Sweet Relief for Cough

If like millions of Americans you reach for drops or syrup at the first sign of a cough this post is for you. Until now, most cough experts were unsure if, and how, these popular remedies work.

However, new findings from the Monell Center –  a non-profit institute dedicated to research on the senses of taste and smell – may provide the answer.

It turns out that  both sucrose and menthol, ingredients used as flavorings in many of these preparations, can themselves, reduce coughing.

Cough is a vital protective reflex that clears the respiratory tract of threats from mechanical stimuli like food and chemical stimuli such as airborne toxins and pollutants. As such, cough is necessary to protect the lungs, and keep our airways clear.

Individuals with a weak cough reflex are at increased risk of pneumonia and of choking. Conversely, many acute and chronic conditions involve frequent coughing, leading to 30 million health care visits annually, with billions spent on over-the-counter medications and billions more lost due to reduced productivity,” said lead author, Paul Wise, PhD, a sensory psychologist at Monell.

However, many aspects of coughing remain poorly understood, including how chemicals act to trigger and modulate cough.

The study, published in Pulmonary Pharmacology and Therapeutics, involved 12 healthy young adults. Each participant  inhaled nebulized capsaicin, the burning ingredient in chili peppers which induces a cough. After each inhalation, the amount of capsaicin was doubled. This procedure continued until the subject coughed three times within 10 seconds. The capsaicin concentration that induced the three coughs was labeled as the individual’s cough threshold.

In some sessions, the subjects held either a very sweet sucrose or plain water in their mouths for three seconds, before spitting the liquid into a sink, and inhaling from the nebulizer.

In other sessions, subjects inhaled three breaths of either menthol-saturated air or clean air before each capsaicin inhalation. The menthol concentration was selected to approximate the cooling intensity of a menthol cigarette.

Both sucrose and menthol increased the amount of capsaicin needed to elicit a cough relative to plain water or clean air, respectively. Sucrose increased cough threshold by about 45%, while menthol increased it by approximately 25%.

This is the first study to empirically show that sweet taste reduces cough. This also is the first study to show that menthol alone can reduce coughing in response to a cough-eliciting agent,” said co author Paul Breslin, PhD.

The findings support the hypothesis that adding menthol to cigarettes may make it easier to begin smoking by suppressing the cough reflex, thus making the first cigarettes less distressing.

The researchers are planning further studies to explore the chemical elicitation of cough, along with the receptors and genes involved in this system.

In the meantime, it appears that sweet breath mints might be every bit as effective as cough drops… and possibly a whole lot cheaper.

Loss of a Legend

SRxA’s Word on Health is mourning the loss of a great physiologist and a dear friend. Professor John Widdicombe, one of the worlds foremost authorities on cough passed away on Thursday, 25th August after a brief illness.

A few weeks ago I was privileged to interview him for Cough It Up!  At the time neither of us dreamed that these could be his last published words.

As a tribute we are reproducing the article in its entirety. While the interview includes many touching insights into his life and personality, perhaps more telling was his response to it. Within hours of receiving the draft he got back to me, despite a 5 hour time difference and the fact he was leaving for a months vacation in France that very day.  In his email, he commended my efforts and gave his approval to publish but added: “I would have preferred to seem more modest, but then perhaps I am not.”

So modest, so generous and so inspiring to the end. Professor Widdicombe will be sorely missed, not just by his wife and family but by the legions of doctors, researchers and students whose lives he touched over the years.  In the short time I knew him, he taught me to be a better person and reminded me you are never too old to learn.

Rest in peace, my friend.  The world just lost a great man but heaven gained an awesome teacher…and student.


Words of Wisdom

During the course of the 2011 American Cough Conference, Cough It Up!  was privileged to sit down with one of the all time greats of the cough world.  In a remarkably frank interview, Professor John Widdicombe shared with us some of his thoughts on cough past, present and future.

In your research career spanning over 60 years who or what has been the biggest influence?

Without a doubt it’s been the people I have been fortunate enough to work with over the years. Mentors, colleagues and students have all influenced me.

How did you get started in cough research? 

I started research in 1950 at the Nuffield Institute for Medical Research in Oxford.  In those days it took only 4 weeks to get a licence to do animal experiments. While I was waiting I was told to go to the library and read up the physiology of the oesophagus ‘the most neglected tube in the body’, and also to learn German. After a month I returned to my boss and told him “No-one, including me, is interested in the oesophagus. The tracheobronchial tree is an even more neglected tube and far more interesting. Can I work on cough and respiratory reflexes?” He agreed, and cough and airway physiology and pathophysiology have been my main research interests ever since.

How has our knowledge of cough improved since you started your research career?    

In 1953, when I was writing my doctorate thesis I could only find six references on cough sensory mechanisms. Now hundreds or thousands are quoted in Pubmed (depending on your question). Before 1996 there was only one monograph on cough (Korpas and Tomori, 1979) and there had been no international symposia. Now there are at least 10 books, including monographs, and one or two international symposia are held each year on the subject. I am happy and proud to have been part of this expansion of interest. We all cough, many of us suffer from it, and we are beginning to understand why.

What has been your biggest achievement in cough research?

I think that what, some decades ago ago, seemed rather a simple reflex, like the stretch reflex or the blink reflex, turned out to be extremely complex. Sorting out some of its complexities has been of great scientific interest and also, I hope, of help to patients.

What further developments in cough research would you like to see in your lifetime?

At present, treatment of cough is like treating headache with a rubber hammer to the head. I would like to see development of drugs known to act on particular components of the cough mechanism, and ‘specific’ to particular types of cough.

What’s the greatest piece of advice you’ve been given during your career?

