Recommendations for the proper use of nonprescription cough suppressants and expectorants in solid-organ transplant recipients.

PubMed

Gabardi, Steven; Carter, Danielle; Martin, Spencer; Roberts, Keri

2011-03-01

To describe the pharmacology and safety of oral over-the-counter cough suppressants and expectorants and to present recommendations for the use of these agents in solid-organ transplant recipients based on the potential for adverse drug reactions or drug-disease interactions. Data from journal articles and other sources describing the pharmacology and safety of over-the-counter cough suppressants and expectorants, drug-drug interactions with immunosuppressive agents, and drug-disease state interactions are reviewed. Potential and documented drug-drug interactions between immunosuppressive agents and over-the-counter cough medications guaifenesin, dextromethorphan, diphenhydramine, and codeine were evaluated on the basis of pharmacokinetic and pharmacodynamic principles. Interactions between these cough medications and the physiological changes in the body following transplantation also were examined. Diphenhydramine requires additional monitoring when used to treat cough in transplant recipients owing to its anticholinergic properties and the potential for interactions with cyclosporine. Dextromethorphan can be used in most transplant recipients, although greater caution should be exercised if the patient has undergone liver transplant or has liver impairment. Guaifenesin can be used in transplant recipients but should be used with caution in patients receiving kidney or lung transplants and in patients with renal impairment. Codeine combined with guaifenesin is another option for cough and can be used in most transplant patients although those with reduced renal function should be monitored carefully for adverse events.

Observational study on the dispensing of cough syrups to children with acute cough by community pharmacists in France.

PubMed

Allaert, François-André; Villet, Stéphanie; Vincent, Stéphane; Sauve, Laurent

2018-04-01

Over-the-counter medicines may be proposed by pharmacists for children with acute cough. Study objectives were to describe the sociodemographic profile of children who were proposed a cough syrup by a pharmacist, the nature of the cough and type(s) of cough syrup proposed and to assess the evolution of the cough, tolerance and satisfaction with treatment. Observational, prospective, longitudinal, multicentre study with 157 pharmacies in France. Children who were proposed a cough syrup by a pharmacist were recruited. Questionnaires were completed by the pharmacists and/or parents at inclusion and by the parents after 5 days of treatment. Four hundred fourteen children were included (mean age: 6.0±2.9 years); 45.9% had a dry and 43.3% a productive cough. 30.4% were proposed an allopathic antitussive syrup, 28.3% an allopathic expectorant syrup and 23.7% a homeopathic syrup. Children with a dry cough were more likely to be given an allopathic antitussive (55.2%) or homeopathic (28.2%) syrup. Children with a productive cough or cough of several days duration were more likely to be given an allopathic expectorant syrup (70.1%). Cough disappearance was more frequent with homeopathic syrups compared to allopathic expectorants (P=0.002), or allopathic antitussives (P=0.042). Adverse events were most common with allopathic antitussive syrups (18.7%) (P<0.001). Two-thirds of parents were satisfied with the treatment their child received. Pharmacists play an important role in the management of acute cough in children. Homeopathic cough syrups may have an interest in terms of public health.

Inappropriate prescription of cough remedies among children hospitalised with respiratory illness over the period 2002-2015 in Kenya.

PubMed

Maina, Michuki; Akech, Samuel; Mwaniki, Paul; Gachau, Susan; Ogero, Morris; Julius, Thomas; Ayieko, Phillip; Irimu, Grace; English, Mike

2017-03-01

To examine trends in prescription of cough medicines over the period 2002-2015 in children aged 1 month to 12 years admitted to Kenyan hospitals with cough, difficulty breathing or diagnosed with a respiratory tract infection. We reviewed hospitalisation records of children included in four studies providing cross-sectional prevalence estimates from government hospitals for six time periods between 2002 and 2015. Children with an atopic illness were excluded. Amongst eligible children, we determined the proportion prescribed any adjuvant medication for cough. Active ingredients in these medicines were often multiple and were classified into five categories: antihistamines, antitussives, mucolytics/expectorants, decongestants and bronchodilators. From late 2006, guidelines discouraging cough medicine use have been widely disseminated and in 2009 national directives to decrease cough medicine use were issued. Across the studies, 17 963 children were eligible. Their median age and length of hospital stay were comparable. The proportion of children who received cough medicines shrank across the surveys: approximately 6% [95% CI: 5.4, 6.6] of children had a prescription in 2015 vs. 40% [95% CI: 35.5, 45.6] in 2002. The most common active ingredients were antihistamines and bronchodilators. The relative proportion that included antihistamines has increased over time. There has been an overall decline in the use of cough medicines among hospitalised children over time. This decline has been associated with educational, policy and mass media interventions. © 2016 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Rococo study: a real-world evaluation of an over-the-counter medicine in acute cough (a multicentre, randomised, controlled study)

PubMed Central

Birring, S S; Brew, J; Kilbourn, A; Edwards, V; Wilson, R; Morice, A H

2017-01-01

Objectives To investigate the efficacy and safety of CS1002, an over-the-counter cough treatment containing diphenhydramine, ammonium chloride and levomenthol in a cocoa-based demulcent. Design A multicentre, randomised, parallel group, controlled, single-blinded study in participants with acute upper respiratory tract infection-associated cough. Setting 4 general practitioner (GP) surgeries and 14 pharmacies in the UK. Participants Participants aged ≥18 years who self-referred to a GP or pharmacist with acute cough of <7 days' duration. Participant inclusion criterion was cough severity ≥60 mm on a 0–100 mm visual analogue scale (VAS). Exclusion criteria included current smokers or history of smoking within the past 12 months (including e-cigarettes). 163 participants were randomised to the study (mean participant age 38 years, 57% females). Interventions Participants were randomised to CS1002 (Unicough) or simple linctus (SL), a widely used cough treatment, and treatment duration was 7 days or until resolution of cough. Main outcome measures The primary analysis was intention-to-treat (157 participants) and comprised cough severity assessed using a VAS after 3 days' treatment (prespecified primary end point at day 4). Cough frequency, sleep disruption, health status (Leicester Cough Questionnaire (LCQ-acute)) and cough resolution were also assessed. Results At day 4 (primary end point), the adjusted mean difference (95% CI) in cough severity VAS between CS1002 and SL was −5.9 mm (−14.4 to 2.7), p=0.18. At the end of the study (day 7) the mean difference in cough severity VAS was −4.2 mm (−12.2 to 3.9), p=0.31. CS1002 was associated with a greater reduction in cough sleep disruption (mean difference −11.6 mm (−20.6 to 2.7), p=0.01) and cough frequency (mean difference −8.1 mm (−16.2 to 0.1), p=0.05) compared with SL. There was greater improvement in LCQ-acute quality of life scores with CS1002 compared with SL: mean difference (95% CI) 1.2 (0.05 to 2.36), p=0.04 after 5 days' treatment. More participants prematurely stopped treatment due to cough improvement in the CS1002 group (24.4%) compared with SL (10.7%; p=0.02). Adverse events (AEs) were comparable between CS1002 (20.5%) and SL (27.6%) and largely related to the study indication. 6 participants (7%) in the CS1002 group reduced the dose of medication due to drowsiness/tiredness, which subsequently resolved. These events were not reported by participants as AEs. Conclusions Although the primary end point was not achieved, CS1002 was associated with greater reductions in cough frequency, sleep disruption and improved health status compared with SL. Trial registration number EudraCT number 2014-004255-31. PMID:28093442

Dextromethorphan Addiction Mediated Through the NMDA System: Common Pathways With Alcohol?

PubMed

Roy, A Kenison; Hsieh, Chenen; Crapanzano, Kathleen

2015-01-01

Dextromethorphan, an antitussive (cough suppressant) drug of the morphinan class with sedative and dissociative properties found in cough syrup and other over-the-counter products, is also a substance of abuse, seen primarily in young adults all over the world. A case of dextromethorphan use disorder is presented in a 45-year-old women. Her repeated attempts at abstinence were unsuccessful secondary to continued intense cravings. Treatment with topiramate resulted in complete resolution of her cravings. Topiramate was chosen empirically because of a common action with dextromethorphan in the NMDA system. Genetic testing was obtained and the patient was found to be a carrier of the GRIK1 rs2832407(C:C) allele. The (C:C) allele has been associated with an increased risk of alcohol use disorder and a treatment response of patients with heavy drinking to topiramate. This case provides an opportunity to discuss personalized medicine (treatment options aided by the use of genetic testing) and the possible shared genetic susceptibility for dependence in 2 substances of abuse.

Honey for treatment of cough in children

PubMed Central

Goldman, Ran D.

2014-01-01

Abstract Question Cough is a very common presentation among sick children in my clinic. There is almost no day without a child being examined for upper respiratory tract infection and cough. While I understand that no medications are recommended for relief of cough—prescribed or over the counter—is it true that honey might help relieve cough symptoms in children? Answer Most prescribed and over-the-counter preparations for cough in children are not effective and might carry the risk of adverse events. A single dose of honey before bedtime was shown in recent studies to diminish cough and the discomfort experienced by children and their parents. Recent evidence also supports administering a few daily doses, but this practice will need further study to assess its effectiveness and safety. PMID:25642485

Rococo study: a real-world evaluation of an over-the-counter medicine in acute cough (a multicentre, randomised, controlled study).

PubMed

Birring, S S; Brew, J; Kilbourn, A; Edwards, V; Wilson, R; Morice, A H

2017-01-16

To investigate the efficacy and safety of CS1002, an over-the-counter cough treatment containing diphenhydramine, ammonium chloride and levomenthol in a cocoa-based demulcent. A multicentre, randomised, parallel group, controlled, single-blinded study in participants with acute upper respiratory tract infection-associated cough. 4 general practitioner (GP) surgeries and 14 pharmacies in the UK. Participants aged ≥18 years who self-referred to a GP or pharmacist with acute cough of <7 days' duration. Participant inclusion criterion was cough severity ≥60 mm on a 0-100 mm visual analogue scale (VAS). Exclusion criteria included current smokers or history of smoking within the past 12 months (including e-cigarettes). 163 participants were randomised to the study (mean participant age 38 years, 57% females). Participants were randomised to CS1002 (Unicough) or simple linctus (SL), a widely used cough treatment, and treatment duration was 7 days or until resolution of cough. The primary analysis was intention-to-treat (157 participants) and comprised cough severity assessed using a VAS after 3 days' treatment (prespecified primary end point at day 4). Cough frequency, sleep disruption, health status (Leicester Cough Questionnaire (LCQ-acute)) and cough resolution were also assessed. At day 4 (primary end point), the adjusted mean difference (95% CI) in cough severity VAS between CS1002 and SL was -5.9 mm (-14.4 to 2.7), p=0.18. At the end of the study (day 7) the mean difference in cough severity VAS was -4.2 mm (-12.2 to 3.9), p=0.31. CS1002 was associated with a greater reduction in cough sleep disruption (mean difference -11.6 mm (-20.6 to 2.7), p=0.01) and cough frequency (mean difference -8.1 mm (-16.2 to 0.1), p=0.05) compared with SL. There was greater improvement in LCQ-acute quality of life scores with CS1002 compared with SL: mean difference (95% CI) 1.2 (0.05 to 2.36), p=0.04 after 5 days' treatment. More participants prematurely stopped treatment due to cough improvement in the CS1002 group (24.4%) compared with SL (10.7%; p=0.02). Adverse events (AEs) were comparable between CS1002 (20.5%) and SL (27.6%) and largely related to the study indication. 6 participants (7%) in the CS1002 group reduced the dose of medication due to drowsiness/tiredness, which subsequently resolved. These events were not reported by participants as AEs. Although the primary end point was not achieved, CS1002 was associated with greater reductions in cough frequency, sleep disruption and improved health status compared with SL. EudraCT number 2014-004255-31. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

An objective evaluation of nocturnal cough count and cough pattern in children with psychogenic cough.

PubMed

Imai, Eri; Hirai, Kota; Mikami, Yoshiko; Nukaga, Mariko; Enseki, Mayumi; Tabata, Hideyuki; Kato, Masahiko; Mochizuki, Hiroyuki

2017-11-01

Two patients with a chronic, barking cough were diagnosed with psychogenic cough. Using an original cough counter we studied the nocturnal cough count and pattern. While the number of coughs when awake was extremely high for both patients, the number of coughs was remarkably reduced during sleep, similar to an exacerbation of asthma. Moreover, the properties of the coughs when awake were clearly different from those of coughs during sleep. In conclusion, an objective examination using a cough counter was useful for the diagnosis, treatment and management of psychogenic cough. Copyright © 2017 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

Over-the-Counter Medicines and Diabetes Care.

PubMed

Taylor, Jeff

2017-12-01

People with diabetes turn to over-the-counter (OTC) medicines for many ailments. The focus of this brief review is the impact common OTC medicines might have on this group of patients. Three types of OTC medicines were selected as most deserving of attention: 3 herbal agents, nonsteroidal anti-inflammatory drugs (NSAIDs) and cough/cold products. Existing literature was used to determine precautions that might be in order. Herbal/natural agents with the potential to impact blood sugar have been identified in various reports. In discussing 3, glucosamine and cinnamon (at doses recommended on commercial products) should have minimal impact on diabetic management, whereas St. John's wort is a concern involving potential drug interactions. For colds, of about 11 active ingredients, only decongestants (primarily oral) need be considered for their possible effects on blood sugar. Finally, NSAIDs (even at OTC doses) must be used with caution, given their cardiovascular, renal and gastrointestinal risks. Care guidelines do encourage patients to take ownership of their condition. Yet the ability to self-medicate safely is not a certainty. In spite of easy access and a reasonable level of safety, OTC medicines still can negatively impact a user. NSAIDs available without prescription continue to cause concern. Before the use of any medicine, a person must ensure it will be safe. A health-care provider can be asked for assistance, but that option may not always be employed. Package information is there to provide critical information in lieu of that, something the self-medicating patient will, it is hoped, embrace. Copyright © 2017 Diabetes Canada. Published by Elsevier Inc. All rights reserved.

Over-the-Counter Medicines

MedlinePlus

Over-the-counter (OTC) medicines are drugs you can buy without a prescription. Some OTC medicines relieve aches, pains and itches. Some prevent or cure ... the Food and Drug Administration decides whether a medicine is safe enough to sell over-the-counter. ...

21 CFR 341.3 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... COLD, COUGH, ALLERGY, BRONCHODILATOR, AND ANTIASTHMATIC DRUG PRODUCTS FOR OVER-THE-COUNTER HUMAN USE... used for the relief of the symptoms of hay fever and upper respiratory allergies (allergic rhinitis...

Therapeutic options for acute cough due to upper respiratory infections in children.

PubMed

Paul, Ian M

2012-02-01

Cough due to upper respiratory tract infections (URIs) is one of the most frequent complaints encountered by pediatric health-care providers, and one of the most disruptive symptoms for children and families. Despite the frequency of URIs, there is limited evidence to support the few therapeutic agents currently available in the United States (US) to treat acute cough due to URI. Published, well-designed, contemporary research supporting the efficacy of narcotics (codeine, hydrocodone) and US Food and Drug Administration (FDA)-approved over-the-counter (OTC) oral antitussives and expectorants (dextromethorphan, diphenhydramine, chlophedianol, and guaifenesin) is absent for URI-associated pediatric cough. Alternatively, honey and topically applied vapor rubs may be effective antitussives.

Cough in children.

