According to a recent study, nintedanib exhibited reduced deterioration of dyspnoea, fatigue, and cough, along with the impact of interstitial lung disease (ILD) over a duration of 52 weeks in progressive pulmonary fibrosis (PPF) patients, as indicated by the changes in Living with Pulmonary Fibrosis (L-PF) questionnaire scores. This study's findings were published in the European Respiratory Journal.

This study included 663 patients who had a fibrosing[DKJ1] [SB2]  interstitial lung disease (ILD) other than idiopathic pulmonary fibrosis that affected more than 10% of their lungs on high-resolution computed tomography (HRCT) and met the interstitial lung disease progression criteria within before 24 months. They were randomly assigned in a 1:1 ratio to receive either nintedanib or placebo. Mixed models for repeated measures were used to analyze the variations in L-PF questionnaire scores from baseline to week 52.

The nintedanib group exhibited significantly smaller increases [worsening’s] in various measures when compared to the placebo group. The adjusted mean L-PF questionnaire total score showed a difference of 0.5 versus 5.1, symptoms score showed a difference of 1.3 versus 5.3, dyspnoea score showed a difference of 4.3 versus 7.8, and fatigue score showed a difference of 0.7 versus 4.0 at week 52. The nintedanib group exhibited a decrease in the L-PF cough score (-1.8) while the placebo group exhibited an increase in the cough score (4.3). Additionally, the L-PF impacts score exhibited a slight reduction (-0.2) in the nintedanib group while the placebo group exhibited an increase (4.6) in the impacts score. These findings were similar among patients with a usual interstitial pneumonia-like fibrotic pattern on HRCT as well as those with other fibrotic patterns on HRCT.

The above study demonstrated that nintedanib decreased the worsening of dyspnoea, fatigue, and cough, as well as the impact of ILD in patients with PPF throughout a 52-week period. This positive effect was measured by the changes observed in the scores of the L-PF questionnaire.

In a recent study, it was shown that metoprolol significantly decreased the risk of bucking during extubation in patients who underwent general anesthesia when compared to the placebo. This study’s findings were published in the Brazilian journal of anesthesiology (Elsevier).

This was a double-blind, placebo-controlled randomized trial that included 207 patients, comprising both males and females aged between 18 and 80 years, with an American Society of Anesthesiologists (ASA) physical status I–III. These patients were randomly allocated into two groups: one group received intravenous metoprolol 5 mg IV (n=102) while the other group received a placebo (n=105) post-surgery. The primary endpoint of the study was to assess the percentage of patients who exhibited bucking as a result of endotracheal tube stimulation of the tracheal mucosa during extubation. Secondary outcomes evaluated included coughing, laryngospasm, bronchospasm, Heart Rate (HR) levels, and Mean Arterial Pressure (MAP).

At the end of the study, the incidence of bucking was significantly lower in patients who were received metoprolol (43.1% vs. 64.8%). In the metoprolol group, 6 (5.9%) patients experienced moderate/severe coughing, while 33 (31.4%) in the placebo group reported the same.

The above results demonstrated that in patients undergoing general anesthesia, metoprolol was found to significantly lower the risk of bucking during extubation when compared with the placebo.

The existing consensus meets the present requirement and can assist doctors in diagnosing and treating cough efficiently in the primary healthcare facilities in India. This consensus was published in The Journal of the Association of Physicians of India.

A consensus on clinical statements was achieved through the use of the modified Delphi method. The panel consisted of 10 experts, encompassing pulmonologists, otolaryngologists, a general physician and a pediatrician. The discussions were focused on the domains of definition, etiology, diagnosis, and treatment.

A total of 109 clinical statements were developed, with 75 achieving consensus, 13 reaching near consensus, and 21 failing to reach consensus. The empirical use of nonopioid antitussive agents for relieving symptoms of acute dry cough is recommended. Symptom relief for cough associated with upper airway cough syndrome (UACS) or rhinitis may be achieved by considering the use of fixed-dose combinations (FDCs) containing oral antihistamines, mucoactive agents, or oral decongestants. Adequate hydration plays a key role in managing a productive cough. Codeine-based preparations should be reserved as a last resort for patients with unexplained chronic cough when other treatments have proven ineffective. Insights were gathered on nonpharmacologic therapy, special populations, red flag signs, and referral to specialized centers. A management algorithm with an integrated care pathway approach for subacute, acute, and chronic coughs was recommended by subject matter experts.

It can be concluded that the current consensus meets the existing needs and can support the physician in diagnosing and managing cough effectively in the primary healthcare setting in India. The general consensus was that the use of fixed-dose combination medications containing oral antihistamines, mucoactive agents, or oral decongestants can help relieve symptoms of UACS or rhinitis. Maintaining proper hydration can also alleviate productive coughs, and it is recommended to consider codeine-based treatments only if other treatments have proven ineffective.

According to a recent study, temperature-controlled radiofrequency (TCRF) neurolysis of the posterior nasal nerve (PNN) leads to a notable improvement in both postnasal drip (PND) and chronic cough (CC), thereby alleviating the symptomatology associated with chronic rhinitis. This study’s findings were published in the International forum of allergy & rhinology.

The combined data of 228 patients (57.9% women, 42.1% men) were gathered from three prospective studies, which included two single-arm studies and the active treatment arm of a randomized controlled trial. Adult patients with a baseline reflective total nasal symptom score (rTNSS) score of 6 or higher underwent TCRF neurolysis at nonoverlapping regions of the PNN. The severity of PND and CC symptoms was assessed on a scale ranging from 0 (none) to 3 (severe).

Initially, the mean baseline rTNSS was 8.1, which later decreased to 3.2 at 6 months. At the beginning, 97.4% of patients exhibited PND, while 80.3% had CC. The median baseline CC and PND symptom scores were 2 [interquartile range (IQR), 1-2] and 3[(IQR), 2-3] respectively. These scores had decreased to 0 (IQR, 0-1) and 1 (IQR, 0-2)  respectively at 6 months, indicating a significant improvement from the baseline. Spearman correlation coefficients between rTNSS components (rhinorrhea, congestion, itching, and sneezing) ranged from 0.16 to 0.22 for CC and 0.19 to 0.46 for PND, indicating a weak to moderate correlation.

The above study demonstrated that PND and CC contribute to the symptomatology of chronic rhinitis, and the TCRF neurolysis of the PNN yields a significant improvement in both PND and CC. Including PND and CC symptoms in an assessment instrument for chronic rhinitis could provide valuable additional insights into the nature of the disease and the outcomes following therapeutic interventions.