RESUMO
The traditional use of the M. charantia L. plant to treat coughs, fever and expectoration is widely practiced in different cultures, but its effectiveness and safety still require scientific investigation. This study sought to perform a chemical analysis and evaluate the antitussive, expectorant and antipyretic effects of the ethanolic extract of M. charantia leaves (EEMc) in rats and mice. The EEMc was subjected to chemical analysis by HPLC-DAD, revealing the presence of the flavonoids astragalin and isoquercetin. Acute oral toxicity in mice did not result in deaths, although changes in liver weight and stool consistency were observed. EEMc demonstrated an antitussive effect at doses of 100 and 300â mg/kg in mice subjected to cough induction by citric acid nebulization. Furthermore, it showed expectorant activity at a dose of 300â mg/kg, assessed based on the elimination of the phenol red marker in bronchoalveolar lavage. In the evaluation of antipyretic activity in rats, fever induced by Saccharomyces cerevisiae was reduced at all doses tested during the first hour after treatment. This innovative study identified the presence of astragalin and isoquercetin in EEMc and indicated that the extract has antitussive, expectorant and antipyretic properties. Therefore, EEMc presents itself as a promising option in herbal medicine for the treatment of respiratory symptoms and fever.
Assuntos
Antipiréticos , Antitussígenos , Etanol , Expectorantes , Momordica charantia , Extratos Vegetais , Folhas de Planta , Animais , Extratos Vegetais/química , Extratos Vegetais/farmacologia , Extratos Vegetais/isolamento & purificação , Camundongos , Antitussígenos/farmacologia , Antitussígenos/química , Antitussígenos/isolamento & purificação , Folhas de Planta/química , Ratos , Etanol/química , Antipiréticos/farmacologia , Antipiréticos/química , Antipiréticos/isolamento & purificação , Masculino , Momordica charantia/química , Expectorantes/farmacologia , Expectorantes/isolamento & purificação , Expectorantes/química , Tosse/tratamento farmacológico , Ratos Wistar , Relação Dose-Resposta a Droga , Saccharomyces cerevisiae/efeitos dos fármacos , Febre/tratamento farmacológicoRESUMO
El eucalipto se ha empleado popularmente para tratar afecciones respiratorias. Muchas veces en nuestras consultas como médicos de familia, los pacientes con problemas respiratorios nos preguntan sobre esta práctica y sus efectos en la salud. Por esto, decidimos hacer una búsqueda de la evidencia disponible. Luego de realizar una búsqueda bibliográfica y seleccionar la evidencia más reciente y de mejor calidad, podemos decir, que el eucalipto tuvo un efecto estadísticamente significativo en comparación con el placebo en cuanto a los síntomas relacionados con la tos como así también en su frecuencia. Igualmente, concluimos que estos efectos del eucalipto sobre la tos en procesos respiratorios agudos, deberían tomarse con precaución, siempre informando a nuestros pacientes sobre la evidencia actual limitada disponible, sin olvidar las creencias de cada persona para la toma de decisiones (AU)
Eucalyptus has been popularly used to treat respiratory conditions. Many times in our consultations as family doctors, patients with respiratory problems ask us about this practice and its effects on health. For this reason, we decided to do a search of the available evidence. After conducting a literature search and selecting the most recent and best-quality evidence, we can say that eucalyptus had a statistically significant effect compared to placebo in terms of cough-related symptoms as well as their frequency . Likewise, we conclude that these effects of eucalyptus on coughing in acute respiratory processes should be taken with caution, always informing our patients about the limited current evidence available, without forgetting each person's beliefs for decision-making (AU)