PubMed

Lamas, Adelaida; Ruiz de Valbuena, Marta; Máiz, Luis

2014-07-01

Cough during childhood is very common, and is one of the most frequent reasons for consultation in daily pediatric practice. The causes differ from those in adults, and specific pediatric guidelines should be followed for correct diagnosis and treatment. The most common cause of cough in children is viral infection producing "normal cough", but all children with persistent cough, i.e. a cough lasting more than 4-8weeks or "chronic cough", must be carefully evaluated in other to rule out specific causes that may include the entire pediatric pulmonology spectrum. The treatment of cough should be based on the etiology. Around 80% of cases can be diagnosed using an optimal approach, and treatment will be effective in 90% of them. In some cases of "nonspecific chronic cough", in which no underlying condition can be found, empirical treatment based on the cough characteristics may be useful. There is no scientific evidence to justify the use of over-the-counter cough remedies (anti-tussives, mucolytics and/or antihistamines), as they could have potentially serious side effects, and thus should not be prescribed in children. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

Comparative Antitussive Effects of Medicinal Plants and Their Constituents.

PubMed

Saadat, Saeideh; Shakeri, Farzaneh; Boskabady, Mohammad Hossein

2018-01-15

Context • The cough is a protective reflex, with 2 types, one being more sensitive to mechanical stimulation and the other to chemical stimulation, such as sulfur dioxide, ammonia, citric acid, and capsaicin. Some evidence is available that suppressant therapy is most effective when used for the short-term reduction of coughing. Today, use of herbal drugs is increasing all over the world for various ailments, including to provide antitussive activity. Objective • The study intended to review the antitussive effects of various extracts, some fractions, and some constituents of the studied medicinal plants. Design • Various databases, including the Medline, Science Direct, Scopus, and Google Scholar, were searched for studies published between 1978 and 2015, using the keywords antitussive and cough and the names of various medicinal plants and their constituents. Setting • The study took place in the districts related to Mashhad University of Medical Sciences (Mashhad, Iran). Outcome Measures • The antitussive effects of medicinal plants and their constituents were normalized to 50 mg/kg and 1 mg/mL against various cough stimulants and compared. Results • The most potent antitussive effect was observed for Nigella sativa and Linum usitatissimum on coughs induced by sulfur dioxide. Artemisia absinthium showed a higher antitussive effect on cough induced by ammonia compared with the other studied medicinal plants. The antitussive effects of Cuminum cyminum and Glycyrrhiza glabra were more potent on cough induced by citric acid than other medicinal plants. Conclusions • These results suggest the therapeutic potential of the studied medicinal plants as antitussive therapies. However, only a few clinical studies have examined the antitussive effects of medicinal plants, and more clinical studies are needed. The underlying mechanisms of the antitussive effects of medicinal plants should be also examined in further studies.

A Review of the Ingredients Contained in Over the Counter (OTC) Cough Syrup Formulations in Kenya. Are They Harmful to Infants?

PubMed Central

Kigen, Gabriel

2015-01-01

Background Cough syrups are widely used in the developing world, but safety of their use in infants and children less than two years has not been well documented. Some syrups contain multiple combinations of such drugs as promethazine, diphenhydramine and ephedrine; which are individually now contraindicated in children less than two years. Despite this, the syrups are available as over the counter drugs and may be dispensed to mothers who are unaware of the potentially hazardous effects to their infants. A descriptive cross-sectional study was used to investigate suitability of cough syrups sold within Eldoret municipality for use in children less than two years of age based on their formulations and available literature. Methods Two semi-structured questionnaires were administered to pharmacy attendants and mothers attending sick child clinic at a referral hospital to establish whether cough syrups containing more than one active ingredient of compounds, now contraindicated in children are administered to infants, and awareness of potential serious adverse effects. Data from labeled contents of cough syrups from retail pharmacies was recorded and corroborated with information from literature to determine those deemed to contain the ingredients. The second questionnaire was administered to mothers with children less than two years to ascertain whether they had used the identified syrups. A total of 260 mothers and 55 pharmacy attendants were interviewed. Results There was widespread use of the syrups in children, including infants, with 192 (74%) of the respondents having used identified syrups and over 90% of these on children less than 2 years including those less than three months.146 (76%) mothers had administered the syrup at double the recommended dose. Conclusion The regulatory authorities should make concerted efforts to discourage use of cough syrups containing ingredients that pose adverse events to infants, including campaigns to educate pharmacy workers and mothers. PMID:26540251

A Review of the Ingredients Contained in Over the Counter (OTC) Cough Syrup Formulations in Kenya. Are They Harmful to Infants?

PubMed

Kigen, Gabriel; Busakhala, Naftali; Ogaro, Francis; Chesire, Emily; Saat, Nathan; Too, Robert; Nyandiko, Winstone

2015-01-01

Cough syrups are widely used in the developing world, but safety of their use in infants and children less than two years has not been well documented. Some syrups contain multiple combinations of such drugs as promethazine, diphenhydramine and ephedrine; which are individually now contraindicated in children less than two years. Despite this, the syrups are available as over the counter drugs and may be dispensed to mothers who are unaware of the potentially hazardous effects to their infants. A descriptive cross-sectional study was used to investigate suitability of cough syrups sold within Eldoret municipality for use in children less than two years of age based on their formulations and available literature. Two semi-structured questionnaires were administered to pharmacy attendants and mothers attending sick child clinic at a referral hospital to establish whether cough syrups containing more than one active ingredient of compounds, now contraindicated in children are administered to infants, and awareness of potential serious adverse effects. Data from labeled contents of cough syrups from retail pharmacies was recorded and corroborated with information from literature to determine those deemed to contain the ingredients. The second questionnaire was administered to mothers with children less than two years to ascertain whether they had used the identified syrups. A total of 260 mothers and 55 pharmacy attendants were interviewed. There was widespread use of the syrups in children, including infants, with 192 (74%) of the respondents having used identified syrups and over 90% of these on children less than 2 years including those less than three months.146 (76%) mothers had administered the syrup at double the recommended dose. The regulatory authorities should make concerted efforts to discourage use of cough syrups containing ingredients that pose adverse events to infants, including campaigns to educate pharmacy workers and mothers.

Assessment of antitussive efficacy of dextromethorphan in smoking related cough: objective vs. subjective measures

PubMed Central

Ramsay, James; Wright, Caroline; Thompson, Rachel; Hull, David; Morice, Alyn H

2008-01-01

AIMS Using an established model of smokers cough we measured the antitussive effects of dextromethorphan compared with placebo. METHODS The study was a randomized, double-blind placebo controlled, crossover comparison of 22 mg 0.8 ml−1 dextromethorphan delivered pregastrically with matched placebo. Objective and subjective measurements of cough were recorded. Subjective measures included a daily diary record of cough symptoms and the Leicester quality of life questionnaire. Cough frequency was recorded using a manual cough counter. The objective measure of cough reflex sensitivity was the citric acid, dose–response cough challenge. RESULTS Dextromethorphan was significantly associated with an increase in the concentration of citric acid eliciting an average of two coughs/inhalation (C2) when compared with placebo, 1 h post dose by 0.49 mM (95% CI 0.05, 0.45, geometric mean 3.09) compared with placebo 0.24 mM (geometric mean 1.74) P < 0.05 and at 2 h 0.57 mM (95% CI 0.01, 0.43, geometric mean 3.75) compared with placebo 0.34 mM (geometric mean 2.19) P < 0.05). There was a highly significant improvement in the subjective data when compared with baseline. However, there was no significant difference between placebo and active treatment. No correlation was seen between cough sensitivity to citric acid and recorded cough counts or symptoms. When both subjective and objective data were compared with screening data there was evidence of a marked ‘placebo’ effect. CONCLUSIONS The objective measure of cough sensitivity demonstrates dextromethorphan effectively diminishes the cough reflex sensitivity. However, subjective measures do not support this. Other studies support these findings, which may represent a profound sensitivity of the cough reflex to higher influences. WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT Dextromethorphan is widely used as a cough suppressant in over the counter medications. Its efficacy in altering cough reflex sensitivity has been shown in healthy volunteers. In contrast evidence for an effect on clinically important cough is poor. WHAT THIS STUDY ADDS A significant decrease in evoked cough was seen with dextromethorphan compared with placebo. However, both placebo and active treatment improved subjective data to a similar degree. We doubt the validity of currently used objective tests in the investigation of antitussives. PMID:18279476

Antidiarrheal Medicines: OTC Relief for Diarrhea

MedlinePlus

... types of OTC medicines treat diarrhea? You can buy over-the-counter (OTC) medicines without a prescription from your doctor. Some OTC ... short for "over-the-counter." OTC drugs are medicines you can buy without a prescription from your doctor. About Support ...

Common Cold

MedlinePlus

... cure for the common cold. But there are treatments that can make you feel better while you wait for the cold to go away on its own: Getting plenty of rest Drinking fluids Gargling with warm salt water Using cough drops or throat sprays Taking over-the-counter pain ...

Natural products for chronic cough: Text mining the East Asian historical literature for future therapeutics.

PubMed

Shergis, Johannah Linda; Wu, Lei; May, Brian H; Zhang, Anthony Lin; Guo, Xinfeng; Lu, Chuanjian; Xue, Charlie Changli

2015-08-01

Chronic cough is a significant health burden. Patients experience variable benefits from over the counter and prescribed products, but there is an unmet need to provide more effective treatments. Natural products have been used to treat cough and some plant compounds such as pseudoephedrine from ephedra and codeine from opium poppy have been developed into drugs. Text mining historical literature may offer new insight for future therapeutic development. We identified natural products used in the East Asian historical literature to treat chronic cough. Evaluation of the historical literature revealed 331 natural products used to treat chronic cough. Products included plants, minerals and animal substances. These natural products were found in 75 different books published between AD 363 and 1911. Of the 331 products, the 10 most frequently and continually used products were examined, taking into consideration findings from contemporary experimental studies. The natural products identified are promising and offer new directions in therapeutic development for treating chronic cough. © The Author(s) 2015.

Mandatory labeling requirements and over-the-counter cough and cold medication use in early childhood.

PubMed

DeGroot, Julie; Anderson, Laura N; Chen, Yang; Birken, Catherine S; Parkin, Patricia C; Carsley, Sarah; Khovratovich, Marina; Mamdani, Muhammad; Maguire, Jonathon L

2016-03-16

Due to rare but severe adverse events, Health Canada in October 2009 required manufacturers to relabel over-the-counter (OTC) cough and cold medication (CCM) to state that the products should not be used in children <6 years of age. The main objective of this study was to determine whether this labeling standard decreased OTC CCM use among young children with a recent cough, cold or flu. An interrupted time series study was conducted using data from the TARGet Kids! practice-based research network. A total of 3,515 healthy children 1-5 years of age were recruited from 2008-2011; of these, 1,072 had a cough, cold or flu in the previous month. Parents completed a standardized survey instrument. For the primary analysis, use of OTC CCMs prior to and after October 1, 2009 was compared using time series analyses. For the secondary analysis, multivariable logistic regression was used to identify predictors of recent OTC CCM use. OTC CCM use was reported in 222 of 1,072 (20.7%) children with a cough, cold or flu within the previous month. OTC CCM use declined from 22.2% to 17.8% following the October 2009 Health Canada labeling standard (p = 0.014). Maternal age <35 years (OR 1.49; 95% CI: 1.05-2.13) and having older siblings (OR 1.65; 95% CI: 1.16-2.35) were independently associated with OTC CCM use. Labeling legislation against OTC CCM use for children <6 years resulted in a small decrease in OTC CCM use. Stronger measures may be needed to curtail OTC CCM use, particularly for younger parents and those with multiple children.

[Posterior reversible encephalopathy syndrome induced by a cough and cold drug containing pseudoephedrine].

PubMed

Ebbo, M; Benarous, L; Thomas, G; Jourde, N; Genot, S; Bernit, E; Veit, V; Harlé, J-R; Schleinitz, N

2010-06-01

Posterior reversible encephalopathy syndrome is a clinico-radiological entity characterized by neurologic symptoms in association with usually reversible bilateral posterior hemispheric oedema on neuroimaging. Many pathological conditions and treatments have been associated with this syndrome. We report a 19-year-old woman, followed-up for hypocomplementemic urticarial vasculitis, who presented with a posterior reversible encephalopathy syndrome induced by the intake of an over-the-counter cold remedy containing pseudoephedrine. Clinical manifestations and radiological abnormalities resolved after anti-hypertensive therapy and withdrawal of sympathomimetic drug. The diagnosis of posterior reversible encephalopathy syndrome should be considered in patients with compatible clinical and radiological presentation because of its potential reversibility with an appropriate management. Intake of drugs, including over-the-counter cough and cold drugs, should be looked for in the history as well as autoimmune disorders. Copyright 2010 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

Cough mixtures: rational or irrational prescribing in Hong Kong?

PubMed

Wong, William C W; Dickinson, James; Chan, Cynthia

2005-08-01

To investigate the extent and how cough mixtures are prescribed, and what conditions or specific groups of people would contribute to its prescription in Hong Kong. Using diagnosis and drug data obtained from logbooks submitted by participants in the diploma in family medicine course between 1999 and 2003, we selected and analysed all patients with a diagnosis of cough or cough-related illnesses as well as cough mixtures that were used to treat them. This study confirmed that cough-related illnesses were common in the Hong Kong primary care setting and cough mixtures were used quite liberally irrespective of the patients' age and sex. Combination preparations accounted for over half of the prescriptions and cough mixture was used less in severe cases when antibiotics were given. Private doctors working in the public sector. Given the current health care system, inappropriate and over-prescribing of cough mixtures can be improved by promoting health education and awareness among patients seeking medical help for this common medical condition.

Department of Health and Human Services Semiannual Regulatory Agenda

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-20

... Manufacturing Practice in Manufacturing, Packing, Labeling, or Holding 0910-AB88 Operations for Dietary Supplements 341 Over-the-Counter (OTC) Drug Review--Cough/Cold (Nasal Decongestant) Products 0910-AF34 342... repeated incidents in which cryogenic containers of harmful industrial gases have been connected to medical...

21 CFR 341.90 - Professional labeling.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 5 2010-04-01 2010-04-01 false Professional labeling. 341.90 Section 341.90 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE COLD, COUGH, ALLERGY, BRONCHODILATOR, AND ANTIASTHMATIC DRUG PRODUCTS FOR OVER-THE-COUNTER...

21 CFR 341.90 - Professional labeling.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 5 2011-04-01 2011-04-01 false Professional labeling. 341.90 Section 341.90 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE COLD, COUGH, ALLERGY, BRONCHODILATOR, AND ANTIASTHMATIC DRUG PRODUCTS FOR OVER-THE-COUNTER...

21 CFR 341.90 - Professional labeling.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 5 2014-04-01 2014-04-01 false Professional labeling. 341.90 Section 341.90 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE COLD, COUGH, ALLERGY, BRONCHODILATOR, AND ANTIASTHMATIC DRUG PRODUCTS FOR OVER-THE-COUNTER...

21 CFR 341.90 - Professional labeling.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 5 2012-04-01 2012-04-01 false Professional labeling. 341.90 Section 341.90 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE COLD, COUGH, ALLERGY, BRONCHODILATOR, AND ANTIASTHMATIC DRUG PRODUCTS FOR OVER-THE-COUNTER...

21 CFR 341.90 - Professional labeling.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 5 2013-04-01 2013-04-01 false Professional labeling. 341.90 Section 341.90 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE COLD, COUGH, ALLERGY, BRONCHODILATOR, AND ANTIASTHMATIC DRUG PRODUCTS FOR OVER-THE-COUNTER...

Adolescent cough medicine abuse in Hong Kong: implications for the design of positive youth development programs in Hong Kong.

