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Objective To evaluate the diagnostic value and limitation of multichannel intraluminal esophageal impedance and pH (MII-pH) monitoring on the diagnosis of gastroesophageal reflux-related chronic cough (GERC).Methods The patients with suspicious GERC consecutively referred to our respiratory clinic between May 2010 and July 2011 underwent a MII-pH monitoring,and received anti-reflux drug therapy,irrespective of the laboratory findings.Chronic cough due to gastroesophageal reflux was determined when there was a favorable response to anti-reflux therapy.Then,the sensitivity,specificity,false positive and negative rate,total consistence,positively and negatively predictive value,the area under the curve of ROC and the Kappa value of the laboratory investigation were calculated for the diagnosis of GERC.Results During the research period,56 patients completed MII-pH monitoring.Among them,the abnormal reflux was found in 35 patients,and GERC was finally confirmed in 30 patients (85.7％) including 25 patients (83.3％) due to acid reflux and 5 patients (16.7％) due to non-acid reflux.In the remaining 21 patients with normal reflux episodes,6 patients (28.6％) could be explained by non-acid reflux for their cough because of a relatively predominant weakly acid reflux and favorable response to empirical anti-reflux therapy.For the diagnosis of GERC,MII-pH monitoring had the sensitivity of 83.3％,the specificity of 75.0％,false positive rate of 25.0％,false negative rate of 16.7％,total consistence of 80.4％,positive predictive value of 85.7％,negative predictive value of 71.4％,the area under the curve of ROC of 0.792 and Kappa value of 0.577 respectively.Conclusion MII-pH is a sensitive and reliable tool for the diagnosis of GERC due to its ability to detect both acid and non-acid reflux.
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Objective To validate the repeatability of the simplified cough score and its responsiveness to effective treatment and investigate the relationship between the simplified cough score and cough symptom score.MethodsA total of 119 patients with chronic cough referred to our respiratory clinic were recruited into the study between June 2010 and February 2011. Cough severity was evaluated by the simplified cough score,cough symptom score,Leicester cough questionnaire,and cough reflex sensitivity detection,and the correlations among them were analyzed.The change ratio,effect size,and standardized response mean of the simplified cough score were calculated after a 2-week course of effective treatment.The repeatability of the simplified cough score was assessed in 99 untreated patients with stable chronic cough.ResultsThe intraclass correlation coefficient in a 3-day test-retest interval of simplified cough score was 0.90 ( 95 ％ CI =0.84 - 0.92,P =0.00 ) for daytime and 0.89 ( 95 ％ CI =0.91 - 0.96,P =0.00 ) for nighttime. There was an obvious positive linear correlation between the simplified cough score and cough symptom score ( daytime:r =0.82,P =0.00 ; nighttime:r =0.92,P =0.00 ),a significant negative linear correlation between the cough score and Leicester cough questionnaire,and a weak but significant negative correlation between the simplified cough score and cough threshold C2 or C5 to capsaicin. After a 2-week course of effective treatment,the change ratio,effect size,and standardized response mean were 46.71％,1.16,and 1.05 for daytime and 71.87％,1.09,and 1.10 for nighttime,respectively.ConclusionThe simplified cough score is a reliable and valid tool for evaluation of cough severity in clinical practice.
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AIM: To investigate the effects of selective phosphodiesterase 3 inhibitor olprinone on cough response in guinea pigs sensitized and challenged with ovalbumin. METHODS: Forty sensitized guinea pigs were randomly divided into control ( n = 10), challenged ( n = 10), olprinone ( n = 10) and aminophylline group ( n = 10 ). Two hours after challenged with the aerosol of 1% ovalbumin or saline, animals were intraperitoneally injected either with saline,25 mg/kg of olprinone or 25 mg/kg aminophylline. At 24 h, the injection was repeated with 2. 5 mg/kg and 25 mg/kg olprinone or 2. 5 mg/kg and 25 mg/kg aminophylline respectively in olprinone and aminophylline group, cough response to inhaled capsaicin and airway responsiveness to methacholine (PC150) were measured. Then, total cell number and differential counts were analyzed in bronchoalveolar lavage fluid. RESULTS: The cough frequency was (5 ± 2) times/3 min in control group and (24 ± 3 ) times/3 min in challenged group ( P ＜ 0. 05 ), while PC150 was (659 + 57 ) mg/L in control group and (238 + 67 ) mg/L inchallenged group ( P ＜ 0. 05 ). 25 mg/kg olprinone significantly inhibited the augmented cough response and airway hyperresponsiveness, the cough frequency and PC150 were (15 ±2) times/3 min and (580 ±45) mg/L (P ＜ 0. 05 ), which differed significantly from (18 ± 2) times/3 min and (438± 52) mg/L in aminophilline group (P ＜ 0. 05). However, olprinone failed to reverse the elevated total cell number and percentage of eosinophils in bronchoalveolar lavage fluid from guinea pigs challenged with ovalbumin (P ＞ 0. 05 ). CONCLUSION: Phosphodiesterase 3 inhibitor attenuates cough response associated with eosinophilic airway inflammation by bronchodilatory effect.