Assuntos
Humanos , Adulto , Tosse/tratamento farmacológico , Eucalyptus/efeitos dos fármacos , Doenças Respiratórias/tratamento farmacológico , Farmacodinâmica do Medicamento HomeopáticoRESUMO
PURPOSE: Methods for cough elicitation frequently involve aerosolized tussive agents. Here, we sought to determine whether healthy individuals demonstrate a quantifiable cough response after inhaling a volatile ester and if breath control techniques modify this chemically induced cough response. METHOD: Sixty adult male and female participants inhaled prepared liquid dilutions of ethyl butyrate dissolved in paraffin oil at 20%, 40%, and 60% v/v concentrations in triplicate, with presentation order randomized. We delivered stimuli through a face mask connected to an olfactometer and respiratory pneumotachograph. Participants rated sensations of their urge to cough and pleasantness of the odor while cough airflow was measured. Following baseline testing, participants were randomized to implement pursed-lip breathing or slow-paced breathing after inhaling ethyl butyrate to determine the effects of breath control on cough measures. RESULTS: Inhaled ethyl butyrate elicited cough in 70% of participants. Higher concentrations of ethyl butyrate resulted in significantly greater sensation of the urge to cough, F(2, 80) = 10.72, p < .001, and significantly more generated coughs, F(2, 63) = 13.14, p < .001. Compared to baseline, participants rated significantly decreased urge to cough during breath control techniques, F(1, 40) = 11.01, p = .0019. No significant changes were observed in the number of generated coughs between baseline and breath control techniques, F(1, 31) = 7.23, p = .01. CONCLUSIONS: Airborne ethyl butyrate is a tussigenic agent in humans. Our findings provide opportunities for future research directions in normal and disordered cough responses to volatile compounds.
Assuntos
Capsaicina , Tosse , Humanos , Masculino , Adulto , Feminino , Tosse/induzido quimicamente , Tosse/diagnóstico , Tosse/tratamento farmacológico , Capsaicina/efeitos adversos , Butiratos/efeitos adversos , PulmãoRESUMO
Cannabis sativa is a millenary medicinal plant. However, contrary to worldwide paradigm-shifting, countries like Brazil still prohibit C. sativa cultivation and its medicinal use, even though many populations use aerial parts and roots of this plant for healthcare. As such, the objective of this work was to identify substances in the samples of the C. sativa roots, tracing a correlation with antitussive and expectorant effects. Therefore, samples of C. sativa roots were donated by the Polícia Federal Brasileira, and its aqueous extract (AECsR) was prepared with subsequent lyophilization, to maintain the material stability. After that, the material was analyzed by LC-MS to observe its chemical profile. Four samples (AECsR-A, B, C, and D) were tested in animal models of citric acid-induced cough (0.4 M) and phenol red expectoration (500 mg/kg). Using LC-MS it was possible to identify 5 molecules in C. sativa roots: p-coumaroyltyramine, tetrahydrocannabinol-C4, feruoiltyramine, anhydrocanabisativine, and cannabisativine. In experimental protocols, male mice (Mus musculus) were treated with samples of AECsR at doses of 12.5, 25, or 50 mg/kg regardless of the pharmacological test. In these tests, all samples showed the potential to treat cough and promote fluid expectoration, differing only in the dose at which these effects were observed. Therefore, the data showed that the C. sativa roots of the Brazilian Northeast showed antitussive and expectorant effects, even with intense secondary metabolites' variation, which alters its potency, but not its effect. This highlights the importance of this medicinal plant for future therapy and corroborates to traditional use.