PubMed

Shek, Daniel T L; Lam, Ching-man

2006-01-01

This study examines the phenomenon of adolescent cough medicine abuse in Hong Kong. Quantitative data obtained from questionnaire survey with 225 adolescents showed that there were personal, peer, family and community factors influencing adolescent cough medicine abuse. Part 2 of the study obtained qualitative data from focus group interviews with cough medicine abusers (N = 8), their family members (N = 5) and service providers (N = 6). The accounts of the participants revealed that the primary factors accounting for adolescent cough medicine abuse were social pressure (peer and environmental influences), family (difficult relationships or harmful incidents), availability (ease of access), and ignorance (unaware of the consequence of cough medicine use and belief that cough medicine was non-addictive). The present findings provide useful pointers for the development of the positive youth development program supported by the Hong Kong Jockey Club Charities Trust.

Treatment of Acute Cough Due to the Common Cold: Multi-component, Multi-symptom Therapy is Preferable to Single-Component, Single-Symptom Therapy--A Pro/Con Debate.

PubMed

Eccles, Ronald; Turner, Ronald B; Dicpinigaitis, Peter V

2016-02-01

Acute viral upper respiratory tract infection, or, the common cold, affects essentially every human being, and cough is reported as its most frequent associated symptom. Billions of dollars are spent worldwide annually by individuals seeking relief from this multi-symptom syndrome. Thousands of non-prescription, over-the-counter products are available worldwide, aimed at relieving the various bothersome symptoms induced by the common cold. Differences of opinion exist as to whether optimal therapy for cough associated with the common cold consists of multi-component, multi-symptom cough/cold preparations, or, whether single-component medications, aimed at relief of specific symptoms, represent the optimal therapeutic approach. The 5th American Cough Conference, held in Washington, D.C. in June, 2015, provided an ideal forum for discussion and debate of this issue between two internationally recognized experts in the field of the common cold and its treatment.

Characterization of medication advertisements in a popular US parenting magazine.

PubMed

Mongiovi, Jennifer; Cadorett, Valerie; Basch, Corey

2017-01-01

Background: Medication advertisements in magazines typically provide minimal educational benefit. This is of particular concern when targeted to caregivers responsible for making major medical decisions for their children. Methods: A cross-section of 72 issues from Parents magazine were collected and categorized by health condition and availability of the medication by prescription or over-the-counter (OTC).The type of medicine, dose, warning label, indication for child or adult, presence of a cartoon character, and the marketing theme used were documented. Chi-square analysis was used to determine significant differences in content. Results: Fewer than 30% (95% CI: 25.4%, 34.5%) of advertisements contained dosage information and approximately 50% (95% CI: 50.3%, 60.2%) contained side effect warnings. The greatest number of advertisements was for cold, cough and flu medications (14.7%; 95%CI: 11.6%, 18.6%). Conclusion: Medicine advertisements often do not include important information that could help consumers make informed decisions and avoid negative implications. Further research is needed to determine the attitudes of consumers to better understand and support consumers 'needs.

Cold and Cough Medicines

MedlinePlus

... What can you do for your cold or cough symptoms? Besides drinking lots of fluids and getting ... medicines. There are lots of different cold and cough medicines, and they do different things. Nasal decongestants - ...

Development and Production of a Leishmania Skin Test

DTIC Science & Technology

2009-03-01

including over-the-counter medicines, such as aspirin, acetaminophen [Panadol, Tylenol ] or ibuprofen [Brufen]) should not be taken within two days of BB...Medications (including over-the-counter medicines, such as aspirin, acetaminophen . [Panadol, Tylenol ] or ibuprofen [BrufenD should not be taken

Prescription Drugs, Over-the-Counter Drugs, Supplements and Herbal Products

MedlinePlus

... at risk? Zika virus and pregnancy Folic acid Medicine safety and pregnancy Birth defects prevention Learn how ... the-counter drugs, supplements and herbal products Prescription drugs, over-the-counter drugs, supplements and herbal products ...

Whooping Cough Alleviated by Homeopathic Medicines: A Case Report.

PubMed

Chung, Youngran

2017-10-02

Context • Pertussis cough (whooping cough) is distressing due to the intensity and chronicity of its cough. No specific drugs are available that can alleviate the cough's intensity or significantly shorten its duration. Homeopathic medicines are used for a wide variety of medical conditions, including cough. Objective • The study investigated the benefits of homeopathic medicines for whooping cough, to alleviate the cough's intensity and to shorten its duration. Design • The current study was a case series of patients with whooping cough. Setting • The study took place at one of the suburban hospital clinics of the Ann & Robert H. Lurie Children's Hospital of Chicago (Chicago, IL, USA). Participants • Participants were 20 patients aged 21 mo to 20 y, of whom 11 were female and 18 were male, who visited the hospital clinic for treatment of the chronic cough that is characteristic of whooping cough. The details of the cases of 3 representative participants are highlighted in the text. Intervention • The 3 representative patients all received 1 dose weekly of a 30c dilution of homeopathic pertussinum and a 6c dilution of homeopathic Drosera 3 times daily. The homeopathic medicines most often used for the other participants were the same doses of pertussinum and Drosera. Outcome Measures • Verbal feedback from patient or family were obtained at the follow-up visits. Results • The intensity and duration of participant's coughs were alleviated within days to 1 wk in most cases. Conclusions • Homeopathic medicines can alleviate the intensity or reduce the duration of whooping cough, with no adverse effects.

American Association of Poison Control Centers

Science.gov Websites

centers in their efforts to prevent and treat poison exposures. Poison centers offer free, confidential ۼ Over-the-Counter Medicine Safety Over-the-Counter Medicine Safety is a 100% free, evidence-based after the close of the data year in the journal Clinical Toxicology and is available for download free

[Construction and analysis of questionnaires on AIDS cough in traditional Chinese medicine diagnosis and treatment procedures].

PubMed

Zhang, Ying; Xue, Liu-Hua; Chen, Yu-Xia; Huang, Shi-Jing; Pan, Ju-Hua; Wang, Jie

2013-08-01

To norm the behavior of AIDS cough in traditional Chinese medicine diagnosis and treatment and improve the clinical level of cough treatment for HIV/AIDS, and build AIDS cough diagnosis and treatment procedures in traditional Chinese medicine. Combined with clinical practice,to formulate questionnaire on AIDS cough in traditional Chinese medicine diagnosis and treatment by both English and Chinese literature research to expertise consultation and verify the results of the questionnaires on the statistics using the Delphi method. Questionnaire contents consist of overview, pathogeny, diagnosis standard, dialectical medication (phlegm heat resistance pulmonary lung and kidney Yin deficiency lung spleen-deficiency), treating spleen-deficiency (lung), moxibustion treatment and aftercare care and diet and mental, average (2.93-3.00), full mark rate (93.10%-100%) ranks average (9.91-10.67) and (287.50-309.50) of which are the most high value, and the variation coefficient is 0.00, the Kendall coefficient (Kendalls W) is 0.049 which is statistical significance, the questionnaire reliability value of alpha was 0.788. Preliminary standarded concept, etiology and pathogenesis, diagnosis and syndrome differentiation treatment of AIDS cough, basically recognised by the experts in this field, and laid the foundation of traditional Chinese medicine diagnosis and treatment on develop the AIDS cough specifications.

Xylometazoline abuse induced ischemic stroke in a young adult.

PubMed

Leupold, Daniela; Wartenberg, Katja E

2011-01-01

substance abuse is an important cause of ischemic stroke in the young. This includes over-the-counter dietary supplements and cough and cold remedies, which were reported to be an independent risk factor for hemorrhagic stroke. this article describes a young male patient with acute ischemic infarctions in the posterior inferior cerebellar and posterior cerebral artery territories bilaterally, the right cerebral peduncle, the left pontine tegmentum, and lateral pons following abuse of xylometazoline-containing nasal decongestant for 10 years. this is the first report in the literature of posterior circulation strokes because of chronic xylometazoline abuse. We hope to contribute to increase knowledge and awareness of the public about these serious complications of cough-and-cold remedies as well as dietary supplements containing sympathomimetics.

Effect of multiple honey doses on non-specific acute cough in children. An open randomised study and literature review.

PubMed

Miceli Sopo, S; Greco, M; Monaco, S; Varrasi, G; Di Lorenzo, G; Simeone, G

2015-01-01

Honey is recommended for non-specific acute paediatric cough by the Australian guidelines. Current available randomised clinical trials evaluated the effects of a single evening dose of honey, but multiple doses outcomes have never been studied. To evaluate the effects of wildflower honey, given for three subsequent evenings, on non-specific acute paediatric cough, compared to dextromethorphan (DM) and levodropropizine (LDP), which are the most prescribed over-the-counter (OTC) antitussives in Italy. 134 children suffering from non-specific acute cough were randomised to receive for three subsequent evenings a mixture of milk (90ml) and wildflower honey (10ml) or a dose of DM or LDP adjusted for the specific age. The effectiveness was evaluated by a cough questionnaire answered by parents. Primary end-point efficacy was therapeutic success. The latter was defined as a decrease in cough questionnaire score greater than 50% after treatment compared with baseline values. Three children were excluded from the study, as their parents did not complete the questionnaire. Therapeutic success was achieved by 80% in the honey and milk group and 87% in OTC medication group (p=0.25). Milk and honey mixture seems to be at least as effective as DM or LDP in non-specific acute cough in children. These results are in line with previous studies, which reported the health effects of honey on paediatric cough, even if placebo effect cannot be totally excluded. Copyright © 2014 SEICAP. Published by Elsevier Espana. All rights reserved.

Brief Intervention Helps Adolescents Curb Substance Use

MedlinePlus

... Club Drugs Cocaine Fentanyl Hallucinogens Inhalants Heroin Marijuana MDMA (Ecstasy/Molly) Methamphetamine Opioids Over-the-Counter Medicines ... Drugs Inhalants K2/Spice Kratom LSD (Acid) Marijuana MDMA (Ecstasy) Methamphetamine Opioids Other Drugs Over-the-Counter ...

Honey: An Effective Cough Remedy?

MedlinePlus

... cough remedy? Is it true that honey calms coughs better than cough medicine does? Answers from James M. Steckelberg, M. ... throat. But honey alone may be an effective cough suppressant, too. In one study, children age 2 ...

Cough and Cold Medicine Abuse (For Parents)

MedlinePlus

... to OTC medications in stores and over the Internet probably contributes to this. The major difference between ... years past is that teens now use the Internet to not only buy DXM in pure powder ...

Medicines in My Home: Information for Adults on Using Over-the-Counter Medicines Safely

MedlinePlus

Medicines In My Home More about using medicines safely Medicines in My Home: www.fda.gov/medsinmyhome FDA Consumer Medicine Education: www.fda.gov/usemedicinesafely National Council on Patient Information and ...

Coughing (For Parents)

MedlinePlus

... usually don't prescribe antibiotics because these only work against bacteria. Unless a cough won't let your child sleep, cough medicines are not needed. They might help a child stop coughing, but they don't treat the cause of the cough. If you do use an ...

Canker sore

MedlinePlus

... most cases, the canker sores go away without treatment. Try not to eat hot or spicy foods, which can cause pain. Use over-the-counter medicines that ease pain in the area. Rinse your mouth with salt water or mild, over-the-counter mouthwashes. (DO NOT ...

[Development of cough-relieving herbal teas].

PubMed

Puodziūniene, Gene; Janulis, Valdimaras; Milasius, Arvydas; Budnikas, Vytautas

2005-01-01

Cough-relieving medicinal herbs in tea are used from ancient times. Mucilage present in them or secretion produced under the influence of the active substances covers the oral and throat mucosa soothing its irritability and relieving dry, tiresome cough. It is known that the mixtures of medicinal herbs (Specias) have a complex influence on the human organism and the rational combination of medicinal herbs can improve their curative action and decrease the undesirable side effects. Having summarized the properties of those medicinal herbs we decided to create two formulations of cough-relieving herbal tea. The first formulation consists of marshmallow roots, liquorice roots and lime flowers, the second -- of marshmallow roots, Iceland moss and lime flowers. The methods for identification and assay of the active substances in the compounds were applied. The purity of the mixtures was regulated by limitation of the loss on drying, total ash, microbial contamination, contamination with radionuclides, heavy metals, pesticides and foreign matter. The expiry date of both cough-relieving herbal teas was approved to be 2 years.

Chronic cough due to occupational factors

PubMed Central

Groneberg, David A; Nowak, Dennis; Wussow, Anke; Fischer, Axel

2006-01-01

Within the large variety of subtypes of chronic cough, either defined by their clinical or pathogenetic causes, occupational chronic cough may be regarded as one of the most preventable forms of the disease. Next to obstructive airway diseases such as asthma or chronic obstructive pulmonary disease, which are sometimes concomitant with chronic cough, this chronic airway disease gains importance in the field of occupational medicine since classic fiber-related occupational airway diseases will decrease in the future. Apart from acute accidents and incidental exposures which may lead to an acute form of cough, there are numerous sources for the development of chronic cough within the workplace. Over the last years, a large number of studies has focused on occupational causes of respiratory diseases and it has emerged that chronic cough is one of the most prevalent work-related airway diseases. Best-known examples of occupations related to the development of cough are coal miners, hard-rock miners, tunnel workers, or concrete manufacturing workers. As chronic cough is often based on a variety of non-occupational factors such as tobacco smoke, a distinct separation into either occupational or personally -evoked can be difficult. However, revealing the occupational contribution to chronic cough and to the symptom cough in general, which is the commonest cause for the consultation of a physician, can significantly lead to a reduction of the socioeconomic burden of the disease. PMID:16722562

Does diurnal variation in cough reflex testing exist in healthy young adults?

PubMed

Perry, Sarah; Huckabee, Maggie-Lee

2017-05-01

The aim of this study was to investigate whether diurnal variation in cough reflex sensitivity exists in healthy young adults when a tidal-breathing method is used. Fifty-three participants (19-37 years) underwent cough reflex testing on two occasions: once in the morning (between 9 am - midday) and once in the afternoon (between 2-5 pm). The order of testing was counter-balanced. Within each assessment, participants inhaled successively higher citric acid concentrations via a facemask, with saline solution randomly interspersed to control for a placebo response. The lowest concentration that elicited a reflexive cough response was recorded. Morning cough thresholds (mean=0.6mol/L) were not different from afternoon cough thresholds (mean=0.6mol/L), p=0.16, T=101, r=-0.14. We found no evidence of diurnal variability in cough reflex testing. There was, however, an order effect irrespective of time of day, confirming that healthy participants are able to volitionally modulate their cough response. Copyright © 2017 Elsevier B.V. All rights reserved.

Comparison of the Effect of Two Kinds of Iranian Honey and Diphenhydramine on Nocturnal Cough and the Sleep Quality in Coughing Children and Their Parents

PubMed Central

Ayazi, Parviz; Mahyar, Abolfazl; Yousef-Zanjani, Mahdieh; Allami, Abbas; Esmailzadehha, Neda; Beyhaghi, Taraneh

2017-01-01

Coughing in a child induced by upper respiratory tract infections (URTIs) can be a problem, both for the child and its parents. Current studies show a lack of proven efficacy for over-the counter (OTC) medications, but promising data support the use of honey for children. The aim of this study was to compare the effects of two kinds of Iranian honey with diphenhydramine (DPH) on nocturnal pediatric coughs and the sleep quality of children and their parents. This was a clinical trial (registered in IRCT; No.: 28.20.7932, 15 October 2013). The study consisted of 87 patients. All the parents completed a standard previously validated questionnaire. The children were randomly assigned to one of three treatment groups: Group 1, Honey type 1 (Kimia Company, Iran) (n = 42), Group 2, Honey type 2 (Shahde-Golha, Iran) (n = 25), and Group 3, DPH (n = 20). Each group received double doses of the respective treatments on two successive nights. A second survey was then administered via a telephone interview in which the parents were asked the same questions. The mean scores for all aspects of coughs were significantly decreased in each group before and after the treatment. All three treatments improved the cough and sleep scores. Honey type 1 was superior to DPH in improving all aspects of coughs, except the frequency, and Honey type 2 was more effective than DPH in improving all aspects of coughs, except the sleep quality of the child. There was no significant difference between Honey type 1 and 2 in any aspects of cough relief in the present study. The results suggest that honey may provide better cough relief than DPH in children and improve the sleep quality of children and their parents. PMID:28103276

Pregnancy and Medicines

MedlinePlus

Not all medicines are safe to take when you are pregnant. Some medicines can harm your baby. That includes over-the-counter or prescription drugs, herbs, and supplements. Always speak with your health ...

