Support Meeting for               Aspergillosis Patients                              LED BY GRAHAM ATHERTON              ...
Programme 1pm Introduction 1:05 Jaclyn Smith 2:00 Tea & Coffee 2.10 LIFE art competition entries 2.30 Announcement of...
Tackling Cough             Dr Jacky Smith    MRC Clinician Scientist/ReaderUniversity of Manchester and University      Ho...
Talk Plan•   What is a cough?•   Why do people cough?•   How big a problem is cough?•   A bit about my research….•   Concl...
Why am I interested in cough?• Cough is really common• Cough affects peoples quality of life• Cough is difficult to treat
What is a Cough?• A reflex in healthy people• A symptom of disease  – Lung  – Nose and Sinuses  – Gullet
What is a Cough?Breathe              Start to           Close                 Open                     breathe  in      Vo...
What is a Cough?
Why do people cough?                       The Cough Reflex                                      rve                      ...
Nerves important in Cough                 Human                   Human             C FIBRES                              ...
H+H   +        C FIBRE     Aδ FIBRE        TERMINALS   TERMINALS
General Practice Visits: US 2001–               02                 Schappert SM, Burt CW. Vital Health Stat 13(159). 2006
Over- the-Counter Sales UK                        PAGB report 2010
Over-The-Counter Medicines SalesSales (millions of US dollars)
Classification of Cough
Estimated UK Incident of Acute Cough Hospitalisations GP Consults Self Medication Acute Cough Viral InfectionANNUAL COSTS ...
Chronic Cough Case History•   56 year old woman•   Dry cough for 4 years•   Had lots of treatments ‘nothing works’•   Driv...
Hypersensitivity of Chronic CoughPatients to Environmental Exposures                           Young et al (unpublished da...
Hypersensitivity of Chronic Cough    Patients to Temperature                         Young et al (unpublished data)
Hypersensitivity to Mechanical Stimuli                             Young et al (unpublished data)
Chronic Cough is miserable           PHYSICAL   PSYCHOLOGICAL   SOCIAL
Chronic Cough is miserable     Sleep disturbance   Exhaustion       Syncope                Chest pain   Urinary   Incontin...
Chronic Cough is miserable           PHYSICAL                               Absenteeism                                  E...
Chronic Cough is miserable                     PHYSICAL         Anger  Frustration          PSYCHOLOGICAL     SOCIALEmbarr...
Chronic Cough is miserable          Sleep disturbance         Exhaustion                Syncope                  Chest pai...
Causes of Chronic CoughAlmost all Chronic Lung Diseases Cause Cough• Asthma• Chronic Obstructive Pulmonary Disease  (Smoki...
Other Causes of Chronic Cough                     ‘Idiopathic’
Gastro-oesophgeal Reflux & Cough              Laryngo-      Micro-              Pharyngeal    aspiration              Refl...
‘Rice Ball’ Cough
TracheobronchopathiaOsteochrondroplastica
Unexplained Chronic Cough              Haque et al Chest May 2005 vol. 127 no. 5 1710-1713
Typical Cough Sound
Measuring Cough Sounds                                  25                                  20          cough frequency cs...
Cough Frequency in Respiratory Diseases
Diurnal Variation in Chronic Cough
How to treat a Chronic Cough?i.     Treat any underlying conditionsii.    Low dose Morphineiii.   Speech and Language Ther...
Conclusions• Chronic Cough is a common problem• Very significant impact for patients• Increasing recognition of ‘unexplain...
Questions?
Student competitionsAim: Building awareness amongst younger people & parents Art & music Original compositions £1200 pr...
Annual Survey of Patients105 patients asked10% had been to a Support Meeting9% viewed online26% viewed recordings47% ...
Annual Survey of PatientsWhy don’t you attend the Aspergillosis Support Meeting?
Time and PlaceMost attend clinic on FridayCloser to Clinic the betterMeeting now to be held in Friday afternoons at 1.30...
Format & contentNumbers attending smallerSome comments that content is less relevant to all and a return to talks on asp...
Format changes – 20 min sessions
Other suggestionsDoctor present for 20 min at every meetingWe have a session held by a patient – once per month (volunte...
Thank You“The best chance we have of beating this illness is to                  work together”    Living with it, Working...
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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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  • $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
  • Chronic Cough: What it is and how to try to reduce its impact on your life

    1. 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 MANCHESTERFungal Research Trust
    2. 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. 3. Tackling Cough Dr Jacky Smith MRC Clinician Scientist/ReaderUniversity of Manchester and University Hospital South Manchester
    4. 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. 5. Why am I interested in cough?• Cough is really common• Cough affects peoples quality of life• Cough is difficult to treat
    6. 6. What is a Cough?• A reflex in healthy people• A symptom of disease – Lung – Nose and Sinuses – Gullet
    7. 7. What is a Cough?Breathe Start to Close Open breathe in Voicebox voicebox out
    8. 8. What is a Cough?
