### Cough

1) All basic scientific articles should refer to cough as a three-phase motor act. For the purposes of acoustic recordings in clinical studies, however, cough should be described as a forced expulsive manoeuvre or manoeuvres against a closed glottis that are associated with a characteristic sound or sounds.

2) All scientific articles should include a clear definition of what the authors have used as their definition of cough.

### Capsaicin and citric acid inhalation cough challenge

1) The methodology for the performance of inhalation cough challenge should be standardised so as to facilitate universal interpretation and comparison of data generated by different laboratories.

2) Comprehensive normal ranges need to be developed using the standardised methodology advocated in the present document.

3) The single-breath concentration–response method using a flow-limited dosimeter is recommended for most experimental protocols.

4) Both C2 and C5 should be recorded.

5) Since there is wide inter-individual variation, cough challenge data have no intrinsic significance, but may usefully be used to follow change in cough reflex sensitivity in an individual.

### Cough induced by inhalation of aqueous solutions

1) Aerosolised aqueous solutions represent a useful experimental tool in cough research.

2) The cough challenge with ultrasonic distilled water (fog) is difficult to standardise since it is highly dependent upon nebuliser output.

3) Consideration should be given to potential adverse events, such as bronchoconstriction and cross-infection.

### Cough monitors

1) No cough monitor is currently the gold standard.

2) Monitors should be developed that are ambulatory, are capable of being digitally processed and permit prolonged (24-h) recording.

3) There is little to commend any particular method of quantifying cough over any other.

### Assessment of quality of life of patients with chronic cough

1) Cough can have profound effects on health status, which can be assessed by cough-specific health status questionnaires.

2) Cough visual analogue scale (VAS, 0–100 mm) should be used to assess cough severity in patients with chronic cough.

3) Patients with chronic cough should be assessed with cough-specific quality-of-life questionnaires in clinical studies.

### Animal models of cough

1) The most useful animal model of cough is …

/pdf/ers-guidelines-on-the-assessment-of-cough-3gr3n85c88.pdf

ERS guidelines on the assessment of cough

In 2011, a European Respiratory Society Task Force embarked on a process to determine the position and clinical relevance of the cough hypersensitivity syndrome, a disorder characterised by troublesome coughing often triggered by low levels of thermal, mechanical or chemical exposure, in the management of patients with chronic cough. A 21-component questionnaire was developed by an iterative process supported by a literature review. 44 key opinion leaders in respiratory medicine were selected and interviewed as to their opinions.

There was a high degree of unanimity in the responses obtained, with all opinion leaders supporting the concept of cough hypersensitivity as a clinically useful paradigm. The classic stratification of cough into asthmatic, rhinitic and reflux-related phenotypes was supported. Significant disparity of opinion was seen in the response to two questions concerning the therapy of chronic cough. First, the role of acid suppression in reflux cough was questioned. Secondly, the opinion leaders were split as to whether a trial of oral steroids was indicated to establish a diagnosis of eosinophilic cough.

The cough hypersensitivity syndrome was clearly endorsed by the opinion leaders as a valid and useful concept. They considered that support of patients with chronic cough was inadequate and the Task Force recommends that further work is urgently required in this neglected area.

Cough hypersensitivity syndrome was clearly endorsed by opinion leaders as a valid and useful concept

