Cough Sound Analysis in Adults for Better Diagnosis

Cough sounds can be distinct based on the underlying cause of cough. Clinicians can get a lead to diagnosis, based on the analysis of cough sounds. Some of the common cough sounds are listed below:
1. A brassy cough occurs when an intrathoracic tumor (such as an aneurysm or mediastinal tumor) compresses the trachea, resulting in a cough with a metallic or harsh tonal quality, typically involving the trachea or bronchi.
2. A bovine cough manifests when a tumor affects the recurrent laryngeal nerve, altering the normal vocal cord movement. This results in a prolonged, less forceful cough often accompanied by wheezing.
3. A whooping cough is identified by a characteristic "whoop" sound as air is forcefully inhaled between coughing fits, common in pertussis.
4. A hysterical cough is typically loud and repetitive, often with a bark-like quality, and can be psychogenic in origin.
5. A barking cough (commonly associated with croup) involves noisy, high-pitched breathing sounds during both inhalation and exhalation due to subglottic pathology.
6. A paroxysmal cough is marked by intense, violent coughing episodes, often seen in conditions like bronchial asthma or heart failure.
7. A persistent cough with productive sputum, especially worse in the mornings and lasting for months or years, is characteristic of chronic bronchitis.
This classification aids in the clinical assessment of coughs, helping identify underlying pathologies based on auditory characteristics.
 

Application of the CHIldren with acute COugh (CHICO) framework to enhance the management of antibiotics

Recent research demonstrated that the CHIldren with acute COugh (CHICO) intervention is a valuable tool for clinicians to make decisions about antibiotic prescriptions and engage with caregivers about their worries and treatment options. Adjusting the intervention might be necessary to create a better fit with how clinicians manage their consultations, both in traditional settings and through remote means. The data from this study were presented in The British Journal of General Practice.
Interviews were conducted to assess the acceptability and utilization of the CHICO intervention. Various healthcare providers from clinics with different antibiotic dispensing patterns, including those with high and low rates, were recruited for the study. The data collection and thematic analysis were based on normalization process theory.
Clinicians generally found the intervention to be beneficial because it was straightforward and quick to implement, allowing them to address carer concerns while reassuring both themselves and the carers about the treatment decisions being made. However, it was mainly used as a supportive tool for treatment choices rather than a method for changing behavior. The advice leaflet that came with it was useful for explaining treatment decisions and encouraging self-care. There were instances where the intervention did not align with the clinicians' standard procedures, which could hinder its application. As familiarity with the algorithm grew, the reliance on interventions decreased, a trend that increased during the COVID-19 pandemic when practices changed and remote consultations became more common.
In summary, the CHICO intervention serves as a valuable resource for healthcare professionals. It helps clinicians make informed decisions about antibiotic prescriptions and encourages discussions with caregivers regarding their concerns and available treatment options.
 

Montelukast Sodium Combination Therapy Significantly Improves Outcomes in Pediatric Cough Variant Asthma

A recent meta-analysis has demonstrated the clinical efficacy of montelukast sodium combination therapy for children with cough variant asthma (CVA). This study reviewed 18 clinical trials from Chinese populations, comparing combination therapy (montelukast sodium plus standard treatments) to control treatments, which included budesonide, fluticasone propionate, salmeterol-fluticasone, or ketotifen alone.
The analysis revealed that the combination therapy group had a significantly higher effective treatment rate (relative ratio [RR]: 1.23, 95% confidence interval [CI]: 1.18-1.29, p < 0.001) than the control group, with no significant difference in adverse reactions between groups (RR: 0.65, 95% CI: 0.42-1.02, p = 0.060). 
Pulmonary function parameters, including peak expiratory flow (PEF), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and FEV1/FVC ratios, were significantly improved in the combination therapy group compared to controls (p < 0.001).
Moreover, the combined therapy resulted in significantly lower levels of inflammatory markers, including tumor necrosis factor-α (TNF-α), interleukin-4 (IL-4), and IgE, indicating better control of airway inflammation (p < 0.001).
This meta-analysis highlights that montelukast sodium, when used alongside standard asthma treatments, provides superior clinical outcomes in managing pediatric CVA. These findings support the use of combination therapy as a practical approach to improving both respiratory function and inflammation control in children with CVA.
 

Insights from the Tasmanian Longitudinal Health Study Identifies Treatable Traits in Adult Cough Subclasses

Cough is a prevalent yet complex condition with distinct subclasses, but its characteristics and progression over time remain poorly understood in general populations. This study analyzed data from the Tasmanian Longitudinal Health Study (TAHS), a prospective community-based cohort that began in 1968, following participants from childhood to midlife. We aimed to identify cough subclasses among adults and explore their clinical features and lung function trajectories over six decades.

Data were collected from 8,583 baseline participants, with 6,128 traced and invited for follow-up between 2012 and 2016. Of the 3,609 respondents, 2,213 were identified as current coughers and classified into six cough subclasses through latent class analysis: minimal cough (9.3%), cough with colds only (53.7%), cough with allergies (13.8%), intermittent productive cough (9.6%), chronic dry cough (6.6%), and chronic productive cough (6.9%). Chronic and intermittent productive coughers had significantly worse lung function trajectories, such as persistent low FEV1 and early low-rapid decline in FEV1/FVC, compared to those with minimal cough.

These findings reveal distinct treatable traits across cough subclasses, such as asthma, allergies, and smoking, particularly in productive cough types. They underscore the need for tailored management strategies in primary care, including routine spirometry for productive cough, distinct from those used for dry cough, suggesting that future studies could refine cough management in community settings.

Insights from the RHINESSA Study suggest Chronic Cough to be Heritable Across Generations

This study investigated the heritability of chronic cough, examining whether individuals with chronic cough are more likely to have offspring who also develop cough, and whether this association varies by cough type (productive vs. nonproductive).

The RHINESSA Generation Study included 7,155 parents aged 30-54 who completed detailed questionnaires in 2000 and 2010, and 8,176 offspring aged ≥20 who completed similar questionnaires between 2012-2019. Chronic cough was classified as either productive or nonproductive. Mixed-effects logistic regression analyses were conducted to assess the associations between parental and offspring cough, adjusting for multiple factors including offspring age, sex, body mass index, smoking history, asthma, rhinitis, gastroesophageal reflux, and parental smoking.

Results indicated that offspring of parents with nonproductive cough had a higher prevalence of nonproductive cough (11%) compared to those with parents without nonproductive cough (7%), with an adjusted odds ratio (aOR) of 1.59 (95% CI: 1.20-2.10). Similarly, offspring of parents with productive cough had a higher prevalence of productive cough (14%) compared to those with non-productive cough parents (11%), with an aOR of 1.34 (95% CI: 1.07-1.67). No significant associations were found between mismatched cough types.

These findings suggest that chronic cough, independent of asthma, may be a distinct heritable trait with type-specific transmission patterns.