense mechanism of the lungs. It helps in clearing excessive secretions, fluids, infections or foreign material from the airway. In most of the cases, cough occurs as part of a brief, self-limiting illness. However, it can become a persistent symptom in several cases. The etiology of cough is very diverse and commonly includes environmental causes (cigarette smoke, pollutants, dust mites, etc.) and several disease entities, including both respiratory and nonrespiratory causes. Postnasal drip syndrome and postinfectious cough are the most common respiratory causes of chronic cough. The objective of this article is to highlight the importance and consequences of cough and discuss the effective diagnosis and management of upper airway cough syndrome and postinfectious cough. For this article, PUBMED was searched for studies and guidelines published in the English language using the medical subject heading terms cough, causes of cough, etiology of cough, postinfectious cough, post-viral cough, upper airway cough syndrome, and postnasal drip.

Effectiveness of Syouhangekabukuryoto in Post Nasal Dripping / 日本東洋医学雑誌

Shohangekabukuryoto, an herbal mixture, was administered to 15 patients with postnasal drip. Ten patients responded to this therapy and 5 failed to respond to it. Subjective symptoms and objective findings were analyzed and compared between the responders and nonresponders. Nausea was not observed in any patient. In the responders, watery rhinorrhea and <I>shinsuion</I> was often noted. Patients showing viscous rhinorrhea without <I>shinsuion</I> were considered nonresponders. These results suggest that shohangekabukuryoto is an herbal mixture that may be used for treating patients with postnasal watery rhinorrhea accompanied by <I>shinsuion</I>, despite the absence of evident nausea.

Efficacy and Tolerability of Theobromine in Patients with Upper Airway Cough Syndrome: A Multicenter, Double-Blind, Randomized, Active Drug Comparative Study

OBJECTIVES: The objective of this study is to evaluate the efficacy and tolerability of theobromine in patients with upper airway cough syndrome compared to those of levocloperastine. MATERIALS AND METHOD: This was a randomized, double-blind study. One hundred sixty-five patients with upper airway cough syndrome participated in a 5 day treatment; 85 subjects were included in the theobromine treatment group and 80 in the levocloperastine control group. Cough severity score, daytime cough symptom (DCS), nighttime cough symptom (NCS) and cough quality of life questionnaire (CQLQ) were analyzed for symptom analysis, and vital signs and laboratory study were performed for safety evaluation before and after medication administration. RESULTS: The primary efficacy analysis showed that the mean change in cough grade between baseline and follow-up in the treatment group was lower than that in the control group. This led to the conclusion that theobromine has similar efficacy to control treatment. The secondary efficacy analysis of changes in DCS, NCS and CQLQ verified this conclusion. Considering safety, only one case of dyspepsia was considered to be probably related to theobromine. Other tests conducted before and after treatment confirmed the safety of treatment medications. CONCLUSION: Theobromine is a novel natural antitussive medication that has similar efficacy to levocloperastine and adequate safety.

Postnasal Drip Syndrome

Postnasal drip syndrome is one of the most common causes of chronic cough, and is caused by a variety of conditions including vasomotor rhinitis, allergic rhinitis, nasal polyps and chronic sinusitis. Postnasal drip syndrome is diagnosed based on clinical symptoms, and patients may complain of tickles or drainage of liquid in the back of the throat. Cobblestoning of the nasal or oropharyngeal mucosa may be observed upon physical examination. However, in many patients cough may be the only symptom of postnasal drip syndrome. Confirmation of the diagnosis may depend on the resolution of symptoms after treatments with antihistamines and intranasal or systemic corticosteroids.