Geoffrey Dawes, my mentor back in the early days at Oxford, told me Language is the first tool of the scientist.”  This so true.  If you don’t understand your language then you don’t know what you are talking about.

And the worst?

Geoffrey also told me “German is the language of science.”  That was not true even in 1950. Still, I’m glad he taught me this; it led to me translating the Bismarckian German of Breuer and Kratchsmer and discovering their genius in spite of the fact that they didn’t seem to know that cough existed.

What is the one piece of advice you would give to someone starting out in cough research today?

I am not sure that I would give advice, except to say they must be enthusiastic. I would also suggest that then spend four weeks or more in the library before making up their minds!

What was your biggest take-home message from the 2011 American Cough Conference?

That there was wonderful extension and dissemination of information on cough, and great advances are being made.

You officially retired almost 20 years ago, but here you are at the Cough Conference, still moderating sessions and still writing papers on cough. Why?

When I retired I made a number of firm resolutions. Since then, I have broken them all! While retirement should have been the end of cough for me, my friends and colleagues would not allow this. In my retirement I think back to my 1968 ‘sabbatical-in-residence’ at Oxford, during which time I contracted viral pneumonia.  It lasted about a week and led to three chance observations. Firstly, after that episode I always coughed on forced deflation. This is well known clinically but had never been studied until Giovanni Fontana and colleagues did so in 2010. Their paper (Lavorini et al, 2010), on which my name proudly sits, is the first mention of deflation cough in the literature.  Secondly, the sensation of collapsed lung tearing open is quite well known clinically (Macklem, 1968, personal communication), but nobody has identified its afferent pathway. It is not cough, pain, irritation or dyspnea. I still ask myself, do we have Velcro receptors in the lungs?  Thirdly, ever since that pneumonia I have had mild attacks of ‘chronic cough’ every year or two. I think the virus is sitting in my lungs like herpes can in the skin, waiting to break out. My clinical friends tell me this is nonsense, but I’d like to see some evidence before I abandon my theory.

Tell us about your happiest memory

One of the happiest and most memorable events in my life was organized by my wife and family. To celebrate my 80th birthday, they invited family, friends and colleagues from all over the world to a beautiful venue inIreland.  Over dinner, cough was mentioned frequently.  Songs, limericks and anecdotes were even devoted to it, but always as a joke. On that occasion we got our priorities right.

Thank You Professor Widdicombe, it was a pleasure chatting to you.

Cough It Up!

Back in June, SRxA’s Word on Health attended the 2011 American Cough Conference (ACC) in New York.  At the time, many people were surprised to learn that cough is the most common complaint for which Americans seek medical attention, and also one of the least understood.

The ACC is the nation’s leading educational program on cough and attracted physicians, researchers and allied health professionals from all over the world.  The Scientific Committee, led by Dr. Peter Dicpinigaitis, brought together an outstanding faculty representing the Who’s Who of the cough world.  Over 150 delegates from 11 countries attended and enjoyed a mix of plenary sessions, oral presentations and a pro-con debate. The informal, multi-specialty format provided attendees with both state-of-the-art science and the opportunity to translate it into best clinical practice for their patients through peer-to-peer discussion.

The scientific proceedings of the 2011 ACC will be published in Lung later this year.  In the meantime, the conference organizers asked SRxA to produce an e-Newsletter to be disseminated to attendees as well as pulmonologists, allergists, otolaryngologists and speech pathologists not fortunate enough to have been there.

The resulting publication – Cough It Up! was released yesterday and we invite you to be among its first readers.

Cough It Up! provides an interactive review of the ACC, featuring a mix of the meeting highlights, cough trivia and an exclusive interview with one of the all time greats of cough.

Written, developed and designed by SRxA, its distribution was supported by Pfizer Consumer Health.

If you are planning a medical meeting or conference and would like to have the same type of coverage for your event we’d love to hear from you.

Turning up the AC for the ACC (and the MRS)

While most of Washington, DC is still trying to figure out how to stay cool during this early summer heat-wave, your Word on Health bloggers are packing their bags and temporarily moving north. The reason?  Well, this week SRxA and two of our preferred partner organizations: TREAT Education and LifeSciencesPress are involved with major medical meetings in New York and Chicago. The Big Apple is the venue for the 2011 American Cough Conference (ACC)- the nation’s leading educational program for health care professionals involved in the management of patients with cough. The meeting will provide a state-of-the-art, academic update on cough,  which, you may be surprised to learn, is one the most common reasons patients worldwide seek medical attention.

The American Cough Conference will be chaired by one of SRxA’s Clinical Advisors – Peter Dicpinigaitis, MD. Dr. Dicpinigaitis is Professor of Clinical Medicine at the Albert Einstein College of Medicine in New York, and Founder/Director of the Montefiore Cough Center, one of the few specialty centers in the world exclusively committed to the evaluation and management of patients with chronic cough. He will be joined at the meeting by an extensive international faculty representing the Who’s Who of cough and approximately 150 attendees from around the world.

Meanwhile, in the Windy City, Dr. Judith Farrar, Editor-in-Chief of LifeSciencesPress, will act as Executive Director of the Midwest Reproductive Symposium (MRS). The MRS is an annual educational program, chaired by SRxA Advisor, Dr. Angeline Beltsos,  that discusses issues relevant to reproductive medicine.

Internationally recognized as a program of excellence, the MRS provides the most up-to-date information on clinical and research topics. Sessions and workshops during the 2-day program are designed for maximum interaction. A Reproductive Endocrinology Fellows Poster Session and a Nurse Practicum Day precede the meeting.

Word on Health will be at both meetings and will, of course, bring you exclusive coverage in the coming days. In the meantime if you’re a health professional and interested in attending it’s not too late to register.