Study on mechanism of Qinbaohong Oral Liquid in anti-inflammation, stopping cough, eliminating phlegm and relieving asthma based on network pharmacology / 中国中药杂志

This study aimed to investigate the anti-inflammatory, antitussive, expectorant, and anti-asthmatic effects of Qinbaohong Oral Liquid in mouse experiments and explore its action mechanism based on network pharmacology. The mouse auricle swelling was induced by xylene for detecting the anti-inflammatory effect of Qinbaohong Oral Liquid, whose antitussive effect was then examined in mice with cough after exposure to ammonium hydroxide. The expectorant effect was determined based on the excretion of phenol red into the mouse trachea. The mouse model of asthma induced by histamine phosphate and acetylcholine chloride was used to observe the anti-asthmatic effect. The chemical components of Qinbaohong Oral Liquid were retrieved from TCMSP and literature, followed by target prediction based on BATMAN-TCM. The targets of inflammation, cough, expectoration, and asthma collected from GeneCards were intersected with drug targets for GO and KEGG enrichment analysis using Metascape. The results were imported into STRING for exploring protein-protein interactions and screening the key targets. As demonstrated by our findings, Qinbaohong Oral Liquid at 4.5 and 9.0 mL·kg~(-1) obviously decreased the weight(P<0.05) and thickness(P<0.01) of the right swelling ear and also the weight diffe-rence(swelling degree) between the two ears(P<0.05), prolonged the incubation period of cough(P<0.05), reduced the frequency of cough within 3 min(P<0.05), and increased the excretion of phenol red into the mouse trachea(P<0.01). Qinbaohong Oral Li-quid at 2.3, 4.5, and 9.0 mL·kg~(-1) dramatically prolonged the incubation period of asthma(P<0.05). A total of 324 chemical components and 1 245 targets were harvested for the Qinbaohong Oral Liquid, together with 10 272 inflammation targets, 4 400 cough targets, 192 expectoration targets, and 7 533 asthma targets. Their intersection revealed that the anti-inflammatory, antitussive, expectorant and anti-asthmatic effects of Qinbaohong Oral Liquid were correlated with such GO biological processes as the regulation of ion transport and blood circulation and such KEGG pathways as cancer-related signaling pathways and neuroactive ligand-receptor interaction. Qinbaohong Oral Liquid has been confirmed by both experiments and network pharmacology analysis to be efficient in anti-inflammation, stopping cough, eliminating phlegm, and relieving asthma.

Eficacia de la miel para el tratamiento de la tos aguda en niños atendidos en forma ambulatoria / Efficacy of honey for treatment of acute cough in pediatric outpatients

A partir de una consulta en la central de emergencias de un niño con tos aguda, el autor del artículo realiza una búsqueda bibliográfica para revisar la evidencia sobre el uso de la miel para aliviar este síntoma. Luego de la lectura crítica de una revisión sistemática, el autor concluye que ésta podría ser una alternativa elegible frente a los jarabes para la tos, por su perfil de seguridad y su posible beneficio en el alivio de la tos. (AU)

Based on a consultation at the emergency room of a child with acute cough, the author of this article performs a bibliographic search to review the evidence on the use of honey to alleviate this symptom. After the critical appraisal of a systematic review, the author concludes that honey could be an eligible alternative to cough syrups, due to its safety profile and its possible benefit in cough relief. (AU)

O que é bom para tosse? Uma perspectiva médico-sociológica sobre os remédios para tratar tosse e resfriado em pediatria / What is good for cough? A medical-sociological perspective on medicines to treat coughs and colds in pediatrics

As medicações para tosse e resfriados são amplamente conhecidos e utilizados pela população brasileira. O objetivo dessa dissertação é entender por que essas medicações são tão populares apesar das preocupações médicas a respeito do seu uso em crianças. A metodologia utilizada foi a busca de evidências científicas sobre o padrão de segurança e eficácia dessas substâncias, além do fichamento e análise de uma reunião ocorrida em 2008 pelo Food and Drugs Admnistration. Também foram utilizados autores da filosofia e sociologia para analisar os resultados encontrados como Van der Geest, Fernando Lefèvre, Philipe Pignarre e Georges Canguilhem. Os resultados obtidos indicam que essas substâncias são utilizadas pelo seu potencial sedativo em diversos casos; o estudo não encontrou evidências médicas que sustentem o uso das medicações no ponto de vista biomédico baseado em eficácia e padrão de segurança. No entanto, a análise sociológica permitiu a elaboração de que esses medicamentos assumem o papel de cuidado médico, atribuindo valores simbólicos para os processos que envolvem os quadros de resfriado e gripe. A conclusão do estudo permite afirmar que um olhar exclusivamente bioquímico sobre a substância é insuficiente se quisermos compreender o lugar social desses medicamentos, suas formas de uso e os sentidos a eles atribuídos. Os xaropes, como essa pesquisa optou por nomear genericamente essas medicações apesar do seu efeito bioquímico questionável, são capazes de exercer grande impacto nas atribuições simbólicas de doença e cura. (AU)

