Cough: neurophysiology, methods of research, pharmacological therapy and phonoaudiology

Int. Arch. Otorhinolaryngol. 2012;16(2):259-268. DOI: 10.7162/S1809-97772012000200016 Review Article Cough: neurophysiology, methods of research, pharmacological therapy and phonoaudiology Tosse: neurofisiologia, métodos de pesquisa, terapia farmacológica e fonoaudiológica Aracy Pereira Silveira Balbani 1 1) PhD in Medicine. Otorhinolaryngologist. Institution: Author’s Own practice. Tatui – SP – Brazil. Mailing address: Aracy P. S. Balbani - Capitão Lisboa Street, 715 - Tatuí / SP – Brazil - Zip-code: 18270-070 - Telephone: (+55 15) 3259-1152 - E-mail: Article received in March 13, 2011. Article approved in June 25, 2011. SUMMARY RESUMO Introduction: The cough is the more common respiratory symptom in children and adults. Objective: To present a revision on the neurophysiology and the methods for study of the consequence of the cough, as well as the pharmacotherapy and phonoaudiology therapy of the cough, based on the works published between 2005 and 2010 and indexed in the bases Medline, Lilacs and Library Cochrane under them to keywords “cough” or “anti-cough”. Synthesis of the data: The consequence of the cough involves activation of receiving multiples becomes vacant in the aerial ways and of neural projections of the nucleus of the solitary treatment for other structures of the central nervous system. Experimental techniques allow studying the consequence of the cough to the cellular and molecular level to develop new anti-cough agents. It does not have evidences of that anticough exempt of medical lapsing they have superior effectiveness to the one of placebo for the relief of the cough. The phonoaudiology therapy can benefit patients with refractory chronic cough to the pharmacological treatment, over all when paradoxical movement of the vocal folds coexists. Final Comments: The boarding to multidiscipline has basic paper in the etiological diagnosis and treatment of the cough. The otolaryngologist must inform the patients on the risks of the anti-cough of free sales in order to prevent adverse poisonings and effect, especially in children. Keyword: anti-cough, codeine, dextromethorpha, expectorants, cough. Introdução: A tosse é o sintoma respiratório mais comum em crianças e adultos. Objetivo: Apresentar uma revisão sobre a neurofisiologia e os métodos para estudo do reflexo da tosse, bem como a farmacoterapia e terapia fonoaudiológica da tosse, baseada nos trabalhos publicados entre 2005 e 2010 e indexados nas bases Medline, Lilacs e Biblioteca Cochrane sob os unitermos “tosse” ou “antitussígenos”. Síntese dos dados: O reflexo da tosse envolve ativação de múltiplos receptores vagais nas vias aéreas e de projeções neurais do núcleo do trato solitário para outras estruturas do sistema nervoso central. Técnicas experimentais permitem estudar o reflexo da tosse ao nível celular e molecular para desenvolver novos agentes antitussígenos. Não há evidências de que antitussígenos isentos de prescrição médica tenham eficácia superior à do placebo para o alívio da tosse. A terapia fonoaudiológica pode beneficiar pacientes com tosse crônica refratária ao tratamento farmacológico, sobretudo quando coexiste movimento paradoxal das pregas vocais. Comentários Finais: A abordagem multidisciplinar tem papel fundamental no diagnóstico etiológico e tratamento da tosse. O otorrinolaringologista deve informar os pacientes sobre os riscos dos antitussígenos de venda livre a fim de prevenir intoxicações e efeitos adversos, especialmente em crianças. Palavras-chave: antitussígenos, codeína, dextrometorfano, expectorantes, tosse. Int. Arch. Otorhinolaryngol., São Paulo - Brazil, v.16, n.2, p. 259-268, Apr/May/June - 2012. 259 Cough: neurophysiology, methods of research, pharmacological therapy and phonoaudiology. INTRODUCTION The cough is a mechanism of protection of the aerial ways and also the more common respiratory symptom in children and adults. It can elapse of innumerable infectious causes (Table 1) and not infectious (Table 2), to be characterized as it dries or productive, and classified, in accordance with the duration, in acute (less than 3 weeks), sub-acute (3-8 weeks) or chronicle (more than 8 weeks) (1,2). The cough paroxysms can harm the quality of life of the patient for intervening with sleep, to provoke dysphonia, vomits, chronic headache or urinary incontinence. Anti-cough and mucolytics - many of which are exempt of medical lapsing, are between consumed medicines more in the world. They offer to risk of Balbani APS. adverse effect and poisoning, over all in infancy. Survey made in 63 Casualties North Americans disclosed that 5.7% of the poisonings in minors of 12 years had been provoked by anti-cough and anti-flu, with predominance of the cases (64%) in children of two the five years of age (3). The toxicity of the exempt anti-cough of lapsing and the inconclusive data of its clinical effectiveness (4) had taken the authorities of health of Canada to contraindicate them it the minors of six years and to adopt measured of security you add: warning in papal brief on the cares in the use for children of 6 the 12 years and standardization of packings (bottle to the test of opening for the child, followed of batcher cup) (5). In Brazil, the warning consists in papal brief of that anti-cough they do not have to be used in lesser children of two years of age, and the pharmaceutical industries are not obliged to use packings to the manuscript test for children. Table 1. Infectious causes of cough. Virus Cooled common Influenza (flu) Bronchiolitis Tranqueobronquitis acute Hantavirus Bacteria Whooping Cough Tranqueobronquitis acute Rinosinusites (syndrome of the cough of the by airmail superior one) Bacterial Pneumonia Mycobacteriosis typical and atypical Parasites Eosinophilia pulmonary parasitic (Syndrome of Loeffler) Examples of etiological agents adenovirus, coronavirus, enterovirus, parainfluenza virus influenza A e B respiratory synctial virus (VSR) virus influenza, VSR virus Juquitiba, Araraquara, Castelo dos Sonhos, Laguna Negra, Anajatuba Bordetella pertussis Mycoplasma pneumoniae Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis Streptococcus pneumoniae Mycoplasma pneumoniae Chlamydophila pneumoniae Haemophilus influenzae Mycobacterium tuberculosis Chronic Schistosomiasis Pulmonary Larva migrans visceral Singamus Ascaris lumbricoides Ancylostoma duodenale Strongyloides stercoralis Schistosoma mansoni Toxocara canis, Toxocara cati Syngamus laryngeus Protozoan Visceral Leishmaniasis Leishmania chagasi Fungus Aspergillosis Blastomycosis Cryptococcosis Histoplasmosis Paracoccidioidomycosis Pneumocystosis Aspergillus spp Blastomyces dermatitidis Cryptococcus neoformans Histoplasma capsulatum Paracoccidioides brasiliensis Pneumocystis jiroveci Int. Arch. Otorhinolaryngol., São Paulo - Brazil, v.16, n.2, p. 259-268, Apr/May/June - 2012. 260 Cough: neurophysiology, methods of research, pharmacological therapy and phonoa (...truncated)