Dos and Don'ts of Giving OTC Cough and Cold Medicines to Your Child

MedlinePlus

... workers, extended family members, or babysitters) knows what medicines your child is taking and when he or she should ... ts Don’t give OTC cough and cold medicines to a child younger than 4 years of age unless your ...

Translating Cough Mechanisms Into Better Cough Suppressants.

PubMed

Keller, Jennifer A; McGovern, Alice E; Mazzone, Stuart B

2017-10-01

Chronic cough is a significant problem, and in many patients cough remains refractive to both disease-specific therapies and current cough-suppressing medicines, creating a need for improved antitussive therapies. Most patients with chronic cough also display heightened sensitivity so that they experience a persistent sense of the need to cough, and often innocuous stimuli can trigger their coughing. This hypersensitivity underpins the newly described concept of cough hypersensitivity syndrome (CHS), a term that encapsulates the notion of common underlying mechanisms producing neuronal activation, sensitization and/or dysfunction, which are at the core of excessive coughing. Understanding these mechanisms has been a focus of recent research efforts in the field in the hope that new therapies can be developed to selectively target sensitized unproductive cough while maintaining the reflexive cough essential for airway protection. However, efforts to achieve this have been slower than expected, in part because of some significant challenges and limitations translating current cough models. In this review, we summarize recent advances in our understanding of the sensory circuits innervating the respiratory system that are important for cough, how cough sensory pathways become hypersensitive, and some of the recently described neural targets under development for treating chronic cough. We present the case that better use of current cough models or the development of new models, or both, is ultimately needed to advance our efforts to translate the discovery of basic cough mechanisms into effective medicines for treating patients with chronic cough. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Dextromethorphan: a case study on addressing abuse of a safe and effective drug.

PubMed

Spangler, David C; Loyd, Catherine M; Skor, Emily E

2016-06-23

Dextromethorphan is a safe, effective cough suppressant, available without a prescription in the United States since 1958. Due to a perceived prevalence of abuse of dextromethorphan by teens, in 2007 the Drug Enforcement Administration requested the Food and Drug Administration evaluate whether dextromethorphan should be recommended for scheduling under the Controlled Substances Act. The Food and Drug Administration held an Advisory Committee meeting in 2010 to provide a scientific and medical evaluation of dextromethorphan and its abuse potential. To address reports of abuse, particularly by teens in the United States, the Consumer Healthcare Products Association initiated an abuse mitigation plan in 2010 with specific goals related to awareness of the behavior, perception of risk, social disapproval, and access to the products. In identifying abuse interventions, experts acknowledge that substance abuse among teens is a highly complex behavior and indicate that the best course of action is to address prevention by focusing on the factors that impact teen behavior. It is noteworthy that the annual prevalence of over-the-counter cough medicine abuse has sharply decreased since 2010. While a true cause-and-effect relationship cannot be assured, the Consumer Healthcare Products Association and its member companies believe that the increased awareness of the issue since the 2010 Food and Drug Administration Advisory Committee meeting, and the subsequent implementation of a well-delivered and targeted abuse mitigation plan that addressed the levers influencing teen decisions is contributing to the observed reduction in abuse. During the period of 2010-2015, reported abuse of dextromethorphan by 8(th), 10(th), and 12(th) graders decreased 35 %. The authors believe this reduction supports the view of the Consumer Healthcare Products Association at the outset of the abuse mitigation plan effort and today: Controlled substance scheduling or prescription requirements would result in a reduction in the legitimate use of this medicine that has benefits that far outweigh its risks. Instead, there are more targeted, more effective, and less disruptive interventions to address dextromethorphan abuse.

Comorbidity

MedlinePlus

... Alcohol Club Drugs Cocaine Fentanyl Hallucinogens Inhalants Heroin Marijuana MDMA (Ecstasy/Molly) Methamphetamine Opioids Over-the-Counter Medicines Prescription Medicines Steroids (Anabolic) Synthetic Cannabinoids (K2/Spice) Synthetic Cathinones (Bath Salts) Tobacco/ ...

High frequency analysis of cough sounds in pediatric patients with respiratory diseases.

PubMed

Kosasih, K; Abeyratne, U R; Swarnkar, V

2012-01-01

Cough is a common symptom in a range of respiratory diseases and is considered a natural defense mechanism of the body. Despite its critical importance in the diagnosis of illness, there are no golden methods to objectively assess cough. In a typical consultation session, a physician may briefly listen to the cough sounds using a stethoscope placed against the chest. The physician may also listen to spontaneous cough sounds via naked ears, as they naturally propagate through air. Cough sounds carry vital information on the state of the respiratory system but the field of cough analysis in clinical medicine is in its infancy. All existing cough analysis approaches are severely handicapped by the limitations of the human hearing range and simplified analysis techniques. In this paper, we address these problems, and explore the use of frequencies covering a range well beyond the human perception (up to 90 kHz) and use wavelet analysis to extract diagnostically important information from coughs. Our data set comes from a pediatric respiratory ward in Indonesia, from subjects diagnosed with asthma, pneumonia and rhinopharyngitis. We analyzed over 90 cough samples from 4 patients and explored if high frequencies carried useful information in separating these disease groups. Multiple regression analysis resulted in coefficients of determination (R(2)) of 77-82% at high frequencies (15 kHz-90 kHz) indicating that they carry useful information. When the high frequencies were combined with frequencies below 15kHz, the R(2) performance increased to 85-90%.

Careful: Acetaminophen in Pain Relief Medicines Can Cause Liver Damage

MedlinePlus

... and Fever Reducers Careful: Acetaminophen in pain relief medicines can cause liver damage Share Tweet Linkedin Pin ... ingredient in many over-the-counter and prescription medicines that help relieve pain and reduce fever. More ...

Cough Medicine: Understanding Your OTC Options

MedlinePlus

... and expectorants. A common antitussive is dextromethorphan (some brand names: Triaminic Cold and Cough, Robitussin Cough, Vicks ... expectorant available in OTC products is guaifenesin (2 brand names: Mucinex, Robitussin Chest Congestion). How do OTC ...

Use Over-the-Counter Medicines Wisely

MedlinePlus

... correctly. Simply put, this means that when you buy or use an OTC medicine, remember to: ● Respect that OTCs are serious medicines ... simple steps: ● Read the label—every time you buy or use a nonprescription medicine pay special attention to the ingredients, and directions ...

Using over-the-counter medicines safely

MedlinePlus

... about OTC drugs. About OTC Medicines You can buy OTC medicines without a prescription in: Drug stores Grocery stores ... Safely You should: Examine the package before you buy it. Make sure it has not been tampered with. Never use medicine you have bought that does not look the ...

Cough: an unmet clinical need

PubMed Central

Dicpinigaitis, Peter V

2011-01-01

Cough is among the most common complaints for which patients worldwide seek medical attention. Thus, the evaluation and treatment of cough result in tremendous financial expenditure and consumption of health care resources. Yet, despite the clinical significance of cough, research efforts aimed at improving diagnostic capabilities and developing more effective therapeutic agents have been, to date, disappointing in their limited scope and outcomes. Acute cough due to the common cold represents the most common type of cough. Currently, available medications for the symptomatic management of acute cough are inadequate due to lack of proven efficacy and/or their association with undesirable or intolerable side effects at anti-tussive doses. Subacute cough, often representing a prolonged post-viral response, is typically refractory to standard anti-tussive therapy. Few clinical trials have evaluated therapeutic options for subacute cough. Diagnostic challenges facing the clinician in the management of chronic cough include the determination of whether symptoms of upper airway cough syndrome (formerly, postnasal drip syndrome) or gastro-oesophageal reflux disease are indeed the underlying cause of cough. Chronic, refractory unexplained (formerly, idiopathic) cough must be distinguished from cough that has not been fully evaluated and treated according to current guideline recommendations. Eagerly awaited are new safe and effective anti-tussive agents for use when cough suppression is desired, regardless of underlying aetiology of cough, as well as practical, validated ambulatory cough counters to aid clinical assessment and future research in the field of cough. LINKED ARTICLES This article is part of a themed issue on Respiratory Pharmacology. To view the other articles in this issue visit http://dx.doi.org/10.1111/bph.2011.163.issue-1 PMID:21198555

Antiarrhythmics

MedlinePlus

... even over-the-counter medicines and vitamin or herbal supplements), so he or she can make you aware ... or interactions with other medicines and vitamin or herbal supplements. This information should not be used as medical ...

Medicines in My Home: Information for Students on the Safe Use of Over-the-Counter Medicines

MedlinePlus

... are safer when you follow directions. The active ingredients in OTC medicines can be harmful if you don’t use them as directed on the label. Take for example, the active ingredients in OTC fever and pain medicines.... • Acetaminophen can ...

Analysis of Marketing Strategy for Food Supplements and Over-The-Counter Medicines

PubMed Central

Dzeparoski, Marjan; Trajkovic-Jolevska, Suzana

2016-01-01

Marketing strategy is correlated with the regulations for the corresponding product category. Accordingly, there is a big difference in the marketing strategy of food supplements and over-the-counter medicines. In this paper are presented 2 different marketing strategies of a new small pharmaceutical company in two studies. The findings of studies analysis can be used for developing marketing strategies in the wider sense and other products, for other small to medium sized companies in other countries of interest with similar regulations and help them understand how to position and promote themselves and their products. PMID:27703582

Analysis of Marketing Strategy for Food Supplements and Over-The-Counter Medicines.

PubMed

Dzeparoski, Marjan; Trajkovic-Jolevska, Suzana

2016-09-15

Marketing strategy is correlated with the regulations for the corresponding product category. Accordingly, there is a big difference in the marketing strategy of food supplements and over-the-counter medicines. In this paper are presented 2 different marketing strategies of a new small pharmaceutical company in two studies. The findings of studies analysis can be used for developing marketing strategies in the wider sense and other products, for other small to medium sized companies in other countries of interest with similar regulations and help them understand how to position and promote themselves and their products.

Family Checkup: Positive Parenting Prevents Drug Abuse

MedlinePlus

... Alcohol Club Drugs Cocaine Fentanyl Hallucinogens Inhalants Heroin Marijuana MDMA (Ecstasy/Molly) Methamphetamine Opioids Over-the-Counter Medicines Prescription Medicines Steroids (Anabolic) Synthetic Cannabinoids (K2/Spice) Synthetic Cathinones (Bath Salts) Tobacco/ ...

Popularity and customer preferences for over-the-counter Chinese medicines perceived by community pharmacists in Shanghai and Guangzhou: a questionnaire survey study.

PubMed

Ge, Shuai; He, Tian-Tian; Hu, Hao

2014-01-01

This study interviewed community pharmacists in Shanghai and Guangzhou for their perception of the popular categories of over-the-counter (OTC) Chinese medicines and the factors affecting customer preferences for OTC Chinese medicines. A cross-sectional survey was carried out in six main administrative districts in Guangzhou and eight main administrative districts in Shanghai, China. Descriptive statistical analysis was conducted in this study. OTC Chinese medicines contributed 21-50% among all the pharmaceutical sales by the community pharmacies. The prevalent categories of OTC Chinese medicines were common cold medicines, respiratory system medicines, digestive system agents, gynecological medicines, health tonic medicines, and qing re (heat-clearing) and qu du (detoxifying) medicines. Customers were more concerned about medical factors of OTC Chinese medicines than business factors. Among the medical factors, the most important was drug safety, followed by efficacy, contraindications, indications, and side effects. Among the business factors, the most important were brand and price. This study identified the top sales categories of OTC Chinese medicines in Shanghai and Guangzhou and the important factors such as drug safety, efficacy, period of validity, contraindications, and indications that are affecting the customer preferences for OTC Chinese medicines.

Effect of a Hypocretin/Orexin Antagonist on Neurocognitive Performance

DTIC Science & Technology

2014-09-01

46 NEY-1413 FINAL Version 10.30 JANUARY 2014 ABBREVIATIONS AE Adverse Event AASM American Academy of Sleep Medicine BzRAs Benzodiazepine...ketoconazole, prescription or over- the-counter medications or herbal supplements containing psychoactive properties or stimulants in the judgment of the...medical conditions; 12.) Current use of statins, ketoconazole, prescription or over-the-counter medications or herbal supplements containing

The effects of consultation on over-the-counter medication purchasing decisions.

PubMed

Nichol, M B; McCombs, J S; Johnson, K A; Spacapan, S; Sclar, D A

1992-11-01

This article examines factors that predict changes in consumer purchasing decisions of nonprescription medications. Variables corresponding to factors in Andersen's behavioral model are measured, in addition to data regarding characteristics of the 17 pharmacy consultants who provided counseling services. One thousand seven hundred and thirteen consumers in five stores in southern California were provided consultation during a 6-month period, resulting in 25.4% of the patients purchasing a different drug than intended when entering the pharmacy, 1.3% being referred to a physician, and 13.4% not purchasing any over-the-counter medication at all. Logistic regression techniques demonstrated that one enabling variable (availability of generic medications), and four need factors (the discussion of clinical issues, short encounters, cough and cold products, and vitamin products) were significant predictors of the consumer's decision to purchase a different product than intended. Consultant characteristics (introversion, external locus of control) were also important predictors, but opposite the expected direction. Consumers who received information from female consultants were more likely to change their purchasing decisions.

Implementing an Over-the-Counter Medication Administration Policy in an Elementary School

ERIC Educational Resources Information Center

Foster, Lori S.; Keele, Rebecca

2006-01-01

A major focus of school nursing interventions is to improve school attendance. In many schools, parents are required to leave work and/or to arrange transportation to bring their children over-the-counter medicines. Many times these children went home, missing class and making it difficult to keep up with class work. The purpose of this study was…

Heart Truth for Women: An Action Plan

MedlinePlus

... treat CHD include anticoagulants, also called blood thinners; aspirin and other anticlotting medicines; ACE inhibitors; beta blockers; ... as your health care provider advises. (This includes aspirin and other over-the-counter medicines.) If you ...

Effect of a Hypocretin/Orexin Antagonist on Neurocognitive Performance

DTIC Science & Technology

2012-09-01

NEY-1413 FINAL Version 8.05JAN2012 Page 5 of 45 ABBREVIATIONS AE Adverse Event AASM American Academy of Sleep Medicine BzRAs...Current use of statins, ketoconazole, prescription or over- the-counter medications or herbal supplements containing psychoactive properties or...Current use of statins, ketoconazole, prescription or over-the-counter medications or herbal supplements containing psychoactive properties or

Pharmaceutical counseling: Between evidence-based medicine and profits.