Assuntos
Antitussígenos , Cannabis , Plantas Medicinais , Camundongos , Animais , Antitussígenos/farmacologia , Antitussígenos/uso terapêutico , Expectorantes/farmacologia , Expectorantes/uso terapêutico , Tosse/induzido quimicamente , Tosse/tratamento farmacológico , Brasil , Fenolsulfonaftaleína , Cromatografia Líquida , Dronabinol/uso terapêutico , Espectrometria de Massas em Tandem , Plantas Medicinais/química , Ácido Cítrico/toxicidade , Ácido Cítrico/uso terapêuticoAssuntos
Humanos , Criança , Adolescente , Antitussígenos/efeitos adversos , Descongestionantes Nasais/efeitos adversos , Resfriado Comum/tratamento farmacológico , Tosse/tratamento farmacológico , Antitussígenos/uso terapêutico , Simpatomiméticos/efeitos adversos , Simpatomiméticos/uso terapêutico , Descongestionantes Nasais/uso terapêutico , Combinação de Medicamentos , Antagonistas dos Receptores Histamínicos/efeitos adversos , Antagonistas dos Receptores Histamínicos/uso terapêutico , Analgésicos/efeitos adversos , Analgésicos/uso terapêuticoRESUMO
Dropropizine is a peripheral antitussive drug that acts by inhibiting cough reflex through its action on the peripheral receptors and their afferent conductors. It is marketed in a racemic form or its pure enantiomer called levodropropizine and both are available worldwide in various drug dosage formulations such as tablets, sirup and oral solution. Due to the widespread use of antitussives in the clinic it is necessary to develop efficient analytical methodologies for quality control and also for pharmacokinetic, bioavailability and bioequivalence studies. This review presents a survey of the characteristics, properties and analytical methods used for drug determination, being carried out through scientific articles as well as in official compendia. From the analyzed studies, the majority reports the use of HPLC/UV techniques for drug determination, but also spectrophotometric UV/Vis methods as well as gas chromatography, and voltammetric, potentiometric and conductometric titration methods. In addition, the methodologies addressed the determination of dropropizine or levodropropizine in different types of matrices such as raw material, pharmaceutical formulations, plasma and urine. Despite the extensive clinical use of dropropizine, data from this review evidenced a still limited number of studies dealing with analytical methods for its determination in different matrices, which may be of concern since the applicability of these methods is important for quality assurance, efficacy and safety of the medicine.
Assuntos
Antitussígenos/análise , Cromatografia Líquida de Alta Pressão/métodos , Propilenoglicóis/análise , Antitussígenos/farmacocinética , Antitussígenos/uso terapêutico , Tosse/tratamento farmacológico , Cromatografia Gasosa-Espectrometria de Massas , Meia-Vida , Humanos , Propilenoglicóis/farmacocinética , Propilenoglicóis/uso terapêutico , Espectrofotometria , Estereoisomerismo , Comprimidos/químicaRESUMO
The current study was designed to investigate the traditional recipes used to treat cough in Tehsil Piran, Malakand, Pakistan. These recipes were explored and quantitively analyzed for the first time. A total of 30 species of the plants, 6 animal products and one salt were reported to be used by the community to treat cough. Punica granatum L. and Olea ferruginea Royle dominated with Use value (UV) of 0.84 and Origanum vulgare L. with least use value of 0.1. The frequency citation (FC) of the Papaver somniferum L. is higher (98) while the lowest one is Verbascum thapsus L. (0.13). The large number of traditional recipes used for cough in this area shows that primary health care is still amalgamated in this culture. In future studies, these recipes may be further exploited as a base for modern medicine.
Este estudio fue diseñado con el propósito de investigar las recetas tradicionales utilizadas para tratar la tos en Tehsil Piran, Malakand, Pakistán. Estas recetas fueron exploradas y analizadas cuantitativamente por primera vez. Se constata que la comunidad utilizó un total de 30 especies de plantas, 6 productos animales y una sal para tratar la tos. Punica granatum L. y Olea ferruginea Royle se destacaron con un valor de uso (UV) de 0.84 y Origanum vulgare L. con un valor de uso mínimo de 0.1. La cita de frecuencia (FC) del Papaver somniferum L. es más alta (98) mientras que la más baja es Verbascum thapsus L. (0.13). La gran cantidad de recetas tradicionales utilizadas para la tos en esta área muestra que la atención primaria de salud todavía está amalgamada en esta cultura. En futuros estudios, estas recetas pueden explotarse aún más como base para la medicina moderna.