The medications for cough and cold are widely known and used by brazilian population. The purpose of this dissertation is to understand why these medications are so popular despite medical concerns about their use in children. The methodology used was the search for scientific evidence on safety and efficacy of these substances, in addition to the record and analysis of a meeting that took place in 2008 by the Food and Drugs Admnistration. Philosophy and sociology authors were also used to analyze the results found, such as Van der Geest, Fernando Lefèvre, Philipe Pignarre and Georges Canguilhem. The results obtained were that these substances are used due their sedative potential in several cases; the study found no medical evidence to support the use of medications in the biomedical point of view based on efficacy and safety concerns. However, the sociological analysis allowed the elaboration that these drugs assume the role of medical care, attributing symbolic values to cold and flu processes. The conclusion of the study allows us to affirm that the exclusive biochemical view of the substance is insufficient to understand the social place of these medications, their kinds of use and their meanings. Syrups, as this research chose to name these medications generically, even though they have a questionable biochemical effect, are capable of having a great impact on the symbolic attributions of disease and cure. (AU)

Levodropropizine-Induced Anaphylaxis: Case Series and Literature Review

Levodropropizine is commonly used as an antitussive drug for acute and chronic cough. It is a non-opioid agent with peripheral antitussive action via the modulation of sensory neuropeptide levels in the airways. Thus, levodropropizine has a more tolerable profile than opioid antitussives. However, we experienced 3 cases of levodropropizine-induced anaphylaxis. Three patients commonly presented with generalized urticaria, dyspnea, and collapse after taking cold medication including levodropropizine. To find out the culprit drug, we performed skin tests, oral provocation tests (OPTs), and basophil activation tests (BATs). Two patients were confirmed as having levodropropizine-induced anaphylaxis by OPTs, and one of them showed positive to skin prick tests (SPTs). The other patient was confirmed by skin tests and BATs. When we analyzed pharmacovigilance data related to levodropropizine collected for 5 years, most cases (78.9%) had allergic reactions, such as rash, urticaria, angioedema, and anaphylaxis. Therefore, physicians should consider that levodropropizine can be a culprit drug, when anaphylaxis occurs after taking anti-cough or common cold medication.

Pathophysiology, Causes and Treatment of Chronic Cough in Adults: Literature Review / 대한이비인후과학회지

Chronic cough is a common symptom and the etiology of which can be challenging to diagnose. The key to successful management is to establish a diagnosis and to treat the cause of cough. Asthma, gastro-esophageal reflux, and postnasal drip syndrome have been thought to be most common causes of chronic cough. Various causes such as lung diseases (sarcoidosis, pertussis), obstructive sleep apnea, drug (angiotensin-converting enzyme inhibitor), and psychological status can induce chronic cough. However, many chronic cough patients do not have an identifiable cause. We need to understand the mechanisms underlying central and peripheral sensitization, how they interact with cough triggers and their relationship with the sensations that drive the urge to cough, and the subsequent motor cough response in chronic cough. Heightened cough reflex sensitivity is persistent and their cough is unexplained in many patients. In most patients who visited otorhinolaryngoloy clinics, it is possible to manage a majority of chronic cough patients successfully using a protocol based on presenting symptoms and therapeutic trials for the common causes of cough. However, there are few therapeutic options for patients with unexplained chronic cough. There is a pressing need to understand the physiological basis of unexplained chronic cough and to develop novel antitussive drugs that down regulate cough reflex sensitivity.

