Pharmacology and Therapeutics of CoughK. Fan Chung, John Widdicombe The last decade or so has seen remarkable advances in our knowledge of cough. This applies especially to its basic mechanisms: the types of airway sensors, the phar- cological receptors on their membranes, the brainstem organization of the ‘cough centre’, and the involvement of the cerebral cortex in the sensations and the vol- tary control of cough. With the exception of the last of these, nearly all the studies have been on experimental animals rather than humans, for obvious reasons. One group of experimental studies has particular relevance to human patients, and that is the demonstration of the sensitization of cough pathways both in the periphery and in the brainstem. Similar sensitizations have been shown for patients with chronic cough or who have been exposed to pollutants, and it is reasonable to suppose that this is the basis of their cough and that the underlying mechanisms are generally similar in humans and other species. Important advances are also being made in clinical cough research. For the three main causes of clinical cough, asthma, post-nasal drip syndrome, and gast- oesophageal re?ux disease, we are beginning to understand the pathological processes involved. There remains a diagnostically obdurate group of idiopathic chronic coughers, but even for them approaches are being devised to clarify und- lying mechanisms and to establish diagnoses. Perhaps surprisingly, the ?eld in which there has been the least spectacular - vance is the therapy of cough. |
Contents
3 | |
The Future of Cough | 15 |
Neuronal Mechanisms of Action of Centrally | 20 |
Cough Sensors I Physiological and Pharmacological Properties | 22 |
Cough Sensors II Transient Receptor Potential Membrane Receptors | 49 |
Cough Sensors III Opioid and Cannabinoid Receptors on Vagal | 62 |
Cough Sensors IV Nicotinic Membrane Receptors on Cough Sensors | 77 |
References | 94 |
Pharmacology of Brainstem Pathways D C Bolser 203 | 202 |
Study Approaches | 219 |
Conscious Control of Cough and the Placebo | 241 |
The UrgeToCough A Respiratory Sensation P W Davenport | 263 |
Therapeutic Treatments and Management of Chronic | 277 |
Measuring the Cough Response in the Laboratory 297 | 296 |
What is the Minimal Important Difference for | 311 |
Introduction | 312 |
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Common terms and phrases
action potential afferent nerves afferent neurons agonists airway afferent airway sensory antitussive antitussive activity antitussive drugs antitussive effects Appl Physiol asthma Barnes PJ Belvisi Bolser DC Bonham AC bradykinin brain brainstem bronchoconstriction bronchopulmonary C-fibers cannabinoid capsaicin cells central chronic cough Chung KF citric acid Clin clinical codeine Coleridge cough challenge cough induced cough receptors cough reflex cough response cough sensitivity dextromethorphan disease endogenous fibers guinea pigs human induced cough inflammation inflammatory inhaled inhibit cough inhibitory innervating ion channels Kamei Kollarik Lee LY lung Mazzone SB mechanisms mediated modulation Morice AH neuropeptides Neurosci nicotine NnAChRs nociceptin nociceptors nodose opioid receptors pathways peripheral Pharmacology Pulm Pharmacol Ther pulmonary rapidly adapting RARs receptor agonists receptor antagonist Respir Crit Respir Physiol role sensory nerves sensory neurons stimulation studies substance subunits suppression synaptic tachykinin tracheal transient receptor potential treatment TRPA1 TRPV1 tussive Undem BJ urge-to-cough vagal afferent vanilloid Widdicombe JG