Assuntos
Humanos , Plantas Medicinais , Tosse/tratamento farmacológico , Etnofarmacologia , PaquistãoRESUMO
Coinfection of SARS-CoV-2/Mycobacterium tuberculosis (MTB) in patients with HIV/AIDS has not been previously reported. Here, we present two cases of coinfection of SARS-CoV-2 and MTB in patients with HIV. The first case is a 39-year-old patient who was admitted with a 7-day history of fever, myalgia, headache, and cough. The second patient is a 43-year-old man who had a 1-month history of cough with hemoptoic sputum, evolving to mild respiratory distress in the last 7 days. Both patients already had pulmonary tuberculosis and subsequently developed SARS-CoV-2 infection during the 2020 pandemic. Nonadherence to antiretroviral treatment may have been a factor in the clinical worsening of the patients.
Assuntos
Infecções por Coronavirus/microbiologia , Tosse/microbiologia , Infecções por HIV/microbiologia , Cooperação do Paciente/psicologia , Pneumonia Viral/microbiologia , Síndrome do Desconforto Respiratório/microbiologia , Tuberculose Pulmonar/microbiologia , Adulto , Fármacos Anti-HIV/uso terapêutico , Betacoronavirus/patogenicidade , COVID-19 , Coinfecção , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Tosse/tratamento farmacológico , Tosse/imunologia , Tosse/virologia , HIV/patogenicidade , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Infecções por HIV/virologia , Humanos , Masculino , Mycobacterium tuberculosis/patogenicidade , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , Síndrome do Desconforto Respiratório/tratamento farmacológico , Síndrome do Desconforto Respiratório/imunologia , Síndrome do Desconforto Respiratório/virologia , SARS-CoV-2 , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/imunologia , Tuberculose Pulmonar/virologiaRESUMO
Montelukast sodium is an effective and well-tolerated anti-asthmatic drug. Long non-coding RNAs (lncRNAs) are involved in the treatment of asthma. Therefore, this study aimed to investigate the effect of montelukast sodium on children with cough-variant asthma (CVA) and the role of lncRNA prostate cancer gene expression marker 1 (PCGEM1) in drug efficacy. The efficacy of montelukast sodium was evaluated by assessing the release of inflammatory factors and pulmonary function in CVA children after a 3-month treatment. An ovalbumin (OVA)-sensitized mouse model was developed to simulate asthmatic conditions. PCGEM1 expression in clinical peripheral blood samples and lung tissues of asthmatic mice was determined. Asthmatic mice experienced nasal inhalation of PCGEM1 overexpression with simultaneous montelukast sodium to investigate the roles of PCGEM1 in asthma treatment. The NF-κB axis after PCGEM1 overexpression was detected to explore the underling mechanisms. Consequently, montelukast sodium contributed to reduced levels of pro-inflammatory factors and improved pulmonary function in CVA children. PCGEM1 was poorly expressed in OVA-sensitized asthmatic mice and highly expressed in CVA children with response to the treatment. PCGEM1 overexpression enhanced the anti-inflammatory effects and promoted effects on pulmonary function of montelukast sodium in CVA children and OVA-sensitized asthmatic mice. Furthermore, PCGEM1 inhibited the activation of the NF-κB axis. This study demonstrated the anti-inflammatory and lung-protective effects of montelukast sodium on CVA, which was strengthened by overexpression of PCGEM1. Findings in this study highlighted a potential anti-asthmatic target of montelukast sodium.
