Treating Cough Due to Non-CF and CF Bronchiectasis With Nonpharmacological Airway Clearance: CHEST Expert Panel Report.

BACKGROUND: In bronchiectasis due to cystic fibrosis (CF) and other causes, airway clearance is one of the mainstays of management. We conducted a systematic review on airway clearance by using non-pharmacological methods as recommended by international guidelines to develop recommendations or suggestions to update the 2006 CHEST guideline on cough. METHODS: The systematic search for evidence examined the question, "Is there evidence of clinically important treatment effects for non-pharmacological therapies in cough treatment for patients with bronchiectasis?" Populations selected were all patients with bronchiectasis due to CF or non-CF bronchiectasis. The interventions explored were the non-pharmacological airway clearance therapies. The comparison populations included those receiving standard therapy and/or placebo. Clinically important outcomes that were explored were exacerbation rates, quality of life, hospitalizations, and mortality. RESULTS: In both CF and non-CF bronchiectasis, there were systematic reviews and overviews of systematic reviews identified. Despite these findings, there were no large randomized controlled trials that explored the impact of airway clearance on exacerbation rates, quality of life, hospitalizations, or mortality. CONCLUSIONS: Although the cough panel was not able to make recommendations, they have made consensus-based suggestions and provided direction for future studies to fill the gaps in knowledge.

Effects of systemic capsaicin treatment on TRPV1 and Tachykinin NK(1) receptor distribution and function in the nucleus of the solitary tract of the adult rat.

Vanilloids including capsaicin and resiniferatoxin (RTX) have been identified as potential novel anti-inflammatory and analgesic compounds. We have previously shown that systemic capsaicin administration to neonatal rats evokes profound long-term alterations in transient receptor potential vanilloid 1 (TRPV1)- and neurokinin 1 (NK(1)) receptor-mediated respiratory responses in the commissural nucleus of the solitary tract (cNTS). Whether this effect of capsaicin is unique to developmentally immature animals is unknown. Therefore, in the present study, we investigated the effects of systemic capsaicin administration to adult rats on NK(1) receptor binding sites, TRPV1 and NK(1) immunoreactivity and function in the cNTS. Microinjection of capsaicin (1 nmol) or RTX (75 pmol) into the cNTS of vehicle-pretreated rats produced a profound bradypnoea (maximum change: -45 breaths·min(-1)) and a small increase in tidal volume (VT). Similarly, microinjection of the selective NK(1) receptor agonists [Sar(9), Met(O(2))(11)]substance P (SP; 66 pmol) and septide (20 pmol) decreased respiratory frequency and increased VT. Thirteen to 18 days after systemic administration of capsaicin (125 mg·kg(-1) s.c.), the bradypnoeic responses to both capsaicin and RTX were absent (p < 0.05), indicative of sensory neuron ablation/desensitisation. Systemic capsaicin pretreatment significantly (p < 0.05) reduced the density of both [(125)I]Bolton-Hunter SP binding sites (NK(1) receptors) and NK(1) receptor immunoreactivity in the cNTS, but did not alter the respiratory responses evoked by microinjection of [Sar(9), Met(O(2))(11)]SP and septide into this region. These studies show that systemic capsaicin administration reduces NK(1) receptor density in the cNTS without adversely affecting NK(1) receptor function at this site. We speculate that adult rats may be more resistant than neonatal rats to the neuroplastic effects of systemic capsaicin administration.