PubMed

Egorova, S N; Akhmetova, T

2015-01-01

The number of pharmacies, which produce drug formulations locally, has recently considerably reduced in Russia. Pharmacies mainly operate as retailers of industrially manufactured drugs.Pharmaceutical consultation of customers at pharmacies aimed at responsible self-medication is the most popular and accessible feature of pharmaceutical care. In Russia there is a significant list of medicines approved for sale in pharmacies on a non-prescription basis that is specified in the product label. In this regard, the role of pharmacists in public health in Russia increases. Pharmacist, working directly with population, is an important figure for the rational use of medicines. This type of work requires high level of professional training and appropriate ethics. To explore the current status of pharmaceutical counseling in Russia. Situation analysis, surveys of pharmacists. Our experience in the system of postgraduate professional education, the results of the survey of pharmacists, and the long-term dialogue with pharmacists allowed us to identify several unresolved issues in the work of a pharmacist selling non-prescription drugs.Lack of differentiation in the functions of a pharmacist with a higher education and pharmaceutical technologist: In production/industrial pharmacy technicians are engaged in manufacturing of pharmaceutical formulations. However, due to the loss of production functions technologists had to move away from production laboratories of apothecaries to the sales area. Currently, the apothecary's assignment to receive prescriptions and dispense medications can be fulfilled by either a pharmacist or a pharmaceutical technician. It significantly discerns the pharmacy from the medical organization with clearly delineated functions of doctors and nurses. Russian regulations should consider the level of education required for high-quality pharmaceutical counseling.Contradiction between the pharmacist's special functions and trade procedure with the lack of pharmaceutical counseling standards: Article 1.1 "Code of Ethics of the pharmaceutical worker of Russia" states: "The main task of the professional activity of the pharmaceutical worker - protection of human health", Article 1.3 states that a pharmaceutical worker must take professional decisions solely in the interests of a patient [1]. However, the pharmacy is a trade organization, thus as a retailer the pharmacy is directly interested in making profits and increasing sales of pharmaceutical products, including non-prescription medicines. Moreover, while the clinical medicine is monitored for unjustified prescribing and measures are being taken to prevent polypharmacy, for a pharmacist the growing sales of over-the-counter drugs, active promotion of dietary supplements, homeopathic medicines, medical devices, and, consequently, an increase of financial indicators (particularly "average purchase size") - all are characteristics of success [2].Rational use of over-the-counter medicines requires introduction of pharmaceutical counseling standards (pharmaceutical care) according to symptoms - major reasons to visit a pharmacy as part of responsible self-medication (cold, sore throat, headache, diarrhea, etc.). Standards of pharmaceutical counseling should be objective, reliable and up-to-date and contain recommendations for the rational use of over-the-counter drugs as well as indications requiring treatment to the doctor. Standardization of pharmaceutical counseling in terms of Evidence-based Pharmacy would enhance the efficiency, safety and cost-effectiveness of over-the-counter medicines.Currently, the lack of clinical component in the higher pharmaceutical education and the lack of approved standards of pharmaceutical counseling lead to the introduction of cross-selling technologies (which are broadly applied in other areas of trade, for example, the offer of a boot-polish during the sale of shoes) to the pharmaceutical practice [2, 3]. However, drugs belong to a special group of products, proper selection of which requires special education, and the consumer is not always able to evaluate the quality of the recommendations. Marketing cross-selling recommendations are aimed at promotion of the over-the-counter medicines for customers buying prescription drugs. For example, business coaches recommend the pharmacists to make additional offers: with the purchase of physician-prescribed antibiotics - offer of vitamins, with prescribed nonsteroidal anti-inflammatory drugs - commercially available ointment with non-steroidal topical formulation ("to enhance the effect") and others. These recommendations do not agree with evidence-based medicine and lead to inefficient use of over-the-counter drugs and unjustified financial expenses. Thus, to ensure the rational use of medicines permitted for free (non-prescription) dispensing at the pharmacies, pharmaceutical information needs standardization on the basis of evidence-based medicine as well as standardization of the pharmaceutical counseling service. The development of practical recommendations on the rational use of over-the counter medicines by doctors and pharmacists with further adoption at the state level, the recommendation of most secure, efficient and cost-effective over-the-counter medications during pharmaceutical counseling in pharmacies will contribute to the restoration and preservation of public health.

On the definition of chronic cough and current treatment pathways: an international qualitative study

PubMed Central

2014-01-01

Background The pathogenesis of chronic cough is not well understood and treatment options are limited. In this study we sought to explore the current understanding and management of chronic cough across an international group of specialists. Methods This was an international study of cross sectional qualitative design. In depth interviews were carried out with “Respiratory Specialists” experienced in treating treating Chronic Obstructive Pulmonary Disease (COPD), idiopathic pulmonary fibrosis (IPF), idiopathic chronic cough (ICC) and/or lung cancer patients and with “Disease Experts” in the field of Chronic Cough. Participants in the study were recruited from the USA, UK, Germany, Ireland, Australia and Japan. Interviews with specialists were held at research facilities and with DEs over the telephone. These were preceded by the specialists completing case records of patients recently seen. All interviews were conducted by native speaking trained moderators using a semi-structured interview guide script. This was designed to elicit the definition of chronic cough, explore the unmet needs for each disease state, define therapy goals, identify patient phenotypes and give an overview of the treatment pathway. Results 76 specialists and 10 experts took part in the study. Over two thirds (70%) of respondents defined chronic cough as “cough lasting more than 8/12 weeks” (range 2 weeks to 2 years). Physicians emphasised three interdependent aspects of clinical assessment: impact on quality of life, type of cough (productive versus non-productive) and the underlying pathology. Specialists emphasised treating the underlying cause rather than the cough, this being most prominent in Japan. Experts as a group focussed on chronic cough independently. Evaluation of the respiratory system, GI tract and upper airway (ENT) for establishing an underlying cause was recommended. Type of cough (productive vs non-productive) and impact on quality of life influenced treatment initiation. 33% of patients with ICC were prescribed anti-tussives. With associated diagnoses of COPD, IPF or lung cancer the emphasis was on treating the underlying condition. Alternatives to pharmacological treatments were frequently considered. Conclusion There is significant international variation in our understanding and management of chronic cough. Further work is required to bring forth clear guidance and effective medicines for these patients. PMID:25009577

Overview of the Management of Cough

PubMed Central

French, Cynthia T.; Lewis, Sandra Zelman; Diekemper, Rebecca L.; Gold, Philip M.; Adams, Todd M.; Altman, Kenneth W.; Barker, Alan F.; Birring, Surinder S.; Bolser, Donald C.; Boulet, Louis-Philippe; Braman, Sidney S.; Brightling, Christopher; Callahan-Lyon, Priscilla; Canning, Brendan; Chang, Anne Bernadette; Coeytaux, Remy; Cowley, Terrie; Davenport, Paul; Ebihara, Satoru; El Solh, Ali A.; Escalante, Patricio; Field, Stephen K.; Fisher, Dina; Gibson, Peter; Gould, Michael K.; Harding, Susan M.; Harnden, Anthony; Hill, Adam T.; Kahrilas, Peter J.; Keogh, Karina A.; Lane, Andrew P.; Lim, Kaiser; Malesker, Mark A.; Mazzone, Peter; McCrory, Douglas C.; McGarvey, Lorcan; Murad, M. Hassan; Newcombe, Peter; Nguyen, Huong Q.; Oppenheimer, John; Prezant, David; Pringsheim, Tamara; Restrepo, Marcos I.; Rosen, Mark; Rubin, Bruce; Ryu, Jay H.; Smith, Jaclyn; Tarlo, Susan M.; Turner, Ronald B.; Vertigan, Anne; Weir, Kelly; Wiener, Renda Soylemez

2014-01-01

This overview will demonstrate that cough is a common and potentially expensive health-care problem. Improvement in the quality of care of those with cough has been the focus of study for a variety of disciplines in medicine. The purpose of the Cough Guideline and Expert Panel is to synthesize current knowledge in a form that will aid clinical decision-making for the diagnosis and management of cough across disciplines and also identify gaps in knowledge and treatment options. PMID:25080295

Occurrence of phthalate esters in over-the-counter medicines from China and its implications for human exposure.

PubMed

Jia, Lu-Lu; Lou, Xiang-Ying; Guo, Ying; Leung, Kelvin Sze-Yin; Zeng, Eddy Y

2017-01-01

Food, air, personal care products and indoor dust have been recognized as the main routes of exposure to phthalates in Chinese population, but other sources may have been overlooked, e.g., medicines. To fill the knowledge gap, phthalate esters were measured in 96 over-the-counter medicines made in China, including selected 71 Chinese patented medicines and 25 western medicines. It was found that none of the medicines was free of phthalates. The mean concentrations of individual phthalates ranged from 0.001μg/g (dicyclohexyl phthalate) to 5.85μg/g (diethyl phthalate). Among 9 targeted phthalates, di-n-butyl phthalate was the dominant congener, accounting for >65% of the total phthalates in all medicine samples, followed by di-(2-ethylhexyl) phthalate and diethyl phthalate. Phthalates in medicines appeared to derive from gastroresistant film coatings, plastic packing materials or phthalate contaminated rural herbal plants (especially for Chinese patented medicines). Daily human exposure to phthalates was estimated for local patients for one treatment cycle (e.g., one week) based on suggested consumption dosage and phthalate concentrations. Almost all exposure levels were below the guidelines suggested by the United States Environmental Protection Agency or European Food Safety Authority, indicating low health risk with phthalates from consumption of the medicines. In addition, concentration levels of phthalates in patients would increase upon administration but are expected to decrease to the same values as those in patients before they took medicines in several days. Because the number of medicine samples was limited and the concentrations of phthalates varied in a large range, further investigations are needed to acquire more data for better assessment of human health effects for Chinese population. Capsule: Distribution of phthalate esters in over-the-counter medicines and related exposure for Chinese population are examined. Copyright © 2016 Elsevier Ltd. All rights reserved.

Current Over-the-Counter Medicine Label: Take a Look

MedlinePlus

... of OTC medicines sometimes make changes to their products or labeling (new ingredients, dosages, or warnings). Make sure to read the label each time you use the product. Always look for special "flags" or "banners" on ...

Patients, society, and the increase in self medication.

PubMed Central

Blenkinsopp, A.; Bradley, C.

1996-01-01

Self medication with over the counter medicines has long been a feature of the lay health system. With the reclassification of certain drugs, the public can buy preparations that were previously available only prescription. Sales of over the counter medicines are now equivalent to a third of the NHS drugs bill; governments throughout the world see self medication as a way of shifting some of the cost of health care onto consumers. The trend towards increased self care and with it the increasing empowerment of patients has many potential benefits; collaboration between doctors and pharmacists will be critical. Images p631-a PMID:8595343

Over-the-Counter Medicines: What's Right for You?

MedlinePlus

... Contents: Advice for Americans about Self-Care: Access + Knowledge = Power OTC Know-How: It's on the Label Drug ... Tampering Advice for Americans about Self-Care: Access + Knowledge = Power American medicine cabinets contain a growing choice of ...

Popularity and customer preferences for over-the-counter Chinese medicines perceived by community pharmacists in Shanghai and Guangzhou: a questionnaire survey study

PubMed Central

2014-01-01

Background This study interviewed community pharmacists in Shanghai and Guangzhou for their perception of the popular categories of over-the-counter (OTC) Chinese medicines and the factors affecting customer preferences for OTC Chinese medicines. Methods A cross-sectional survey was carried out in six main administrative districts in Guangzhou and eight main administrative districts in Shanghai, China. Descriptive statistical analysis was conducted in this study. Results OTC Chinese medicines contributed 21–50% among all the pharmaceutical sales by the community pharmacies. The prevalent categories of OTC Chinese medicines were common cold medicines, respiratory system medicines, digestive system agents, gynecological medicines, health tonic medicines, and qing re (heat-clearing) and qu du (detoxifying) medicines. Customers were more concerned about medical factors of OTC Chinese medicines than business factors. Among the medical factors, the most important was drug safety, followed by efficacy, contraindications, indications, and side effects. Among the business factors, the most important were brand and price. Conclusions This study identified the top sales categories of OTC Chinese medicines in Shanghai and Guangzhou and the important factors such as drug safety, efficacy, period of validity, contraindications, and indications that are affecting the customer preferences for OTC Chinese medicines. PMID:25243017

[Thought and method of classic formulae in treatment of chronic cough].

PubMed

Su, Ke-Lei; Zhang, Ye-Qing

2018-06-01

Chronic cough is a common clinical disease with complex etiology, which is easily misdiagnosed and mistreated. Chronic cough guideline has been developed based on the modern anatomical etiology classification, and it may improve the level of diagnosis and treatment. Common causes of chronic cough are as follows: cough variant asthma, upper airway cough syndrome, eosinophilic bronchitis, gastroesophageal reflux-related cough, post-infectious cough, etc. There is a long history and rich experience in treatment of cough in traditional Chinese medicine which is characterized by syndrome differentiation. The four elements of pathogenesis for chronic cough include wind, phlegm, fire, and deficiency. Classic formula is widely used in the treatment of chronic cough, and the focus is on prescriptions corresponding to syndromes. This article attempts to explore the thought and method of classic formulae in treatment of chronic cough based on three perspectives: differentiation of etiology, pathogenesis and formula-syndrome. Three medical cases are selected at last in order to prove its correction. Copyright© by the Chinese Pharmaceutical Association.

Honey for acute cough in children.

PubMed

Oduwole, Olabisi; Meremikwu, Martin M; Oyo-Ita, Angela; Udoh, Ekong E

2012-03-14

Cough causes concern for parents and is a major cause of outpatient visits. It can impact on quality of life, cause anxiety and affect sleep in parents and children. Several remedies, including honey, have been used to alleviate cough symptoms. To evaluate the effectiveness of honey for acute cough in children in ambulatory settings. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2011) which contains the Cochrane Acute Respiratory Infections Group's Specialised Register; MEDLINE (1950 to December week 4, 2011); EMBASE (1990 to January 2012); CINAHL (1981 to January 2012); Web of Science (2000 to January 2012); AMED (1985 to January 2012); LILACS (1982 to January 2012); and CAB abstracts (2009 to January 2012). Randomised controlled trials (RCTs) comparing honey given alone, or in combination with antibiotics, versus nothing, placebo or other over-the-counter (OTC) cough medications to participants aged from two to 18 years for acute cough in ambulatory settings. Two review authors independently screened search results for eligible studies and extracted data on reported outcomes. We included two RCTs of high risk of bias involving 265 children. The studies compared the effect of honey with dextromethorphan, diphenhydramine and 'no treatment' on symptomatic relief of cough using the 7-point Likert scale.Honey was better than 'no treatment' in reducing frequency of cough (mean difference (MD) -1.07; 95% confidence interval (CI) -1.53 to -0.60; two studies; 154 participants). Moderate quality evidence suggests honey did not differ significantly from dextromethorphan in reducing cough frequency (MD -0.07; 95% CI -1.07 to 0.94; two studies; 149 participants). Low quality evidence suggests honey may be slightly better than diphenhydramine in reducing cough frequency (MD -0.57; 95% CI -0.90 to -0.24; one study; 80 participants).Adverse events included mild reactions (nervousness, insomnia and hyperactivity) experienced by seven children (9.3%) from the honey group and two (2.7%) from the dextromethorphan group; the difference was not significant (risk ratio (RR) 2.94; 95% Cl 0.74 to 11.71; two studies; 149 participants). Three children (7.5%) in the diphenhydramine group experienced somnolence (RR 0.14; 95% Cl 0.01 to 2.68; one study; 80 participants) but there was no significant difference between honey versus dextromethorphan or honey versus diphenhydramine. No adverse event was reported in the 'no treatment' group. Honey may be better than 'no treatment' and diphenhydramine in the symptomatic relief of cough but not better than dextromethorphan. There is no strong evidence for or against the use of honey.

Druggists and pharmacists as gatekeepers: sales routines and compliance with sales protocols for over-the-counter naproxen 275 mg medicines in the Netherlands.