Assuntos
Acetatos/uso terapêutico , Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Tosse/tratamento farmacológico , Substâncias Protetoras/uso terapêutico , Quinolinas/uso terapêutico , RNA Longo não Codificante/metabolismo , Animais , Asma/sangue , Criança , Pré-Escolar , Tosse/sangue , Ciclopropanos , Modelos Animais de Doenças , Feminino , Humanos , Masculino , Camundongos , Camundongos Endogâmicos BALB C , SulfetosRESUMO
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)
Assuntos
Humanos , Masculino , Criança , Adolescente , Tosse/terapia , Mel , Antitussígenos/uso terapêutico , Infecções Respiratórias/terapia , Tosse/classificação , Tosse/fisiopatologia , Tosse/tratamento farmacológico , Dextrometorfano/uso terapêutico , Difenidramina/uso terapêutico , Febre , Assistência Ambulatorial/métodos , Revisões Sistemáticas como AssuntoRESUMO
Montelukast sodium is an effective and well-tolerated anti-asthmatic drug. Long non-coding RNAs (lncRNAs) are involved in the treatment of asthma. Therefore, this study aimed to investigate the effect of montelukast sodium on children with cough-variant asthma (CVA) and the role of lncRNA prostate cancer gene expression marker 1 (PCGEM1) in drug efficacy. The efficacy of montelukast sodium was evaluated by assessing the release of inflammatory factors and pulmonary function in CVA children after a 3-month treatment. An ovalbumin (OVA)-sensitized mouse model was developed to simulate asthmatic conditions. PCGEM1 expression in clinical peripheral blood samples and lung tissues of asthmatic mice was determined. Asthmatic mice experienced nasal inhalation of PCGEM1 overexpression with simultaneous montelukast sodium to investigate the roles of PCGEM1 in asthma treatment. The NF-κB axis after PCGEM1 overexpression was detected to explore the underling mechanisms. Consequently, montelukast sodium contributed to reduced levels of pro-inflammatory factors and improved pulmonary function in CVA children. PCGEM1 was poorly expressed in OVA-sensitized asthmatic mice and highly expressed in CVA children with response to the treatment. PCGEM1 overexpression enhanced the anti-inflammatory effects and promoted effects on pulmonary function of montelukast sodium in CVA children and OVA-sensitized asthmatic mice. Furthermore, PCGEM1 inhibited the activation of the NF-κB axis. This study demonstrated the anti-inflammatory and lung-protective effects of montelukast sodium on CVA, which was strengthened by overexpression of PCGEM1. Findings in this study highlighted a potential anti-asthmatic target of montelukast sodium.
Assuntos
Quinolinas/uso terapêutico , Asma/tratamento farmacológico , Antiasmáticos/uso terapêutico , Substâncias Protetoras/uso terapêutico , Tosse/tratamento farmacológico , RNA Longo não Codificante/metabolismo , Acetatos/uso terapêutico , Asma/sangue , Tosse/sangue , Modelos Animais de Doenças , Camundongos Endogâmicos BALB CRESUMO
BACKGROUND: The clinical presentation of acute chest syndrome is similar whether due to infectious or non-infectious causes, thus antibiotics are usually prescribed to treat all episodes. Many different pathogens, including bacteria, have been implicated as causative agents of acute chest syndrome. There is no standardized approach to antibiotic therapy and treatment is likely to vary from country to country. Thus, there is a need to identify the efficacy and safety of different antibiotic treatment approaches for people with sickle cell disease suffering from acute chest syndrome. This is an update of a Cochrane Review first published in 2007, and most recently updated in 2015. OBJECTIVES: To determine whether an empirical antibiotic treatment approach (used alone or in combination):1. is effective for acute chest syndrome compared to placebo or standard treatment;2. is safe for acute chest syndrome compared to placebo or standard treatment;Further objectives are to determine whether there are important variations in efficacy and safety:3. for different treatment regimens,4. by participant age, or geographical location of the clinical trials. SEARCH METHODS: We searched The Group's Haemoglobinopathies Trials Register, which comprises references identified from comprehensive electronic database searches and handsearching of relevant journals and abstract books of conference proceedings. We also searched the LILACS database (1982 to 23 October 2017), African Index Medicus (1982 to 23 October 2017) and trial registries (23 October 2017).Date of most recent search of the Haemoglobinopathies Trials Register: 10 July 2019. SELECTION CRITERIA: We searched for published or unpublished randomised controlled trials. DATA COLLECTION AND ANALYSIS: Each author intended to independently extract data and assess trial quality by standard Cochrane methodologies, but no eligible randomised controlled trials were identified. MAIN RESULTS: For this update, we were unable to find any randomised controlled trials on antibiotic treatment approaches for acute chest syndrome in people with sickle cell disease. AUTHORS' CONCLUSIONS: This update was unable to identify randomised controlled trials on efficacy and safety of the antibiotic treatment approaches for people with sickle cell disease suffering from acute chest syndrome. While randomised controlled trials are needed to establish the optimum antibiotic treatment for this condition, we do not envisage further trials of this intervention will be conducted, and hence the review will no longer be regularly updated.