Misdiagnosis of allergic rhinitis patients with postnasal drip / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the clinical manifestation and the reasons of misdiagnosis of allergic rhinitis patients with postnasal drip. METHODS The clinical data of 3 patients with allergic rhinitis who had the symptom of postnasal dr ip and were mi sdiagnosed were s tudied. RESULTS The three patients to be misdiagnosed as chronic sinusitis treated by antibiotics drugs, post cold cough syndrome without any treatment, and chronic rhinitis treated with partial inferior turbinectomy. The 3 patients were diagnosed allergic rhinitis and cured with budesonide nasal spray. CONCLUSION The reasons of misdiagnosis are listed as follows. 1. The clinic doctors don't listen to the patient's complaint comprehensively and get incorrect information. 2. The symptoms of allergic rhinitis are not typical. 3. Postnasal drip is the main complaint and cause irritable cough, pharyngeal itching, globus. 4. The symptoms of allergic rhinitis are covered by other simultaneous diseases.

Diagnosis and Treatment of Cough

Cough remains the most common reason for patients to seek medical attention. Although the exact prevalence is difficult to estimate, recurrent cough is reported in up to 40% of the population. For the investigation and treatment of chronic cough, it is important to understand its etiology, particularly when the underlying pathology exists outside the respiratory tract. Although there is no consensus as to the best diagnostic strategy for chronic cough, many protocols combine laboratory investigations with empirical trials of treatment. Specific treatment for the underlying disease of cough along with etiologic diagnosis should be emphasized rather than nonspecific antitussive therapy because nonspecific pharmacologic treatments have changed little during the last 50 years, without any significant advances from opiatebased compounds. Recently, molecular structures of cough receptors and mediators have been identified. Vanilloid receptor-1 is one of ion channel receptors expressed on the sensory neurons of cough reflex. Substances inhibiting ion channels and receptor antagonists of tachy-or bradykinins are being investigated. Thus safer and more effective agents to deal with this common problem are believed to be available in the near future.

Chronic cough and postnasal drip syndrome / 医学研究生学报

To discuss the relativity of chronic cough and postnasal drip syndrome(PNDS) for better clinical diagnosis and treatment.

Chronic Cough

Cough is one of the most common symptoms that can be occasionally very distressful and persistently troublesome. Chronic cough is usually defined as a cough persisting for three weeks or longer. The most common etiologies of chronic cough are postnasal drip, asthma, and gastroesophageal reflux, and more than one causes can be identified. Therapeutic trial with decongestants/first-generation antihistamines is usually effective in the diagnosis and management of postnasal drip syndrome. Even cough without postnasal drip can be improved with decongestant/antihistamine. Methacholline challenge bronchoprovocation test is indicated for the exclusion of asthma. The 24-hour esophageal pH monitoring is usually not indicated unless the symptoms are not improving despite the medical management and lifestyle modification for gastroesophageal reflux. Cough may be caused by gastroesophageal reflux in cases not complaining of heartburn or a sour taste in the mouth. Korean patients frequently confuse postnasal drip or throat clearing with sputum from the lower respiratory tract. There is an increasing attention to the pertussis in adults. The laryngeal spasm, that can cause a brief episode of choking sense with cough, is still not well recognized even among physicians. The bronchodilators are to frequently prescribed because many patients and physicians confuse throat clearing with cough or sputum. On the contrary, codein is too much reserved in the management of cough.

Chronic cough: the spectrum and the frequency of etiologies / 결핵

BACKGROUND: Chronic cough is a common symptom that requires the systematic diagnostic approach for proper evaluation. Postnasal drip syndrome(PNDS), bronchial asthma, gastroesophageal reflux disease(GERD), and chronic bronchitis are among the common causes. This study was conducted to evaluate the spectrum and the frequency of the causes of chronic cough. METHODS: We prospectively evaluated 93 patients who had chronic cough despite normal chest radiographic finding. History and physical examination were done along with paranasal sinus radiograph, spirometry, bronchoprovocation test and 24-hours' ambulatory aesophageal pH monitoring as necessary. RESULTS: Forty-nine(52%) of the 93 patients had PNDS, 15 patients(16%) bronchitis, 10 patients(11%) asthma, 4 patients(4%) GERD, 7 patients(8%) both PNDS and asthma, 4 patients(4%) undiagnosed condition and 4 patients(4%) were taking ACE inhibitor. Sixty-nine percent of the patients with PNDS improved after follow up, 73% patients with bronchitis, 80% patients with asthma, 50% patients with GERD, 100% patients with both PNDS and asthma, and 100% patients with ACE inhibitor. CONCLUSION: PNDS was the most common causes of chronic cough. Bronchitis was the second and asthma the third in frequency. The etiology of chronic cough can be determined easily by history and physical examination, successful therapy initiated in most patients. The response to specific therapy also was important in evaluation of chronic cough.