PubMed

van Hoof, Joris J; Cents, Michel H G; Megens, Nicole M J; van der Tang, Sijbrand J

2014-09-01

Since for the sales of over-the-counter (OTC) medicines, prescribing physicians are not involved, and written instructions on/in the medicine boxes are inefficient, druggists and pharmacists are important gatekeepers in preventing customers' accidents. In this study we investigated the sales routines, and compliance with sales protocols, in order to evaluate that gatekeeper's function. By means of the mystery shopping method, 228 pharmacies and drugstores in The Netherlands were visited and a naproxen 275mg medium-risk medicine was requested for a (fictitious) patient who was suffering from severe back pains. According to the sales protocols the vendors should never sell the requested medicine, because the mystery shoppers only gave an answer to one of the four mandatory sales protocol questions. Furthermore, the requested medicine is not the right or best choice for back pains. Four different scenarios were used in a 2×2 design (8-year-old patient vs. 25-year-old patient, and 1 box with 12 pills vs. 3 boxes with 12 pills). Of the drugstores and pharmacies only 16.7% complied with the sales protocols and did not sell the specific (or comparable) medicine, after asking all four mandatory questions (or already after one, two or three questions). Most vendors (83.3%) did not comply and sold the requested medicine, a comparable medicine, or even a more risky medicine after no question at all (or after asking some or even all four questions). Although both score low, pharmacists show better compliance (23.9%) than druggists (10.1%). When it comes to OTC medicines, druggists and pharmacists largely commit sloppy sales. The expected gatekeeping function of pharmacists and druggists is very limited, and customers might be in danger of inappropriate medicine selection, quantity and usage. We call for thorough evaluation of the over-the-counter system, improvement of the educational programs for medicine providers, and national campaigns to inform the public. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Impact of the voluntary withdrawal of over-the-counter cough and cold medications on pediatric ingestions reported to poison centers†

PubMed Central

Klein-Schwartz, Wendy; Sorkin, John David; Doyon, Suzanne

2015-01-01

SUMMARY Purpose To assess the impact of a voluntary withdrawal of over-the-counter cough and cold medications (OTC CCMs) labeled for children under age 2 years on pediatric ingestions reported to the American Association of Poison Control Centers. Methods Trend analysis of OTC CCMs ingestions in children under the age 6 years resulting from therapeutic errors or unintentional poisonings for 27 months before (pre-) and 15 months after (post-) the October 2007 voluntary withdrawal was conducted. The rates and outcome severity were examined. Results The mean annual rate of therapeutic errors involving OTC CCMs post-withdrawal, in children less than 2-years of age, 45.2/100 000 (95%CI 30.7–66.6) was 54% of the rate pre-withdrawal, 83.8/100 000 (95%CI 67.6–104.0). The decrease was statistically significant p < 0.02. In this age group, there was no difference in the frequency of severe outcomes resulting from therapeutic errors post-withdrawal. There was no significant difference in unintentional poisoning rates post-withdrawal 82.1/100 000 (66.0–102.2) vs. pre-withdrawal 98.3/100 000 (84.4–114.3) (p < 0.21) in children less than 2-years of age. There were no significant reductions in rates of therapeutic errors and unintentional poisonings in children ages 2–5 years, who were not targeted by the withdrawal. Conclusions A significant decrease in annual rates of therapeutic errors in children under 2-years reported to Poison Centers followed the voluntary withdrawal of OTC CCMs for children under age 2-years. Concerns that withdrawal of pediatric medications would paradoxically increase poisonings from parents giving products intended for older age groups to young children are not supported. PMID:20533537

Consumer habits and interests regarding non-prescription medications in Hungary.

PubMed

Major, Csilla; Vincze, Zoltán

2010-06-01

Patients increasingly use over-the-counter medicines for self-treatment but such products can be misused and/or abused. The primary aim of the present study is to survey the relationship between pharmacists and self-medication, to give an overview of their opinions on advertisements of non-prescription drugs and to evaluate the knowledge of and familiarity with medicines held by individuals purchasing them for self-treatment. A marketing research study of non-prescription drugs in multiple pharmacies between March and July 2008 was conducted. A total of 2000 questionnaires were handed out, of which 1486 were evaluated. Statistical analysis was performed using SPSS 13.0 software. The majority of participants (72.5%) visited a community pharmacy at least once per month. Half of the respondents reported taking medications regularly. Forty per cent of those surveyed consult a qualified professional about their decision before buying non-prescription medications. Forty-four per cent of respondents reported asking pharmacists about the effects of non-prescription medications. This survey revealed that the general public has a high level of awareness concerning the abuse potential of over-the-counter medicines. Health care professionals should seek to understand and respect patients' choices to assure optimal care. Pharmacists could be more proactive in the management of inappropriate over-the-counter drug use.

The great American medicine show revisited.

PubMed

Tomes, Nancy

2005-01-01

Since the late 1800s, changes in the advertising and marketing of medicinal drugs have produced heated debates in the United States. With the emergence of the modern prescription drug between 1938 and 1951, concerns that once focused primarily on patients' use of over-the-counter drugs were broadened to include physicians and their "doctors' drugs" as well. The medical profession's growing control over their patients' drug choices inevitably heightened the scrutiny of their own performance as consumers. Although deeply divided over issues of the patient's role in medical decision making, consumer activists and physician reformers expressed similar concerns about the impact of aggressive pharmaceutical marketing and advertising on the doctor-patient relationship, and starting in the late 1950s they employed strikingly similar strategies to counter the new corporate "medicine show." Yet their efforts to promote a more rational use of prescription drugs have usually been too little and too late to offset the effectiveness of pharmaceutical advertising and mar-keting activities.

Rosacea Patient Perspectives on Homeopathic and Over-the-counter Therapies

PubMed Central

Lan, Lucy; Kuo, Sandy; Huang, Karen E.; Taylor, Sarah L.; Feldman, Steven R.

2015-01-01

Background: Rosacea patients commonly employ nonprescription therapies. The authors’ aim was to understand rosacea patients’ perceptions of over-the-counter products, complementary and alternative medicine, and homeopathic therapies. Method: A public, online discussion forum comprising 3,350 members and 27,051 posts provided a source of 346 posts on patient perceptions on alternative rosacea treatments. Results: Three major themes of nonprescription treatment were identified—motivation for use, patient-provider discussions, and experience with these treatments. Perceived medication failure, barriers to treatment, and distrust of physicians drive patients to seek nonprescription therapies. Still, patients prefer to consult a physician on incorporating nonprescription therapies into treatment. Complementary and alternative medicine natural products (19.4% of posts), complementary and alternative medicine practices (16.5%), and homeopathic medicine (3.8%) were commonly discussed. Conclusion: Physicians have an opportunity to be a trusted source of information on the strengths and weaknesses of skin care products and other complementary treatments for rosacea. PMID:26557217

Merits of using color and shape differentiation to improve the speed and accuracy of drug strength identification on over-the-counter medicines by laypeople.

PubMed

Hellier, Elizabeth; Tucker, Mike; Kenny, Natalie; Rowntree, Anna; Edworthy, Judy

2010-09-01

This study aimed to examine the utility of using color and shape to differentiate drug strength information on over-the-counter medicine packages. Medication errors are an important threat to patient safety, and confusions between drug strengths are a significant source of medication error. A visual search paradigm required laypeople to search for medicine packages of a particular strength from among distracter packages of different strengths, and measures of reaction time and error were recorded. Using color to differentiate drug strength information conferred an advantage on search times and accuracy. Shape differentiation did not improve search times and had only a weak effect on search accuracy. Using color to differentiate drug strength information improves drug strength identification performance. Color differentiation of drug strength information may be a useful way of reducing medication errors and improving patient safety.

[A case study of BRON (cough suppressant) tablet dependence--its social psychiatric and biological aspects].

PubMed

Kitabayashi, Y; Ueda, H; Narumoto, J; Kita, H; Nakamura, K; Tsuchida, H; Tani, N; Fukui, K

2000-10-01

A case of BRON tablet dependence is demonstrated. BRON is an over-the-counter (OTC) cough suppressant, which contains methylephedrine, dihydrocodeine, chlorpheniramine and caffeine. He took BRON tablet for the first time at the age of 16. In progress, he developed psychomotor excitement twice and finally manifested amotivational syndrome 3 years later from his first use. Longitudinal 123I-IMP SPECT (autoradiography method) findings demonstrated diffuse cerebral blood flow (CBF) decrease and relative hyperactivity in the lower frontal lobe. Diffuse decreased regional CBF, which was unchanged through its course for about 4 months, may show irreversible brain damage due to chronic BRON abuse. The findings of relative hyperactivity in the lower frontal lobe (orbitofrontal lobe) may reflect "craving for BRON" based on abnormal dopaminergic neural system activity. Based on the evidence that orbitofrontal hyperactivity is also seen in cases of cocaine abuse, methylephedrine, which is a cocaine-like central nervous system stimulant, may play the main role in BRON dependence formation. In Japan, BRON syrup abuse and dependence were in fashion for youth in 1980s. After the legal regulation of the market in 1988, it has gone out of fashion. While it is still easy to acquire OTC cough suppressant, reports of BRON tablet abuse and dependence are quite rare through 1980s and 1990s. This case suggests that BRON tablet abuse also could lead to dependence and come into new vogue for youth in the future. We should pay attention to the trend of OTC cough suppressant abuse and may need to regulate the market by law more severely.

Surveillance and uncertainty: community pharmacy responses to over the counter medicine abuse.

PubMed

Cooper, Richard

2013-05-01

The sale of over-the-counter (OTC) medicines from community pharmacies offers important opportunities for members of the public to access medicines and self-treat conditions. They are increasingly recognised, however, as having the potential for abuse and harm despite their perceived relative safety. This study reports on a qualitative study that explored the experiences and views of community pharmacy staff in relation to current practices and concerns, management and support relating to OTC medicine abuse. Semi-structured interviews were undertaken with a purposive sample of ten pharmacists and seven medicines counter assistants in the United Kingdom. Analysis of interviews indicated that a range of medicines was implicated, including opiates, sedative antihistamines, laxatives and decongestants. A surveillance role was apparent for assistants, who placed emphasis on regulations, procedure and monitoring frequency of purchases to manage abuse, with referral on to pharmacists. Frequency of purchase was central to assistants' definition of those suspected of OTC medicine abuse, which pharmacists also utilised as well as a distinction between intentional abuse and unintentional medicine misuse. A lack of information about customers, easy access to, and poor communication between community pharmacies were emergent barriers to pharmacists providing more support. Many appeared uncertain of referral options or how pharmacists could effectively stop the problem of abuse. The commercial environment was a particular concern, in relation to customer expectations, medicine advertising and easy access to different community pharmacies. A key tension emerged between providing medicine supplies that permitted consumer freedom, with the needs of healthcare professionals to understand more about those consumers qua patients. Policy implications include the need for improved knowledge for community pharmacy staff about signposting to relevant services, increased awareness of who might be affected, and a review of how pharmacists can have more information about patients to inform OTC medicine sales. © 2013 Blackwell Publishing Ltd.

Over-the-counter medicines

MedlinePlus

... throat lozenges can be soothing. Be careful in young children because of the choking risk. ALLERGIES Antihistamine pills and liquids work well for treating allergy symptoms . Antihistamines that may ...

Cough-variant asthma: a diagnostic dilemma in the occupational setting.

PubMed

Lipińska-Ojrzanowska, A; Wiszniewska, M; Walusiak-Skorupa, J

2015-03-01

Cough-variant asthma (Corrao's syndrome) is defined as the presence of chronic non-productive cough in patients with bronchial hyperresponsiveness (BHR) and response to bronchodilator therapy. This variant of asthma may present a diagnostic problem in occupational medicine. To describe additional evaluation of cough-variant asthma in a cyanoacrylate-exposed worker in whom standard diagnostic testing was negative. A female beautician was evaluated for suspected occupational allergic rhinitis and asthma. A specific inhalation challenge test (SICT) was performed with cyanoacrylate glues used for applying artificial eyelashes and nails. Spirometry and peak expiratory flow (PEF) measurements were recorded hourly for 24h; methacholine challenge testing was performed and nasal lavage (NL) samples were analysed for eosinophilia. After SICT, the patient developed sneezing, nasal airflow obstruction and cough. Declines in forced expiratory volume in 1 s and PEF were not observed. Eosinophil proportions in NL fluid increased markedly at 4 and 24h after SICT. A significant increase in BHR also occurred 24h after SICT. Clinical symptoms, post-challenge BHR and increased NL eosinophil counts confirmed a positive response to SICT and validated the diagnosis of cough-variant occupational asthma. SICT may be useful in cases where history and clinical data suggest cough-variant asthma and spirometric indices are negative. © The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

efficacy of dry extract of ivy leaves in the treatment of productive cough.

PubMed

Schönknecht, Karina; Fal, Andrzej M; Mastalerz-Migas, Agnieszka; Joachimiak, Monika; Doniec, Zbigniew

Introduction: Coughing is a physiological, spontaneous defense mechanism against irritants that stimulate respiratory mucosa. Productive cough should be not suppressed; instead, mucus-dissolving agents are recommended. One of the expectorants, which increases the excretion volume, is the herbal medicine derived from ivy leaves. The ivy extract contains triterpene saponins, which have secretory properties. The aim of this study was to determine the effectiveness and safety of the treatment with the medicinal product Hedussin®, containing dry ivy extract, in the therapy of productive cough in the course of the respiratory tract infection. Material and methods:This was a non-randomized, non-interventional, multicenter, open-label, post-authorization effectiveness study (PAES). The study group consisted of 464 patients aged 2-12 years with productive cough. The study was supported by a questionnaire that included: the type of cough etiological factor, Bronchitis Severity Score (BSS), temperature, and prescription of antibiotic therapy. Effectiveness and safety of the therapy with Hedussin® was assessed at the follow-up visit. Results and conclusion: Improvement in cough was reported in 93.3% subjects; improvement in chest pain on coughing was reported in 84.7%, in wheezing - in 90.0%, in dyspnoea - in 88.7%, and in auscultation changes - in 94.8%. In addition, decline or normalization of body temperature was found in 96.0% of subjects. No adverse drug reactions were reported in the study population. The non-antibiotic treated group showed similar proportions. The results of this study support the efficacy of Hedussin® prescribed for the treatment of productive cough in the course of respiratory tract infections. Hedussin® was well tolerated by sick children aged 2-12 years.

Pleurisy

MedlinePlus

... Kids and Teens Pregnancy and Childbirth Women Men Seniors Your Health Resources Healthcare Management End-of-Life ... influenza, older adults, Over-the-Counter Medicines, pneumonia, senior, treatment January 23, 2017 Copyright © American Academy of ...

Medications for Arrhythmia

MedlinePlus

... including over-the-counter medications and vitamins (and holistic type supplements). Many rhythm disorders, especially tachycardias, respond ... child about this before the doctor visit. Medicine Management What is compliance? Compliance simply means following the ...

Community pharmacists' perceptions about pharmaceutical care of OTC western medicine: a survey in Harbin of China.

PubMed

Song, Menghuan; Ung, Carolina Oi Lam; Hu, Hao; Wang, Yitao

2015-12-01

In China, increasingly OTC-western medicine is obtained at the community pharmacy. It is unknown which care the community pharmacists in China provides with such medicines. This study investigated community pharmacists' attitude, practice and perceived barriers about pharmaceutical care of over-the-counter western medicine. Moreover, community pharmacists' suggestions of improvement measures were also collected. Questionnaire survey targeting community pharmacist. Respondents generally showed positive attitude towards pharmaceutical care. About 30 % of the respondents reported that they provided pharmaceutical care "whenever necessary", while about 40 % did it "as frequent as possible" or "to all consumers". Respondents considered "ambiguity of the professional role of pharmacists" (50.7 %), "Lack of scientific evidence of over-the-counter western medicine" (42.9), and "Lack of time" (40.0 %) as the main barriers. The 3 most important improvement measures suggested were "Formulating or refining legislation to clarify the legal professional role of pharmacists with respect to western medicine" (63.2 %), "Promoting public education of pharmacist role" (50.7 %), and "Formulating or refining the standards of pharmacists' practice with respect to western medicine" (50.7 %). Community pharmacists in Harbin of China have a relatively positive attitude and intention to provide pharmaceutical care of OTC western medicine. However, lack of professional role definition, limited pharmaceutical knowledge and lack of human and financial resources limited the provision of pharmaceutical care by community pharmacists.