Assuntos
Síndrome Torácica Aguda/tratamento farmacológico , Antibacterianos/uso terapêutico , Síndrome Torácica Aguda/microbiologia , Tosse/tratamento farmacológico , Febre/tratamento farmacológico , Humanos , Hipóxia/tratamento farmacológico , Escarro/metabolismoRESUMO
Introducción: El lupus eritematoso sistémico tiene múltiples formas de presentarse; entre las manifestaciones cardíacas, es frecuente la afectación pericárdica, pero es poco frecuente que su forma de debut sea el derrame pericárdico. Objetivo: Destacar la importancia del diagnóstico precoz de una de las formas menos frecuentes de debut del lupus eritamatoso sistémico. Caso clínico: Se presenta el caso de una paciente de 50 años, que ingresó porque desde hacía 3 meses sufría dolor torácico, disnea, tos, síntomas articulares, dermatológicos y generales. Luego de la sospecha y el estudio clínico, hematológico, imagenológico y biopsia de piel, se diagnosticó precozmente derrame pericárdico por lupus eritematoso sistémico. Se impuso tratamiento oportuno con esteroides, y la evolución fue favorable. Conclusiones: A pesar del bajo índice de sospecha, se tuvo en cuenta al lupus eritematoso sistémico y se procedió a las determinaciones analíticas que confirmaron el diagnóstico(AU)
Introduction: Systemic lupus erythematosus has multiple ways of presentation; among cardiac manifestations, pericardial involvement is frequent, but it is rare that its debut form is the pericardial effusion. Objective: To emphasize the importance of early diagnosis of one of the less frequent forms of systemic lupus erythematosus. Clinical case: We present the case of a 50-year-old patient, who had been admitted for 3 months because of chest pain, dyspnea, cough, joint, dermatological and general symptoms. After the suspicion and the clinical, hematological, imaging and skin biopsy, pericardial effusion was diagnosed early due to systemic lupus erythematosus. Timely treatment with steroids was imposed, and the evolution was favorable. Conclusions: Despite the low index of suspicion, the systemic lupus erythematosus was taken into account and the analytical determinations that confirmed the diagnosis were made(AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/sangue , Pele/microbiologia , Tosse/tratamento farmacológico , Lúpus Eritematoso Sistêmico/complicações , Derrame Pericárdico/diagnóstico por imagem , BiópsiaRESUMO
RESUMEN La tos crónica en los adultos puede ser causada por muchas causas, existen cuatro principales: el síndrome de tos de la vía aérea superior, enfermedad por reflujo gastroesofágico, reflujo laringofaríngeo, asma bronquial, y bronquitis eosinofílica no asmática. Todos los pacientes deben evaluarse clínicamente con espirometria, y comenzar con tratamiento empírico. Otras causas potenciales incluyen el uso de inhibidores de la enzima convertidora de la angiotensina, cambios medioambientales, uso del tabaco, enfermedad pulmonar obstructiva crónica, y la apnea obstructiva del sueño. La radiografía del tórax puede orientar hacia causas infecciosas, inflamatorias, y malignas. Los pacientes con tos crónica refractaria pueden remitirse a la consulta especializada de un neumólogo u otorrinolaringólogo, además de un ensayo terapéutico con gabapentin, pregabalin, y psicoterapia (AU).
ABSTRACT Although chronic cough in adults can be caused by many etiologies, four conditions account for most cases: upper airway cough syndrome, gastro-esophageal reflux disease, also known as laryngo- pharyngeal reflux disease, bronchial asthma, and non-asthmatic eosinophilic bronchitis. All patients should be evaluated clinically with spirometry, and empiric treatment should be initiated. Other potential causes include angiotensin-converting enzyme inhibitor use, environmental triggers, tobacco use, chronic obstructive pulmonary disease, and obstructive sleep apnea. Chest radiography can rule out concerning infectious, inflammatory, and malignant thoracic conditions. Patients with refractory chronic cough should be referred to a pulmonologist or otolaryngologist in addition to a therapeutic trial of gabapentin, pregabalin, and psychotherapy (AU).