https://erj.ersjournals.com/content/erj/44/5/1132.full.pdf

Expert opinion on the cough hypersensitivity syndrome in respiratory medicine

Chronic cough is a common condition that presents to both primary and secondary care. Assessment and management are hampered by the absence of well-validated outcome measures. The present study comprises the validation of the Leicester Cough Monitor (LCM), an automated sound-based ambulatory cough monitor. Cough frequency was measured with the LCM and compared with coughs and other sounds counted manually over 2 h of a 6-h recording by two observers in nine patients with chronic cough in order to determine the sensitivity and specificity of the LCM. Automated cough frequency was also compared with manual counts from one observer in 15 patients with chronic cough and eight healthy subjects. All subjects underwent 6-h recordings. A subgroup consisting of six control and five patients with stable chronic cough underwent repeat automated measurements > or = 3 months apart. A further 50 patients with chronic cough underwent 24-h automated cough monitoring. The LCM had a sensitivity and specificity of 91 and 99%, respectively, for detecting cough and a false-positive rate of 2.5 events x h(-1). Mean+/-SEM automated cough counts x patient x h(-1) was 48+/-9 in patients with chronic cough and 2+/-1 in the control group (mean difference 46 counts x patient x h(-1); 95% confidence interval (CI) 20-71). The automated cough counts were repeatable (intra-subject SD 11.4 coughs x patient x h(-1); intra-class correlation coefficient 0.9). The cough frequency in patients undergoing 24-h automated monitoring was 19 coughs x patient x h(-1); daytime (08:00-22:00 h) cough frequency was significantly greater than overnight cough frequency (25 versus 10 coughs x patient x h(-1); mean difference 15 coughs x patient x h(-1), 95% CI 8-22). The Leicester Cough Monitor is a valid and reliable tool that can be used to assess 24-h cough frequency in patients with cough. It should be a useful tool to assess patients with cough in clinical trials and longitudinal studies.

https://erj.ersjournals.com/content/erj/31/5/1013.full.pdf

The Leicester Cough Monitor : preliminary validation of an automated cough detection system in chronic cough

This paper provides an up-to-date review of the management and outcome of accidental hypothermia patients with and without cardiac arrest. The authors reviewed the relevant literature in their specialist field. Summaries were merged, discussed and approved to produce this narrative review. The hospital use of minimally-invasive rewarming for non-arrested, otherwise healthy, patients with primary hypothermia and stable vital signs has the potential to substantially decrease morbidity and mortality for these patients. Extracorporeal life support (ECLS) has revolutionised the management of hypothermic cardiac arrest, with survival rates approaching 100 % in some cases. Hypothermic patients with risk factors for imminent cardiac arrest (temperature <28 °C, ventricular arrhythmia, systolic blood pressure <90 mmHg), and those who have already arrested, should be transferred directly to an ECLS-centre. Cardiac arrest patients should receive continuous cardiopulmonary resuscitation (CPR) during transfer. If prolonged transport is required or terrain is difficult, mechanical CPR can be helpful. Delayed or intermittent CPR may be appropriate in hypothermic arrest when continuous CPR is impossible. Modern post-resuscitation care should be implemented following hypothermic arrest. Structured protocols should be in place to optimise pre-hospital triage, transport and treatment as well as in-hospital management, including detailed criteria and protocols for the use of ECLS and post-resuscitation care. Based on new evidence, additional clinical experience and clearer management guidelines and documentation, the treatment of accidental hypothermia has been refined. ECLS has substantially improved survival and is the treatment of choice in the patient with unstable circulation or cardiac arrest.

/pdf/accidental-hypothermia-an-update-the-content-of-this-review-57mo7lzuz0.pdf

Accidental hypothermia-an update The content of this review is endorsed by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM)

Chronic cough is globally prevalent across all age groups. This disorder is challenging to treat because many pulmonary and extrapulmonary conditions can present with chronic cough, and cough can also be present without any identifiable underlying cause or be refractory to therapies that improve associated conditions. Most patients with chronic cough have cough hypersensitivity, which is characterized by increased neural responsivity to a range of stimuli that affect the airways and lungs, and other tissues innervated by common nerve supplies. Cough hypersensitivity presents as excessive coughing often in response to relatively innocuous stimuli, causing significant psychophysical morbidity and affecting patients' quality of life. Understanding of the mechanisms that contribute to cough hypersensitivity and excessive coughing in different patient populations and across the lifespan is advancing and has contributed to the development of new therapies for chronic cough in adults. Owing to differences in the pathology, the organs involved and individual patient factors, treatment of chronic cough is progressing towards a personalized approach, and, in the future, novel ways to endotype patients with cough may prove valuable in management. 

Cough hypersensitivity and chronic cough

Cough and Glottic-Stop Reflex Sensitivity in Health and Disease

A novel non-invasive warming technique in severe accidental hypothermia

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Cough and Glottic-Stop Reflex Sensitivity in Health and Disease

A novel non-invasive warming technique in severe accidental hypothermia