Dicpinigaitis Peter V, Spinner Leah, Santhyadka Ganesha, Negassa Abdissa
Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York 10461, USA.
Lung. 2008 Nov-Dec;186(6):369-74. doi: 10.1007/s00408-008-9114-6. Epub 2008 Sep 12.
Cough is the most common complaint for which patients in the United States seek medical attention. Few, if any, effective therapies exist for the most common form of acute cough, that due to viral upper respiratory tract infection (URI). The aim of this study was to evaluate the effect of the anticholinergic agent tiotropium bromide on cough reflex sensitivity in subjects with acute viral URI.
Otherwise healthy adult nonsmokers with acute viral URI were randomized to receive inhaled tiotropium, 18 microg once daily, or matched placebo, for 7 days. A control group of healthy volunteers underwent an identical protocol.
Cough reflex sensitivity to inhaled capsaicin was measured at baseline (Day 0), and 1 h after the first (Day 1) and seventh (Day 7) dose of tiotropium or placebo. Concentrations of capsaicin inducing two or more (C (2)) and five or more coughs (C (5)) were determined. In subjects with URI, tiotropium (n = 11) demonstrated inhibition of cough reflex sensitivity relative to baseline (increased log C (2) [p = 0.004] and log C (5) [p = 0.0004]) after the first dose. No change occurred in the placebo group (n = 10). After 7 days, mean log C (2) was significantly increased in the tiotropium group relative to placebo (p = 0.03). Although FEF(25-75) was also increased in the tiotropium group (p = 0.016), there was no significant correlation between changes in cough reflex sensitivity and FEF(25-75). Tiotropium had no effect in healthy volunteers (n = 24).
Tiotropium inhibits cough reflex sensitivity to capsaicin in subjects with acute viral URI. The antitussive effect of tiotropium may occur through a mechanism other than bronchodilation.
咳嗽是美国患者寻求医疗关注的最常见主诉。对于最常见的急性咳嗽形式，即由病毒性上呼吸道感染（URI）引起的咳嗽，几乎没有有效的治疗方法。本研究的目的是评估抗胆碱能药物噻托溴铵对急性病毒性URI患者咳嗽反射敏感性的影响。
患有急性病毒性URI的其他方面健康的成年不吸烟者被随机分为两组，一组每天吸入一次18微克的噻托溴铵，另一组吸入匹配的安慰剂，为期7天。一组健康志愿者作为对照组，接受相同的方案。
在基线（第0天）、首次（第1天）和第七次（第7天）吸入噻托溴铵或安慰剂后1小时，测量对吸入辣椒素的咳嗽反射敏感性。确定诱导两次或更多次（C(2)）和五次或更多次咳嗽（C(5)）的辣椒素浓度。在URI患者中，与基线相比，首次给药后噻托溴铵组（n = 11）的咳嗽反射敏感性受到抑制（log C(2)增加[p = 0.004]，log C(5)增加[p = 0.0004]）。安慰剂组（n = 10）无变化。7天后，噻托溴铵组的平均log C(2)相对于安慰剂组显著增加（p = 0.03）。虽然噻托溴铵组的FEF(25 - 75)也有所增加（p = 0.016），但咳嗽反射敏感性变化与FEF(25 - 75)之间无显著相关性。噻托溴铵对健康志愿者（n = 24）无影响。
噻托溴铵可抑制急性病毒性URI患者对辣椒素的咳嗽反射敏感性。噻托溴铵的镇咳作用可能通过支气管扩张以外的机制发生。