Assuntos
Humanos , Adulto , Doença Crônica/epidemiologia , Medicina Baseada em Evidências , Tosse/diagnóstico , Tosse/etiologia , Tosse/psicologia , Tosse/tratamento farmacológico , Tosse/terapia , Tosse/epidemiologia , Asma/diagnóstico , Bronquite/diagnóstico , Refluxo Gastroesofágico/diagnóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Pregabalina/uso terapêutico , /uso terapêuticoRESUMO
RESUMEN La tos crónica en los adultos puede ser causada por muchas causas, existen cuatro principales: el síndrome de tos de la vía aérea superior, enfermedad por reflujo gastroesofágico, reflujo laringofaríngeo, asma bronquial, y bronquitis eosinofílica no asmática. Todos los pacientes deben evaluarse clínicamente con espirometria, y comenzar con tratamiento empírico. Otras causas potenciales incluyen el uso de inhibidores de la enzima convertidora de la angiotensina, cambios medioambientales, uso del tabaco, enfermedad pulmonar obstructiva crónica, y la apnea obstructiva del sueño. La radiografía del tórax puede orientar hacia causas infecciosas, inflamatorias, y malignas. Los pacientes con tos crónica refractaria pueden remitirse a la consulta especializada de un neumólogo u otorrinolaringólogo, además de un ensayo terapéutico con gabapentin, pregabalin, y psicoterapia.
ABSTRACT Although chronic cough in adults can be caused by many etiologies, four conditions account for most cases: upper airway cough syndrome, gastro-esophageal reflux disease, also known as laryngo- pharyngeal reflux disease, bronchial asthma, and non-asthmatic eosinophilic bronchitis. All patients should be evaluated clinically with spirometry, and empiric treatment should be initiated. Other potential causes include angiotensin-converting enzyme inhibitor use, environmental triggers, tobacco use, chronic obstructive pulmonary disease, and obstructive sleep apnea. Chest radiography can rule out concerning infectious, inflammatory, and malignant thoracic conditions. Patients with refractory chronic cough should be referred to a pulmonologist or otolaryngologist in addition to a therapeutic trial of gabapentin, pregabalin, and psychotherapy.
Assuntos
Humanos , Adulto , Doença Crônica/epidemiologia , Medicina Baseada em Evidências , Tosse/diagnóstico , Tosse/etiologia , Tosse/psicologia , Tosse/tratamento farmacológico , Tosse/terapia , Tosse/epidemiologia , Asma/diagnóstico , Bronquite/diagnóstico , Refluxo Gastroesofágico/diagnóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Pregabalina/uso terapêutico , Gabapentina/uso terapêuticoAssuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Infecções Respiratórias/tratamento farmacológico , Tosse/tratamento farmacológico , Antibacterianos/uso terapêutico , Prescrições de Medicamentos , Infecções Respiratórias/diagnóstico , Padrões de Prática Médica/estatística & dados numéricos , Estudos Prospectivos , Resultado do Tratamento , Tosse/diagnóstico , Estudos Observacionais como Assunto , Medicina Geral , Reino Unido , Antibacterianos/efeitos adversosRESUMO
La tos es un reflejo protector del aparato respiratorio que si se prolonga en el tiempo puede afectar seriamente la calidad de vida. Recientemente un nuevo paradigma califica a la tos por hipersensibilidad refleja consecuente a una exagerada sensibilidad de las terminaciones nerviosas periféricas a diversos estímulos y a alteraciones en los núcleos centrales integradores del reflejo. Este nuevo paradigma tiene implicancias terapéuticas, más allá del tratamiento de la causa de la tos. En este artículo se revisarán los nuevos mecanismos implicados en la tos por hipersensibilidad refleja y las nuevas drogas en investigación que modulan el reflejo tusígeno. A pesar de las nuevas investigaciones farmacológicas se necesitan evidencias más seguras para aconsejar un tratamiento "sintomático" de estos pacientes que contribuya al control de la hipersensibilidad central y periférica del reflejo de la tos.