Drug therapy for the common cold

The common cold is an acute, self-limiting viral infection of the upper respiratory tract involving the nose, sinuses, pharynx and larynx. Drug therapies for the common cold are normally aimed at relieving the symptoms of the illness. Over-the-counter cough and cold medications should not be used in children younger than four years old because of potential harms and lack of benefit. Antibiotics, antitussives, anti-histamines, and inhaled corticosteroids are not effective in children. Products that may improve symptoms in children include expectorants, mucolytics, honey, vitamin C, zinc lozenges, geranium extract, and nasal saline irrigation. In adults, antihistamines, intranasal corticosteroids, codeine, intranasal ipratopium, and antibiotics are not effective. Decongestants, antihistamine/decongestant combi-nations, expectorants, and mucolytics may improve cold symptoms in adults. Nonsteroidal anti-inflammatory drugs and acetaminophen reduce pain secondary to upper respiratory tract infection in adults. Among complementary and alternative medicinetherapeutics, products containing vitamin C, zinc, or garlic may improve cold symptoms in adults. Prophylactic use of probiotics may decrease the frequency of colds in adults and children.

Expectorant and Antitussive Effect of Hedera helix and Rhizoma coptidis Extracts Mixture

PURPOSE: This study aims to investigate the additive effect of the Hedera helix (HH) and Rhizoma coptidis (RC) extracts mixture on antitussive and expectorant activities in animals. MATERIALS AND METHODS: The expectorant assay was performed with phenol red secretion in mice trachea. Mice or guinea pigs were randomly divided into groups of 8 each, including negative and positive control groups. After gastric administration of the test extracts in mice, 2.5% phenol red solution (0.2 mL) was intraperitoneally injected. Trachea was dissected and optical density of tracheal secretion was measured. After gastric administration of the test extracts in guinea pigs, the antitussive activities were assessed using a citric acid-induced cough measurement. RESULTS: The extracts of HH and RC significantly increased tracheal secretion and inhibited cough. The mixture of HH and RC extracts in a 1:1 concentration at a dose of 200 mg/kg showed a more potent effect on phenol red secretion (25.25+/-3.14) and cough inhibition (61.25+/-5.36) than the individual use of each extracts [phenol red secretion; HH 13.39+/-4.22 (p=0.000), RC 20.78+/-2.50 (p=0.010), cough inhibition; HH 9.89+/-4.14 (p=0.010), RC 30.25+/-7.69 (p=0.000)]. A 3:1 ratio mixture of HH to RC demonstrated an optimal expectorant effect (p<0.001), and this mixture showed expectorant and antitussive effects in a dose-dependent manner. CONCLUSION: This study provides evidence for antitussive and expectorant effect of a 3:1 mixture of HH and RC, which may be a useful therapeutic option for respiratory diseases.

Review of Mesna (Mistabron) as a Mucolytic for Preventing Plumonary complications in Intensive Care Setting.

Impaired mucus clearance or mucus hypersecretion are important feature of many pathological respiratory conditions and in ICU patients. Mesna is a potent mucolytic available as 200 mg/ml solution for neublization and endotracheopulmonary instillation. As effective “mucus clearance” is critical in managing post-operative and other ICU conditions to prevent complications like atelectasis and hypoxia, there is a need to review the clinical results of mucolytic agent Mesna, and its role in mucociliary clearance in critical care patients and in other respiratory conditions.

Erosive potential: Laboratory evaluation of tooth dissolution in cough syrups

AIM: To evaluate the associated weight loss of extracted teeth after immersed in cough syrups for a period of time so as to predict the erosive potential of the liquid medicines. MATERIAL AND METHODS: pHs of the medicines were measured at the start of the study. 25 extracted test teeth were weighed to 0.01 mg and assigned at random to each syrup under evaluation. The test medicines were placed in 10 mL screw-cap plastic containers and the test teeth were weighed after 7 days. RESULTS: 88 % of the medicines caused reduction in weights of the test teeth after seven days of immersion. Weight loss of the test teeth also noticed with basic syrups. Also lowest pH syrup did not produce the greatest weight loss. CONCLUSION: Majority of the cough syrups caused loss of weight of the test teeth. Thus, they possess the potential to cause dental erosion.

Aspergillus Tracheobronchitis in a Mild Immunocompromised Host / 결핵및호흡기질환

Aspergillus tracheobronchitis is a form of invasive pulmonary aspergillosis in which the Aspergillus infection is limited predominantly to the tracheobronchial tree. It occurs primarily in severely immunocompromised patients such as lung transplant recipients. Here, we report a case of Aspergillus tracheobronchitis in a 42-year-old man with diabetes mellitus, who presented with intractable cough, lack of expectoration of sputum, and chest discomfort. The patient did not respond to conventional treatment with antibiotics and antitussive agents, and he underwent bronchoscopy that showed multiple, discrete, gelatinous whitish plaques mainly involving the trachea and the left bronchus. On the basis of the bronchoscopic and microbiologic findings, we made the diagnosis of Aspergillus tracheobronchitis and initiated antifungal therapy. He showed gradual improvement in his symptoms and continued taking oral itraconazole for 6 months. Physicians should consider Aspergillus tracheobronchitis as a probable diagnosis in immunocompromised patients presenting with atypical respiratory symptoms and should try to establish a prompt diagnosis.