Chronic cough: the spectrum and the frequency of etiologies / 결핵

BACKGROUND: Chronic cough is a common symptom that requires the systematic diagnostic approach for proper evaluation. Postnasal drip syndrome(PNDS), bronchial asthma, gastroesophageal reflux disease(GERD), and chronic bronchitis are among the common causes. This study was conducted to evaluate the spectrum and the frequency of the causes of chronic cough. METHODS: We prospectively evaluated 93 patients who had chronic cough despite normal chest radiographic finding. History and physical examination were done along with paranasal sinus radiograph, spirometry, bronchoprovocation test and 24-hours' ambulatory aesophageal pH monitoring as necessary. RESULTS: Forty-nine(52%) of the 93 patients had PNDS, 15 patients(16%) bronchitis, 10 patients(11%) asthma, 4 patients(4%) GERD, 7 patients(8%) both PNDS and asthma, 4 patients(4%) undiagnosed condition and 4 patients(4%) were taking ACE inhibitor. Sixty-nine percent of the patients with PNDS improved after follow up, 73% patients with bronchitis, 80% patients with asthma, 50% patients with GERD, 100% patients with both PNDS and asthma, and 100% patients with ACE inhibitor. CONCLUSION: PNDS was the most common causes of chronic cough. Bronchitis was the second and asthma the third in frequency. The etiology of chronic cough can be determined easily by history and physical examination, successful therapy initiated in most patients. The response to specific therapy also was important in evaluation of chronic cough.

Clinical Significance of Nasal Peak Inspiratory Flow Rate in Patients with Chronic Cough / 결핵

BACKGROUND: The upper respiratory tract is the primary target organ of various airborne pollutants and is easily accessible part of the respiratory tract, and also is the predominant structure where chronic cough originates. The nasal peak inspiratory flow(PIFn), which is the peak inspiratory flow via nose with nasal mask and spirometry, could be a reliable parameter of nasal obstruction. The validity of PIFn has been evaluated in several studies by assessing the correlation between PIFn measurements and other parameters of nasal air flow. This study was designed to show the reproducibility of PIFn, the difference of PIFn between patients with chronic cough and normal subjects, and the usefulness of PIFn in the evaluation of nasal obstruction in patients with chronic cough. METHODS: PIFn was measured by spirometry with nasal mask, twice a day for 3 consecutive days in 7 young normal subjects to evaluate validity of the test. In 32 patients with chronic cough and 25 age-matched normal subjects, PIFn and pulmonary function test(FEV1, FEV1%pred, FVC, and FVC%pred) were measured at first visiting. RESULTS: Values of PIFn, FEV1, and FVC were nearly constant in 7 young normal adults. Patients with chronic cough were 32 (14 males and 18 females) and the mean age was 41.4+/-15.9 years. Normal subjects were 32 (22 males and 10 females) and the mean age was 39.8+/-18.6 years. There was no significant difference of age and pulmonary function test between patients with chronic cough and normal subjects(p<0.05). The PIFn values in patients with chronic cough was significantly lower than those of normal subjects(2.25+/-0.68 L/sec vs. 2.75+/-1.00 L/sec; p=0.02). The postnasal drip syndrome(PNDS) comprised the majority of patients with chronic cough(27). The PIFn in patients with PNDS was significantly lower than that of normal subjects(meanD; 2.18+/-0.66 vs. 2.75+/-1.00 L/sec, p=0.006). CONCLUSION: There was a significant difference of PIFn between patients with chronic cough and normal subjects. Among the patients with chronic cough, patients with PNDS showed the most significant difference with normal subjects in PIFn. The PIFn could be a useful parameter of nasal obstruction in patients with chronic cough, especially in patients with PNDS.