Hydrocodone and acetaminophen overdose

MedlinePlus

... medlineplus.gov/ency/article/002670.htm Hydrocodone and acetaminophen overdose To use the sharing features on this ... painkiller in the opioid family (related to morphine). Acetaminophen is an over-the-counter medicine used to ...

Medicines, injections, and supplements for arthritis

MedlinePlus

The body naturally makes both glucosamine and chondroitin sulfate. They are important for healthy cartilage in your joints. These two substances come in supplement form and can be bought over-the-counter. ...

Mouth sores

MedlinePlus

... gel (Lidex), anti-inflammatory amlexanox paste (Aphthasol), or chlorhexidine gluconate (Peridex) mouthwash. Over-the-counter medicines, such as ... Aphthasol). A special type of mouthwash such as chlorhexidine gluconate (such as Peridex). Alternative Names Aphthous stomatitis; Herpes ...

Role of guaifenesin in the management of chronic bronchitis and upper respiratory tract infections.

PubMed

Albrecht, Helmut H; Dicpinigaitis, Peter V; Guenin, Eric P

2017-01-01

Guaifenesin, a mucoactive drug, acts by loosening mucus in the airways and making coughs more productive. It is used for relief of wet cough and chest congestion due to the common cold, and remains the only legally marketed expectorant in the US (per OTC Monograph). An ingredient in numerous over-the-counter (OTC) cough/cold medications, guaifenesin has a secondary indication for use in stable chronic bronchitis (professional indication). Clinical pharmacology and patient studies support the clinical utility of guaifenesin in respiratory conditions where mucus hypersecretion is prevalent: acute upper respiratory tract infections (URTIs), stable chronic bronchitis, and possibly rhinosinusitis. Guaifenesin has a well-established and favorable safety and tolerability profile in adult and pediatric populations. Its dosing range (200-400 mg 4-hourly, up to 6× daily) allows flexible dose titration to allow an increase of plasma concentrations. Multiple daily doses are needed to maintain 24-h therapeutic effect with immediate-release formulations. Extended-release guaifenesin tablet formulations are available, providing convenience with 12-hourly dosing and portability compared to liquids. Guaifenesin is considered as a safe and effective expectorant for the treatment of mucus-related symptoms in acute URTIs and stable chronic bronchitis. Its clinical efficacy has been demonstrated most widely in chronic respiratory conditions, where excess mucus production and cough are more stable symptoms. Progress is being made to establish clinical models and measures that are more appropriate for studying symptomatic relief with guaifenesin in acute respiratory infections. This will help generate the up-to-date and high-quality data needed to optimize guaifenesin's effectiveness in established uses, and in new respiratory indications associated with mucus hypersecretion.

Rhinovirus Infections

MedlinePlus

... doctor. These over-the-counter medicines do not kill the virus and, in most circumstances, do not help with the symptoms. When to Call Your Pediatrician If your infant is 3 months or younger and develops cold ...

Trimethoprim

MedlinePlus

... a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each ...

Clostridium difficile Infection

MedlinePlus

... These drugs can make your infection worse. Certain probiotics, or “good bacteria,” may help prevent repeat C. ... Your Doctor Drugs, Procedures & Devices Over-the-counter Products Procedures & Devices Prescription Medicines Health Tools Dictionary Symptom ...

OTC Medicines and Pregnancy

MedlinePlus

... Infants and Toddlers Kids and Teens Pregnancy and Childbirth Women Men Seniors Your Health Resources Healthcare Management ... Family Health, Over-the-counter Products, Pregnancy and Childbirth, Your Health ResourcesTags: breastfeeding, Drug Safety, female, Obstetrical, ...

Eldercare at Home: Vision Problems

MedlinePlus

... Contact Aging & Health A to Z Find a Geriatrics Healthcare Professional Medications & Older Adults Making Your Wishes ... including over-the-counter medicines, herbal, and alternative therapies. They may be able to suggest other safer ...

Foods to Avoid or Limit during Pregnancy

MedlinePlus

... you’re buying a cup of coffee or tea. Instead of drinking regular coffee, try coffee that's ... amount of caffeine). Caffeine is also found in tea, chocolate, soda and some over-the-counter medicine. ...

Coughing frequency in patients with persistent cough: assessment using a 24 hour ambulatory recorder.

PubMed

Hsu, J Y; Stone, R A; Logan-Sinclair, R B; Worsdell, M; Busst, C M; Chung, K F

1994-07-01

Cough is an important symptom of many respiratory disorders. We determined the frequency and diurnal variation of cough in normal subjects and in patients with asthma or with persistent cough of unknown cause. We used a portable, solid-state, multiple-channel recorder to record cough sounds over a 24 h period. The audio-signal was recorded from a unidirectional microphone strapped over the chest wall, and electromyographic (EMG) signals from the lower respiratory muscles were simultaneously registered with surface electrodes. The recorded digital data were examined on an IBM-compatible computer, and the typical signals induced by cough (as assessed by voluntary or experimentally-induced cough) were counted. In 12 normal subjects, only 0-16 coughs were recorded over 24 h. In 21 stable asthmatics with a history of chronic cough ("asthma") the median number was 282 (ranges: 45-1,577), and in 14 patients with the predominant symptom of daily dry coughs ("chronic coughers") the median number was 794 (64-3,639). In both groups of patients, there was a diurnal variation of coughs, such that the least numbers occurred between 2 and 5 a.m. (< 3% of total). In the asthma group, there was no significant correlation between forced expiratory volume in one second (FEV1) (% predicted) or diurnal variation of peak expiratory flow and cough frequency. In the chronic coughers, there was a significant correlation between daytime cough numbers and daytime cough symptoms scores but not for the night-time values. Our data show that cough frequency is not determined by the severity of asthma in relatively stable asthmatics on inhaled steroids, and is reduced during sleep in both asthmatics and chronic cough patients. This portable cough recorder may be useful in the assessment of drug therapy for chronic cough.

Receipt and use of spoken and written over-the-counter medicine information: insights into Australian and UK consumers' experiences.

PubMed

Tong, Vivien; Raynor, David K; Aslani, Parisa

2018-04-01

To explore Australian and UK consumers' receipt and use of spoken and written medicine information and examine the role of leaflets for consumers of over-the-counter (OTC) medicines. Semistructured interviews were conducted with 37 Australian and 39 UK consumers to explore information received with their most recent OTC medicine purchase, and how information was used at different times post-purchase. Interviews were audio-recorded, transcribed verbatim and thematically analysed. Similarities were evident between the key themes identified from Australian and UK consumers' experiences. Consumers infrequently sought spoken information and reported that pharmacy staff provided minimal spoken information for OTC medicines. Leaflets were not always received or wanted and had a less salient role as an information source for repeat OTC purchases. Consumers tended not to read OTC labels or leaflets. Product familiarity led to consumers tending not to seek information on labels or leaflets. When labels were consulted, directions for use were commonly read. However, OTC medicine information in general was infrequently revisited. As familiarity is not an infallible proxy for safe and effective medication use, strategies to promote the value and use of these OTC medicine information sources are important and needed. Minimal spoken information provision coupled with limited written information use may adversely impact medication safety in self-management. © 2017 Royal Pharmaceutical Society.

76 FR 44475 - Labeling for Bronchodilators To Treat Asthma; Cold, Cough, Allergy, Bronchodilator, and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-26

...'' section. This proposed section lists specific criteria consumers can use to identify when to seek...- Counter Human Use AGENCY: Food and Drug Administration, HHS. ACTION: Final rule. SUMMARY: The Food and... consumers better understand how to use these products and when it is appropriate to seek treatment from a...

Honey for acute cough in children.

PubMed

Oduwole, Olabisi; Udoh, Ekong E; Oyo-Ita, Angela; Meremikwu, Martin M

2018-04-10

Cough causes concern for parents and is a major cause of outpatient visits. Cough can impact quality of life, cause anxiety, and affect sleep in children and their parents. Honey has been used to alleviate cough symptoms. This is an update of reviews previously published in 2014, 2012, and 2010. To evaluate the effectiveness of honey for acute cough in children in ambulatory settings. We searched CENTRAL (2018, Issue 2), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (2014 to 8 February 2018), Embase (2014 to 8 February 2018), CINAHL (2014 to 8 February 2018), EBSCO (2014 to 8 February 2018), Web of Science (2014 to 8 February 2018), and LILACS (2014 to 8 February 2018). We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trial Registry Platform (WHO ICTRP) on 12 February 2018. The 2014 review included searches of AMED and CAB Abstracts, but these were not searched for this update due to lack of institutional access. Randomised controlled trials comparing honey alone, or in combination with antibiotics, versus no treatment, placebo, honey-based cough syrup, or other over-the-counter cough medications for children aged 12 months to 18 years for acute cough in ambulatory settings. We used standard methodological procedures expected by Cochrane. We included six randomised controlled trials involving 899 children; we added three studies (331 children) in this update.We assessed two studies as at high risk of performance and detection bias; three studies as at unclear risk of attrition bias; and three studies as at unclear risk of other bias.Studies compared honey with dextromethorphan, diphenhydramine, salbutamol, bromelin (an enzyme from the Bromeliaceae (pineapple) family), no treatment, and placebo. Five studies used 7-point Likert scales to measure symptomatic relief of cough; one used an unclear 5-point scale. In all studies, low score indicated better cough symptom relief.Using a 7-point Likert scale, honey probably reduces cough frequency better than no treatment or placebo (no treatment: mean difference (MD) -1.05, 95% confidence interval (CI) -1.48 to -0.62; I² = 0%; 2 studies; 154 children; moderate-certainty evidence; placebo: MD -1.62, 95% CI -3.02 to -0.22; I² = 0%; 2 studies; 402 children; moderate-certainty evidence). Honey may have a similar effect as dextromethorphan in reducing cough frequency (MD -0.07, 95% CI -1.07 to 0.94; I² = 87%; 2 studies; 149 children; low-certainty evidence). Honey may be better than diphenhydramine in reducing cough frequency (MD -0.57, 95% CI -0.90 to -0.24; 1 study; 80 children; low-certainty evidence).Giving honey for up to three days is probably more effective in relieving cough symptoms compared with placebo or salbutamol. Beyond three days honey probably had no advantage over salbutamol or placebo in reducing cough severity, bothersome cough, and impact of cough on sleep for parents and children (moderate-certainty evidence). With a 5-point cough scale, there was probably little or no difference between the effects of honey and bromelin mixed with honey in reducing cough frequency and severity.Adverse events included nervousness, insomnia, and hyperactivity, experienced by seven children (9.3%) treated with honey and two children (2.7%) treated with dextromethorphan (risk ratio (RR) 2.94, 95% Cl 0.74 to 11.71; I² = 0%; 2 studies; 149 children; low-certainty evidence). Three children (7.5%) in the diphenhydramine group experienced somnolence (RR 0.14, 95% Cl 0.01 to 2.68; 1 study; 80 children; low-certainty evidence). When honey was compared with placebo, 34 children (12%) in the honey group and 13 (11%) in the placebo group complained of gastrointestinal symptoms (RR 1.91, 95% CI 1.12 to 3.24; I² = 0%; 2 studies; 402 children; moderate-certainty evidence). Four children who received salbutamol had rashes compared to one child in the honey group (RR 0.19, 95% CI 0.02 to 1.63; 1 study; 100 children; moderate-certainty evidence). No adverse events were reported in the no-treatment group. Honey probably relieves cough symptoms to a greater extent than no treatment, diphenhydramine, and placebo, but may make little or no difference compared to dextromethorphan. Honey probably reduces cough duration better than placebo and salbutamol. There was no strong evidence for or against using honey. Most of the children received treatment for one night, which is a limitation to the results of this review. There was no difference in occurrence of adverse events between the honey and control arms.

The Resolution of Ibuprofen, 2-(4'-Isobutylphenyl) Propionic Acid

ERIC Educational Resources Information Center

McCullagh, James V.

2008-01-01

In this experiment the over-the-counter pain reliever ibuprofen is resolved using (S)-(-)-[alpha]-phenethylamine as the resolving agent. This procedure has several key advantages over previous resolution experiments. First, it involves the resolution of a well-known medicinal compound of commercial importance. Second, the resolution process is…

Antibiotics: When They Can and Can't Help

MedlinePlus

... bacteria and yeasts) found in your intestines. Similar probiotics are available in some foods and…How to ... Your Doctor Drugs, Procedures & Devices Over-the-counter Products Procedures & Devices Prescription Medicines Health Tools Dictionary Symptom ...

The description of cough sounds by healthcare professionals

PubMed Central

Smith, Jaclyn A; Ashurst, H Louise; Jack, Sandy; Woodcock, Ashley A; Earis, John E

2006-01-01

Background Little is known of the language healthcare professionals use to describe cough sounds. We aimed to examine how they describe cough sounds and to assess whether these descriptions suggested they appreciate the basic sound qualities (as assessed by acoustic analysis) and the underlying diagnosis of the patient coughing. Methods 53 health professionals from two large respiratory tertiary referral centres were recruited; 22 doctors and 31 staff from professions allied to medicine. Participants listened to 9 sequences of spontaneous cough sounds from common respiratory diseases. For each cough they selected patient gender, the most appropriate descriptors and a diagnosis. Cluster analysis was performed to assess which cough sounds attracted similar descriptions. Results Gender was correctly identified in 93% of cases. The presence or absence of mucus was correct in 76.1% and wheeze in 39.3% of cases. However, identifying clinical diagnosis from cough was poor at 34.0%. Cluster analysis showed coughs with the same acoustics properties rather than the same diagnoses attracted the same descriptions. Conclusion These results suggest that healthcare professionals can recognise some of the qualities of cough sounds but are poor at making diagnoses from them. It remains to be seen whether in the future cough sound acoustics will provide useful clinical information and whether their study will lead to the development of useful new outcome measures in cough monitoring. PMID:16436200

Measurement of Cough Aerodynamics in Healthy Adults.

PubMed

Feinstein, Aaron J; Zhang, Zhaoyan; Chhetri, Dinesh K; Long, Jennifer

2017-05-01

Cough is a critical human reflex and also among the most frequent symptoms in medicine. Despite the prevalence of disordered cough in laryngeal pathologies, comprehensive and quantitative evaluation of cough in these patients is lacking. Herein we seek to establish normative values for cough aerodynamics to provide a population standard for reference in future studies. Healthy subjects were recruited from an outpatient clinic to perform voluntary cough. Subjects were instructed on the technique for maximal voluntary cough production with measurements recorded on pneumotachograph. Fifty-two subjects were studied, including 29 women and 23 men with a mean age of 51.6 and 52.3 years, respectively. Main Outcomes and Measures: Cough peak airflow, peak pressure, and expiratory rise time. Results were stratified by age, gender, and height. Peak airflow demonstrated significant differences across age, gender, and height, with flow increasing according to increasing height. Peak cough pressure also increased with height and was significantly greater in males versus females. Expiratory rise time, the time from glottal opening to peak airflow, did not vary with age or height but was statistically significantly longer in women. Cough aerodynamics can be readily measured objectively in the outpatient setting. Expiratory rise time, peak flow, and peak pressure are important aspects of each cough epoch. Normative data provided herein can be used for future studies of patients with laryngotracheal disorders, and these cough parameters may prove to be simple, accessible, and repeatable outcome measures.

