Chronic Cough: What it is and how to try to reduce its impact on your life
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Dr Jaclyn Smith (UHSM) talks about chronic cough and what can be done to help sufferers
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Chronic Cough: What it is and how to try to reduce its impact on your life
- 1. Support Meeting for Aspergillosis Patients LED BY GRAHAM ATHERTON SUPPORTED BY MARIE KIRWAN, GEORGINA POWELL & DEBBIE KENNEDY NAC CENTRE MANAGER CHRIS HARRIS COUGH: JACLYN SMITH NATIONAL ASPERGILLOSIS CENTRE UHSM MANCHESTER Fungal Research Trust
- 2. Programme 1pm Introduction 1:05 Jaclyn Smith 2:00 Tea & Coffee 2.10 LIFE art competition entries 2.30 Announcement of changes to this meeting 3:00 Close
- 3. Tackling Cough Dr Jacky Smith MRC Clinician Scientist/Reader University of Manchester and University Hospital South Manchester
- 4. Talk Plan • What is a cough? • Why do people cough? • How big a problem is cough? • A bit about my research…. • Conclusions • Questions
- 5. Why am I interested in cough? • Cough is really common • Cough affects peoples quality of life • Cough is difficult to treat
- 6. What is a Cough? • A reflex in healthy people • A symptom of disease – Lung – Nose and Sinuses – Gullet
- 7. What is a Cough? Breathe Start to Close Open breathe in Voicebox voicebox out
- 8. What is a Cough?
- 9. Why do people cough? The Cough Reflex rve ne Va gu s COUGH IRRITANT Larynx/Airway Expiratory Muscles
- 10. Nerves important in Cough Human Human C FIBRES Aδ FIBRES Chemically Mechanical & acid Sensitive Sensitive Guinea Pig Guinea Pig Unpublished data Dr Pete West Summary from publications by Canning & Undem
- 11. H+ H + C FIBRE Aδ FIBRE TERMINALS TERMINALS
- 12. General Practice Visits: US 2001– 02 Schappert SM, Burt CW. Vital Health Stat 13(159). 2006
- 13. Over- the-Counter Sales UK PAGB report 2010
- 14. Over-The-Counter Medicines Sales Sales (millions of US dollars)
- 16. Estimated UK Incident of Acute Cough Hospitalisations GP Consults Self Medication Acute Cough Viral Infection ANNUAL COSTS TO UK ECONOMY OVER £979 MILLION/YEAR
- 17. Chronic Cough Case History • 56 year old woman • Dry cough for 4 years • Had lots of treatments ‘nothing works’ • Driving husband/partner mad • Sleep separately • Urinary Incontinence
- 18. Hypersensitivity of Chronic Cough Patients to Environmental Exposures Young et al (unpublished data)
- 19. Hypersensitivity of Chronic Cough Patients to Temperature Young et al (unpublished data)
- 20. Hypersensitivity to Mechanical Stimuli Young et al (unpublished data)
- 21. Chronic Cough is miserable PHYSICAL PSYCHOLOGICAL SOCIAL
- 22. Chronic Cough is miserable Sleep disturbance Exhaustion Syncope Chest pain Urinary Incontinence Vomiting PHYSICAL PSYCHOLOGICAL SOCIAL
- 23. Chronic Cough is miserable PHYSICAL Absenteeism Effects on Spouse PSYCHOLOGICAL SOCIAL Social Gatherings Medical Treatment Consultations expense
- 24. Chronic Cough is miserable PHYSICAL Anger Frustration PSYCHOLOGICAL SOCIAL Embarrassment Depression Anxiety
- 25. Chronic Cough is miserable Sleep disturbance Exhaustion Syncope Chest pain Urinary Incontinence Vomiting PHYSICAL Anger Absenteeism Effects on Frustration Spouse PSYCHOLOGICAL SOCIAL Social Embarrassment Gatherings Depression Medical Anxiety Treatment Consultations expense
- 26. Causes of Chronic Cough Almost all Chronic Lung Diseases Cause Cough • Asthma • Chronic Obstructive Pulmonary Disease (Smoking related) – Chronic Bronchitis • Lung Fibrosis • Bronchiectasis........
- 27. Other Causes of Chronic Cough ‘Idiopathic’
- 28. Gastro-oesophgeal Reflux & Cough Laryngo- Micro- Pharyngeal aspiration Reflux Oesophageal Reflux
- 31. Unexplained Chronic Cough Haque et al Chest May 2005 vol. 127 no. 5 1710-1713
- 33. Measuring Cough Sounds 25 20 cough frequency cs/hr Oesophageal Impedance/pH 15 10 5 0 baseline placebo codeine Smith et al J Allergy Clin Immunol. 2006 Apr;117(4):831-5
- 34. Cough Frequency in Respiratory Diseases
- 35. Diurnal Variation in Chronic Cough
- 36. How to treat a Chronic Cough? i. Treat any underlying conditions ii. Low dose Morphine iii. Speech and Language Therapy iv. Gabapentin/Pregabalin* v. Baclofen* *handle with care
- 37. Conclusions • Chronic Cough is a common problem • Very significant impact for patients • Increasing recognition of ‘unexplained cough’ cough • Treatment options limited
- 38. Questions?
- 39. Student competitions Aim: Building awareness amongst younger people & parents Art & music Original compositions £1200 prize (school & individual share) Theme is ‘funky fungi’ UPDATE: 3-400 entries – will be judged over the summer www. projectlifecompetition.org
- 40. Annual Survey of Patients 105 patients asked 10% had been to a Support Meeting 9% viewed online 26% viewed recordings 47% do not use Aspergillus Website Approximately 50% do not use the internet WE NEED TO SUPPORT THOSE PEOPLE NOT USING INTERNET BETTER
- 41. Annual Survey of Patients Why don’t you attend the Aspergillosis Support Meeting?
- 42. Time and Place Most attend clinic on Friday Closer to Clinic the better Meeting now to be held in Friday afternoons at 1.30pm Hope to move the meeting to a room in the North West Lung Centre Provide tea & coffee (possibly even sandwiches) from 1pm – there is a small socialising area
- 43. Format & content Numbers attending smaller Some comments that content is less relevant to all and a return to talks on aspergillosis would be welcome Suggestions: More involvement from centre staff More, shorter sessions in specific areas every month
- 44. Format changes – 20 min sessions
- 45. Other suggestions Doctor present for 20 min at every meeting We have a session held by a patient – once per month (volunteers?) Your choice of subject Patient leader(s) Comment sheet to be available at each meeting for anonymous constructive criticism
- 46. Thank You “The best chance we have of beating this illness is to work together” Living with it, Working with it, Treating it Fungal Research Trust
Editor's Notes
- $16.9 Billions
- Cough consists of 2-3 phases Explosive phase is characteristic sound we recognise as a cough. Produced by sudden opening of the vocal cords, and was always thought to be noise like Voiced phase comes from a partial closure of the vocal cords is not always present, is periodic Intermediate phase affected by sputum in the airways
- Digital format High quality recording, wav format, uncompressed 16,000Hz 16bit 6GB hard drive Overnight recording 2.2GB file Limitation battery life, limited to overnight recording Quality of recording is important Appreciate differences in acoustic properties Allows more sophisticated signal processing techniques