    9. 9. Why do people cough? The Cough Reflex rve ne Va gu s COUGHIRRITANT Larynx/Airway Expiratory Muscles
    10. 10. Nerves important in Cough Human Human C FIBRES Aδ FIBRES Chemically Mechanical & acid Sensitive Sensitive Guinea Pig Guinea PigUnpublished data Dr Pete West Summary from publications by Canning & Undem
    11. 11. H+H + C FIBRE Aδ FIBRE TERMINALS TERMINALS
    12. 12. General Practice Visits: US 2001– 02 Schappert SM, Burt CW. Vital Health Stat 13(159). 2006
    13. 13. Over- the-Counter Sales UK PAGB report 2010
    14. 14. Over-The-Counter Medicines SalesSales (millions of US dollars)
    15. 15. Classification of Cough
    16. 16. Estimated UK Incident of Acute Cough Hospitalisations GP Consults Self Medication Acute Cough Viral InfectionANNUAL COSTS TO UK ECONOMY OVER £979 MILLION/YEAR
    17. 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. 18. Hypersensitivity of Chronic CoughPatients to Environmental Exposures Young et al (unpublished data)
    19. 19. Hypersensitivity of Chronic Cough Patients to Temperature Young et al (unpublished data)
    20. 20. Hypersensitivity to Mechanical Stimuli Young et al (unpublished data)
    21. 21. Chronic Cough is miserable PHYSICAL PSYCHOLOGICAL SOCIAL
    22. 22. Chronic Cough is miserable Sleep disturbance Exhaustion Syncope Chest pain Urinary Incontinence Vomiting PHYSICAL PSYCHOLOGICAL SOCIAL
    23. 23. Chronic Cough is miserable PHYSICAL Absenteeism Effects on Spouse PSYCHOLOGICAL SOCIAL Social Gatherings Medical Treatment Consultations expense
    24. 24. Chronic Cough is miserable PHYSICAL Anger Frustration PSYCHOLOGICAL SOCIALEmbarrassment Depression Anxiety
    25. 25. Chronic Cough is miserable Sleep disturbance Exhaustion Syncope Chest pain Urinary Incontinence Vomiting PHYSICAL Anger Absenteeism Effects on Frustration Spouse PSYCHOLOGICAL SOCIAL SocialEmbarrassment Gatherings Depression Medical Anxiety Treatment Consultations expense
    26. 26. Causes of Chronic CoughAlmost all Chronic Lung Diseases Cause Cough• Asthma• Chronic Obstructive Pulmonary Disease (Smoking related) – Chronic Bronchitis• Lung Fibrosis• Bronchiectasis........
    27. 27. Other Causes of Chronic Cough ‘Idiopathic’
    28. 28. Gastro-oesophgeal Reflux & Cough Laryngo- Micro- Pharyngeal aspiration RefluxOesophagealReflux
    29. 29. ‘Rice Ball’ Cough
    30. 30. TracheobronchopathiaOsteochrondroplastica
    31. 31. Unexplained Chronic Cough Haque et al Chest May 2005 vol. 127 no. 5 1710-1713
    32. 32. Typical Cough Sound
    33. 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. 34. Cough Frequency in Respiratory Diseases
    35. 35. Diurnal Variation in Chronic Cough
    36. 36. How to treat a Chronic Cough?i. Treat any underlying conditionsii. Low dose Morphineiii. Speech and Language Therapyiv. Gabapentin/Pregabalin*v. Baclofen* *handle with care
    37. 37. Conclusions• Chronic Cough is a common problem• Very significant impact for patients• Increasing recognition of ‘unexplained cough’ cough• Treatment options limited
    38. 38. Questions?
    39. 39. Student competitionsAim: 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. 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. 41. Annual Survey of PatientsWhy don’t you attend the Aspergillosis Support Meeting?
    42. 42. Time and PlaceMost attend clinic on FridayCloser to Clinic the betterMeeting now to be held in Friday afternoons at 1.30pm Hope to move the meeting to a room in the North West Lung CentreProvide tea & coffee (possibly even sandwiches) from 1pm – there is a small socialising area
    43. 43. Format & contentNumbers attending smallerSome comments that content is less relevant to all and a return to talks on aspergillosis would be welcomeSuggestions:More involvement from centre staffMore, shorter sessions in specific areas every month
    44. 44. Format changes – 20 min sessions
    45. 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. 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

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