Studies on the anti-asthmatic and antitussive properties of aqueous leaf extract of Bryophyllum pinnatum in rodent species

OBJECTIVE@#To evaluate the antiasthmatic and antitussive properties of the aqueous leaf extract of Bryophyllum pinnatum (B. pinnatum) (BP) Lam.@*METHODS@#Ovalbumin-sensitized guinea pigs which were treated with BP for 21 consecutive days were exposed to 0.2% histamine aerosol in a glass chamber. Mucus viscosity, white blood cell and lymphocyte counts and tracheal wall morphometry were measured. Bouts of cough were counted pre and post acute exposure of extract-treated (× 7 d) guinea pigs to 7.5% citric acid aerosol in a chamber. Phenol red expectoration was estimated in mice after 7 d of daily administration of BP.@*RESULTS@#Doses of 200 and 400 mg/kg/day (×21 d) BP significantly increased the time for guinea pigs to experience preconvulsive dyspnoea. BP and salbutamol (0.5 mg/kg/day ×21 d) reduced mucus viscosity in the sensitized group to values comparable with controls. White blood cell, lymphocyte counts and tracheal morphometry were not significantly altered. Both doses of BP also significantly reduced the bouts of cough but only 400 mg/kg/day significantly inhibited the amount of phenol red secreted.@*CONCLUSIONS@#BP has demonstrated antiasthmatic and antitussive properties in these rodent models. These properties may underscore its use in Nigerian ethnomedicine.

Valuation on analgesic, expectorant and antitussive effects of compatible use of Aconiti radix cocta and Fritillaria cirrhosa or Fritillaria thunbergii / 中国中药杂志

<p><b>OBJECTIVE</b>To study the analgesic, expectorant and antitussive effects of the compatible use of Aconiti Radix Cocta and Fritillaria cirrhosa or F. thunbergii with different matching ratio or dose in mice.</p><p><b>METHOD</b>The two-factor, seven-level uniform design method was adopted to observe the analgesic, expectorant and antitussive effects of the oral administration with the two combined decoctions in rats, with frequency of body torsions induced by acetum, secretion of phenol red in tracheas and frequency of coughs as indexes. Significant matching proportions and doses were collected for verification.</p><p><b>RESULT</b>The effect on the frequency of body torsions: The combined decoctions could effectively reduce the frequency of body torsions. According to a regression analysis, Aconiti Radix Cocta and F. cirrhosa had the synergistic effect, which was maximized with a ratio of 1: 1. The 1: 1 combined decoction played the least role in reducing the frequency of body torsions with a total dose of more than 5 g x kg(-1). The effect on the secretion of phenol red in tracheas. The combined decoctions could effectively increase the secretion of phenol red in tracheas. According to a regression analysis, Aconiti Radix Cocta and F. thunbergii had the antagonism, which was maximized at the ratio of 1: 1, and minimized with a total dose of less than 10 g x kg(-1) and a ratio of 5: 1 between F. thunbergii and Aconiti Radix Cocta. The effect on the frequency of coughs. The combined decoctions could effectively reduce the frequency of coughs. According to a regression analysis, Aconiti Radix Cocta and F. cirrhosa had the antagonism, which was maximized at the ratio of more than 1: 5 and less than 10: 1. There was no interaction between Aconiti Radix Cocta and F. thunbergii. F. thunbergii could reduce the frequency of coughs, whereas Aconiti Radix Cocta showed no effect.</p><p><b>CONCLUSION</b>The compatible application of Aconiti Radix Cocta and F. cirrhosa could enhance the analgesic effect of Aconiti Radix Cocta and reduce the expectorant and antitussive effects of F. cirrhosa, which vary according to different matching ratio and dose. The compatible application of Aconiti Radix Cocta and F. thunbergii shows no effect on the antitussive effect of F. thunbergii. This study provides experimental basis for in-depth studies on the combined effect of Aconiti Radix Cocta and Fritillaria--two of eighteen incompatible pairs.</p>