Cough is a protective reflex of the respiratory system that if persist over time can seriously affect the quality of life. Recently, a new paradigm qualifies cough as a consequence of a reflex hypersensitivity resulting from an exaggerated sensitivity of the peripheral nerve endings to various stimuli and central neural alterations in cough processing. This new paradigm has therapeutic implications, beyond the causal treatment of cough. In this article we will review the new mechanisms involved in cough due to reflex hypersensitivity and new therapeutic strategies under development that modulate the cough reflex. Despite the new pharmacological investigations, safer evidence is needed to advise a "symptomatic" treatment of these patients that contributes to the control of central and peripheral hypersensitivity of the cough reflex
Assuntos
Humanos , Tosse/diagnóstico , Tosse/tratamento farmacológico , Tosse/fisiopatologia , Hipersensibilidade/complicaçõesRESUMO
ETHNOPHARMACOLOGY RELEVANCE: Blepharocalyx salicifolius (Kunth) O. Berg (Myrtaceae) is a tree native to Argentina and Uruguay that grows and is cultivated along the riverside of the Rio de la Plata. The leaves of this plant species, locally known as "anacahuita" are used in South America to prepare infusions for the empiric treatment of cough and bronchospasm, as well as diarrhoea and other intestinal disorders. Although previous phytochemical studies have been performed with the essential oil extracted from Blepharocalyx salicifolius, pharmacological evidence supporting its traditional use is still lacking. AIM OF THE STUDY: To experimentally evaluate the pharmacological properties of Blepharocalyx salicifolius based on its traditional use. The studies were performed with tincture (T-Bs) and essential oil (EO-Bs) prepared from its leaves, in isolated rat trachea, intestine and heart preparations. METHODS: The ex-vivo effects of T-Bs and EO-Bs were evaluated with the agonists carbachol (CCh) and calcium chloride (Ca2+) in the contractile concentration-response curves (CRC) of the isolated intestine. The muscle relaxant effect of EO-Bs was evaluated in the isolated trachea and compared with the effect achieved with papaverine as a positive control. The T-Bs and EO-Bs cardiac effects were analysed by perfusion of an isolated rat heart before a period of ischemia/reperfusion (stunning model). The antitussive effect of both T-Bs and EO-Bs was evaluated in mice exposed to ammonia using codeine as a positive control. RESULTS: Both T-Bs and EO-Bs induced a non-competitive inhibition of the CCh-CRC in the rat intestine, with IC50 values of 170.3 ± 48.5µg T-Bs/mL (n = 6) and 5.9 ± 1.6µg EO-Bs/mL (n = 6), respectively. EO-Bs also inhibited non-competitively the Ca2+-CRC, with IC50 value of 1.8 ± 0.3µg EO-Bs/mL (n = 8). A similar effect was obtained with the main active component of the EO-Bs 1,8-cineole. In isolated trachea, EO-Bs induced the relaxation of the CCh-contracted tissue (1.7 ± 0.2µg EO-Bs/mL, n = 11) up to a maximal relaxation that was 1.9 times higher than that of papaverine. In the isolated heart, EO-Bs induced a poor negative inotropic response, and did not improve the contractile and energetic recovery after ischemia and reperfusion. In the mouse cough model, EO-Bs (90mg/Kg) was as effective as codeine (30mg/Kg) in reducing cough frequency. CONCLUSIONS: The results indicate that the preparations from Blepharocalyx salicifolius leaves were effective as central antitussive, bronchodilating and antispasmodic agents, suggestive of a mechanism associated with the inhibition of Ca2+ influx into smooth muscle. The EO-Bs displayed only a poor ability to reduce cardiac inotropism, and was devoid of any cardioprotective properties. Thus, the present study validates the traditional use of this South American plant for asthma, cough and bronchospasm, shedding new light into its potency and putative mechanism of action.