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.
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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.
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.
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.
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.
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.
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