Antitussive constituents of Disporum cantoniense / 中国中药杂志

The antitussive activity assay for the root extraction of Disporum cantoniense was carried out with coughing mice induced by ammonia liquor. The results showed that the ethanol and water extractions of D. cantoniense possess strong antitussive activity, and the high dose of the former was better than positive control, and then the constituents of the ethanol extraction were separated and purified by various modern chromatographic techniques. Their structures were identified by physico-chemical properties and spectroscopic data. As a result, eight compounds were isolated and identified as stigmast-4-en-3-one(1), (22E, 24R)-ergosta-5, 7, 22-trien-3beta-ol(2), obtucarbamate A(3), obtucarbamate B(4), neotigogenin(5), azo-2, 2'-bis[Z-(2,3-dihydroxy-4-methyl-5-methoxy) phenyl ethylene] (6),dimethyl {[carbonylbis (azanediyl)] bis( 2-methyl-5, 1-phenylene) j dicarbamate (7) , and quercetin-3-O-pB-D-glucopyranoside(8). All compounds were isolated from this plant for the first time, and the result of bioactivity-directed isolation showed that compounds 3, 4, and 6 had obvious effect on antitussive activity, and compound 6 had the same level as positive control.

Antitussive and mucoactive drugs

Cough is the most frequent complaint from medical patients even though coughing is a protective reflex. The principle of relief from a cough is treatment of its underlying disease. However, when the treatment of the cause of coughing is not effective, cough suppression therapy just to relieve the symptom may be attempted. Antitussives and mucoactive drugs are used for this purpose. Unfortunately, the currently available agents are not consistently effective and frequently have intolerable side effects. Therefore, understanding the side effects and mechanism of action of these agents is definitely needed. This review provides a summary of the currently available antitussives and mucoactives.

Serotonin Syndrome After an Overdose of Dextromethorphan and Chlorpeniramine: Two Case Reports

Dextromethorphan and chlorpeniramine are common ingredients of over-the-counter (OTC) cough pills. They are known to be safe when used alone, however, combination with other serotonergic drugs or use of an overdose can cause serotonergic toxicity. We report on a 43-year-old male and a 57-year-old female who ingested an overdose of antitussive drugs containing dextromethorphan and chlorpeniramine. They commonly presented with altered mentality and hyperreflexia on both upper and lower extremities. After conservative therapies, they were discharged with alert mentality. These cases are meaningful in that there are few cases of serotonin syndrome with an overdose of a combination of dextromethorphan and chlorpeniramine. Careful use with medication counseling for OTC cough pills is needed in order to prevent overdose of these ingredients.

Study on pharmacokinetics and in vitro/in vivo correlation of menthol in Zhike Chuanbei Pipa dropping pills in rats / 中国中药杂志

To determine the concentration of menthol in rat plasma by GC. Rats were administered with single dose of Zhike Chuanbei Pipa dropping pills (ZCPDP) and different doses of menthol herbs. DAS 3. 1.6 software was used to calculate pharmacokinetic parameters, and the accumulative absorption percentage of menthol was calculated by Loo-Riegelman method. The linear regression analysis was made in vitro/in vivo accumulative absorption percentages to detect the in vitro/in vivo correlation. The results of the study showed that the pharmacokinetics behavior of menthol in ZCPDP was in conformity with two-compartment model characteristics. The main parameters were: tmax was 10 min, t1/2beta was (183. 93 52. 75) min, CL/F was (0. 426 +/- 0. 194) L . min-1 . kg-1, all of which were no difference between ZCPDP and menthol herbs with the same dosage. There were significant differences in tmax, t1/2beta, CL/F between menthol herbs with different dosages (P <0. 05) , with indirect proportion between AUC0-infinity and dosage. The regression equation of ZCPDP's accumulative absorption percentage and accumulative release percentage was Fa = 1. 160 3Q - 19. 968, r = 0. 981 3. These results suggested that the pharmacokinetics behavior was similar between ZCPDP and menthol herbs with the same dosage in rats, with good in vitro/in vivo correlation. There were significant differences in pharmacokinetics of menthol in the range of 19.2-570 mg . kg-1.

A Case of Immunoglobulin E Mediated Anaphylaxis to Levodropropizine

We experienced a case of immunoglobulin E (IgE) mediated anaphylaxis to levodropropizine. The patient was an 18-year old Korean woman. After taking the common cold medication including acetaminophen, domperidone, and levodropropizine, skin rash, angioedema and anaphylaxis were developed immediately. As she was tolerable to acetaminophen alone, we thought the culprit agent was maybe a levodropropizine tablet. To confirm the culprit, she underwent skin prick test and oral drug provocation test with the suspected one. Finally we detected levodropropizine specific IgE and confirmed the specificity by inhibition enzyme-linked immunosorbent assay (ELISA).