Treatment of Pediculosis Capitis

PubMed Central

Verma, Prashant; Namdeo, Chaitanya

2015-01-01

An endeavour to delineate the salient details of the treatment of head lice infestation has been made in the present article. Treatment modalities including over the counter permethrin and pyrethrin, and prescription medicines, including malathion, lindane, benzyl alcohol, spinosad are discussed. Salient features of alternative medicine and physical treatment modalities are outlined. The problem of resistance to treatment has also been taken cognizance of. PMID:26120148

Home Medication Cabinets and Medication Taking Behavior of the Staffs in a University in China

NASA Astrophysics Data System (ADS)

Xue, Chengbin; Ye, Juan; Dong, Yuzhen; Xu, Chunmei

2018-01-01

Background: A growing sum of medicines is stored in home medication cabinets in China, with the behavior of self-medication increasing. Although responsible self-medication can help prevent and treat ailments that do not need professional consultation, it bears the risk of misuse of medicines issued on prescription due to inadequate prescription medicine administration. Objective: The objective of this study was to investigate the condition and safety of medication storage and intended self-medication in a University in China. Method: The study was conducted over 10 month period (May 2015-March 2016) and involved a random sample of households. The questionnaire survey and personal insight into household medicine supplies was performed by a team of trained pharmacy staffs. Interviewees (N = 398, aged 16-88 y) were visited door to door and the home medication cabinets were catalogued after the participants were interviewed. Results: The majority (89.71%) households have home medicine cabinets. The total number of medicine items in the 398 households was 5600, with a median of 14 per household. The most frequently encountered categories of registered medicines were cough and cold medcines (47.8%), antibacterials for systemic use (30.0%), topical products for joint and muscular pain(26.1%), vitamins (23.2%), medication for functional gastrointestinal disorders (23.2%), oral and external forms have not kept separately(55.1%). The most treatment related problems recorded were curative effect not ideal (57.9%). 68% of the sample population would choose doctors as medication consultation object about medicines purchased. Conclusion: Large sum of medicines were found per household, with a high prevalence of cough and cold medcines. Public services in China, mainly government and health organizations, need put more effort on educating people on how to store medicines, as well as finding a way to raise awareness of the public in promoting behavioral change about medication use.

Honey for acute cough in children.

PubMed

Oduwole, Olabisi; Meremikwu, Martin M; Oyo-Ita, Angela; Udoh, Ekong E

2014-12-23

Cough causes concern for parents and is a major cause of outpatient visits. It can impact on quality of life, cause anxiety and affect sleep in parents and children. Several remedies, including honey, have been used to alleviate cough symptoms. To evaluate the effectiveness of honey for acute cough in children in ambulatory settings. We searched CENTRAL (2014, Issue 10), MEDLINE (1950 to October week 4, 2014), EMBASE (1990 to November 2014), CINAHL (1981 to November 2014), Web of Science (2000 to November 2014), AMED (1985 to November 2014), LILACS (1982 to November 2014) and CAB abstracts (2009 to January 2014). Randomised controlled trials (RCTs) comparing honey given alone, or in combination with antibiotics, versus nothing, placebo or other over-the-counter (OTC) cough medications to participants aged from one to 18 years for acute cough in ambulatory settings. Two review authors independently screened search results for eligible studies and extracted data on reported outcomes. We included three RCTs, two at high risk of bias and one at low risk of bias, involving 568 children. The studies compared honey with dextromethorphan, diphenhydramine, 'no treatment' and placebo for the effect on symptomatic relief of cough using a seven-point Likert scale. The lower the score, the better the cough symptom being assessed.Moderate quality evidence showed that honey may be better than 'no treatment' in reducing the frequency of cough (mean difference (MD) -1.05; 95% confidence interval (CI) -1.48 to -0.62; I(2) statistic 23%; two studies, 154 participants). High quality evidence also suggests that honey may be better than placebo for reduction of cough frequency (MD -1.85; 95% Cl -3.36 to -0.33; one study, 300 participants). Moderate quality evidence suggests that honey does not differ significantly from dextromethorphan in reducing cough frequency (MD -0.07; 95% CI -1.07 to 0.94; two studies, 149 participants). Low quality evidence suggests that honey may be slightly better than diphenhydramine in reducing cough frequency (MD -0.57; 95% CI -0.90 to -0.24; one study, 80 participants).Adverse events included mild reactions (nervousness, insomnia and hyperactivity) experienced by seven children (9.3%) from the honey group and two (2.7%) from the dextromethorphan group; the difference was not significant (risk ratio (RR) 2.94; 95% Cl 0.74 to 11.71; two studies, 149 participants). Three children (7.5%) in the diphenhydramine group experienced somnolence (RR 0.14; 95% Cl 0.01 to 2.68; one study, 80 participants). When honey was compared with placebo, four children (1.8%) in the honey group and one (1.3%) from the placebo group complained of gastrointestinal symptoms (RR 1.33; 95% Cl 0.15 to 11.74). However, there was no significant difference between honey versus dextromethorphan, honey versus diphenhydramine or honey versus placebo. No adverse event was reported in the 'no treatment' group. Honey may be better than 'no treatment', diphenhydramine and placebo for the symptomatic relief of cough, but it is not better than dextromethorphan. None of the included studies assessed the effect of honey on 'cough duration' because intervention and follow-up were for one night only. There is no strong evidence for or against the use of honey.

Testing of Candidate Icons to Identify Acetaminophen-Containing Medicines

PubMed Central

Shiffman, Saul; Cotton, Helene; Jessurun, Christina; Sembower, Mark A.; Pype, Steve; Phillips, Jerry

2016-01-01

Adding icons on labels of acetaminophen-containing medicines could help users identify the active ingredient and avoid concomitant use of multiple medicines containing acetaminophen. We evaluated five icons for communication effectiveness. Adults (n = 300) were randomized to view a prescription container label or over-the-counter labels with either one or two icons. Participants saw two icon candidates, and reported their interpretation; experts judged whether these reflected critical confusions that might cause harm. Participants rated how effectively each icon communicated key messages. Icons based on abbreviations of “acetaminophen” (“Ac”, “Ace”, “Acm”) were rated less confusing and more effective in communicating the active ingredient than icons based on “APAP” or an abstract symbol. Icons did not result in critical confusion when seen on a readable medicine label. Icon implementation on prescription labels was more effective at communicating the warning against concomitant use than implementation on over-the-counter (OTC) labels. Adding an icon to a second location on OTC labels did not consistently enhance this communication, but reduced rated effectiveness of acetaminophen ingredient communication among participants with limited health literacy. The abbreviation-based icons seem most suitable for labeling acetaminophen-containing medications to enable users to identify acetaminophen-containing products. PMID:28970383

Military Interoperable Digital Hospital Testbed (MIDHT)

DTIC Science & Technology

2013-01-01

users of the PACS system in terms of viewing images originating from Miners and Meyersdale are Emergency Medicine and Trauma physicians. This...conditions, over the counter/ herbal medications, physician list, and emergency contacts. Through secure messaging with their physician, patients...et al. (1999). Impact of a patient-centered, computer- based health information/support system. American Journal of Preventive Medicine , 16(1), 1- 9

Have a Baby or Young Child With a Cold? Most Don't Need Medicines

MedlinePlus

... With a Cough or Cold Don't Need Medicines Share Tweet Linkedin Pin it More sharing options ... the correct dose. Giving the Right Dose of Medicine “It’s easy to make errors with liquid medications. ...

MedlinePlus Marks 15th Anniversary | NIH MedlinePlus the Magazine

MedlinePlus

... of people across the country and around the world. It now includes: More than 950 pages providing links to reliable consumer information on important health issues Information on prescription and over-the-counter medicines, ...

Recreational use of dextromethorphan, "Robotripping"-A brief review.

PubMed

Stanciu, Cornel N; Penders, Thomas M; Rouse, Eden M

2016-08-01

Dextromethorphan (DXM) in combination with antihistamines and/or pseudoephedrine is widely available as an over-the counter remedy commonly used for relief of colds and cough. In supra-therapeutic amounts, DXM has psychoactive effects. These cough preparations have been adopted by many young users of recreational drugs for these effects. This paper aims to highlight the increasingly prevalent practice of Robotripping, review pharmacokinetic and dynamic data and discuss potential tolerance and withdrawal from the substance as well as treatment modalities. A Medline search (1985-2015) for literature concerning the DXM was conducted. This was supplemented by references gleaned from recent epidemiological surveys and credible online sources to ensure most up to date information is gathered. Use in amounts exceeding those recommended, a practice known as "Robotripping", may result in a toxidrome of psychomotor agitation, hallucinations and paranoia best characterized as Intoxication Delirium. Increasing misuse places greater numbers at risk. Providers should be alert to such presentations and be aware of methods for managing the symptoms. With chronic use, tolerance and withdrawal has been noted along with prolonging psychiatric sequelae. (Am J Addict 2016;25:374-377). © 2016 American Academy of Addiction Psychiatry.

Rehabilitation of Swallowing and Cough Functions Following Stroke: An Expiratory Muscle Strength Training Trial.

PubMed

Hegland, Karen Wheeler; Davenport, Paul W; Brandimore, Alexandra E; Singletary, Floris F; Troche, Michelle S

2016-08-01

To determine the effect of expiratory muscle strength training (EMST) on both cough and swallow function in stroke patients. Prospective pre-post intervention trial with 1 participant group. Two outpatient rehabilitation clinics. Adults (N=14) with a history of ischemic stroke in the preceding 3 to 24 months. EMST. The training program was completed at home and consisted of 25 repetitions per day, 5 days per week, for 5 weeks. Baseline and posttraining measures were maximum expiratory pressure, voluntary cough airflows, reflex cough challenge to 200μmol/L of capsaicin, sensory perception of urge to cough, and fluoroscopic swallow evaluation. Repeated measures and 1-way analyses of variance were used to determine significant differences pre- and posttraining. Maximum expiratory pressure increased in all participants by an average of 30cmH2O posttraining. At baseline, all participants demonstrated a blunted reflex cough response to 200μmol/L of capsaicin. After 5 weeks of training, measures of urge to cough and cough effectiveness increased for reflex cough; however, voluntary cough effectiveness did not increase. Swallow function was minimally impaired at baseline, and there were no significant changes in the measures of swallow function posttraining. EMST improves expiratory muscle strength, reflex cough strength, and urge to cough. Voluntary cough and swallow measures were not significantly different posttraining. It may be that stroke patients benefit from the training for upregulation of reflex cough and thus improved airway protection. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Achoo! Cold, Flu, or Something Else? | NIH MedlinePlus the Magazine

MedlinePlus

... Flu, or Something Else? Follow us Achoo! Cold, Flu, or Something Else? Photo: iStock Winter and early ... over-the-counter medicines to ease symptoms. Seasonal Flu Symptoms usually last one to two weeks. Include ...

[Over the counter drugs--a new era in Israel].

PubMed

Abadi-Korek, Ifat; Vaknin, Sharona; Marom, Eli; Shemer, Joshua; Luxenburg, Osnat

2011-01-01

The reformation in the marketing of non-prescription medicinal products has been launched. As of May 10th 2005, the pharmacist regulations 2004 (marketing of over-the-counter (OTC) drugs outside of pharmacies, as well as not by a pharmacist) will be in effect. This change aLlows the marketing of medicines outside of pharmacies, as has been the custom in the U.S.A., England and some of the European Union countries for many years. This reformation is incorporated in a policy that encourages self-medication by the use of non-prescription drugs. The self-medication policy originates from the point of view of the consumers who wish to be responsible for their own health and save precious time wasted on doctor visits; and the government's assumption that self-medication of OTC medicines by citizens wiLL decrease expenses for the HMOs in both doctor's billings as well as medication costs. In order to regulate the marketing terms of these medicinal products, regulations and complimentary guidelines were written and published. These documents encompass the following issues: the list of OTC medicines, marketing reguLations, packaging regulations, Licensed marketing Locations, storage regulations as well as display regulations, advertising regulations, monitoring and control. The medicinal products in this category only included medicines containing "safe" active ingredients with restrictions regarding the strength/concentration and packaging size; this category does not include medicines requiring special storage conditions (such as refrigeration or freezing), medicines containing an active ingredient that is addictive, medicines containing an active ingredient with danger of poisoning if misused, and medicines containing an active ingredient that has the potential to harm. The implementation of the regulations and guidelines will improve the consumer's ability to diagnose and treat oneself when sick with minor ailments, without consulting a doctor.

[Cough induction by high-frequency chest percussion in healthy volunteers and patients with common cold].

PubMed

Lee, P C L; Eccles, R

2004-08-01

In patients with chronic obstructive pulmonary disease, chest percussion is often used to facilitate the drainage of respiratory secretions which may be removed from the airway by coughing. The cough reflex is believed to be mediated by mechanically sensitive rapidly adapting receptors (RARs). Chest percussion stimulation may stimulate RAR cough receptors, but there is no evidence that mechanical airway stimulation in man induces cough. The aim of this study was to determine if cough can be induced by high-frequency chest percussion in healthy subjects and in patients with acute upper respiratory tract infection (URTI). Two groups were studied: 15 healthy subjects and 29 subjects with URTI, mean age 22 years. Percussion stimulation (70 Hz) was applied to the chest. Cough frequency and latency were recorded. All subjects were asked to complete a questionnaire about how they felt after the chest percussion by questionnaires. The results demonstrate that high-frequency chest percussion causes cough in human subjects with a recent history of URTI, but induces relatively little cough in healthy subjects. In URTI subjects there was a significant increase in the number of coughs after three periods of airway vibration, whereas in healthy subjects there was no change in cough. Furthermore, analysis of the questionnaires showed that more of the subjects with URTI felt an urge to cough compared to the healthy subjects in the subjective questionnaires. This study demonstrates that cough can be induced in subjects with URTI by chest percussion. This method of inducing cough in subjects with URTI may be useful for studies on the mechanism of cough and for studies on antitussive medicines.

Possible mechanisms of dose-dependent cough suppressive effect of Althaea officinalis rhamnogalacturonan in guinea pigs test system.

PubMed

Sutovská, M; Nosálová, G; Sutovský, J; Franová, S; Prisenznáková, L; Capek, P

2009-07-01

The rhamnogalacturonan, isolated from the roots of medicinal plant Althaea officinalis L., showed various biological effects on the citric acid-induced cough reflex and reactivity of airways smooth muscle in vitro and in vivo conditions. It possessed dose-dependent cough suppression effect comparable with opioid agonist codeine. However, reactivity of the airways smooth muscle, measured in vitro as well as in vivo conditions was not significantly affected by rhamnogalacturonan and thus bronchodilatory activity did not participate in the cough suppression effect of polysaccharide tested. Moreover, the cough suppression effect of the polymer was not significantly modified by pretreatment of K(+)(ATP) ion channels with selective antagonist and therefore activation of this type of ion channels is not involved in the mechanism of rhamnogalacturonan cough suppressive ability. On the contrary, pretreatment of animals with selective 5-HT(2) receptors antagonist significantly decreased rhamnogalacturonan antitussive efficacy. From this point of view it seems that the cough suppression effect of the polymer is associated with the serotonergic 5-HT(2) receptor's function.

Association of over-the-counter pharmaceutical sales with influenza-like-illnesses to patient volume in an urgent care setting.

PubMed

Liu, Timothy Y; Sanders, Jason L; Tsui, Fu-Chiang; Espino, Jeremy U; Dato, Virginia M; Suyama, Joe

2013-01-01

We studied the association between OTC pharmaceutical sales and volume of patients with influenza-like-illnesses (ILI) at an urgent care center over one year. OTC pharmaceutical sales explain 36% of the variance in the patient volume, and each standard deviation increase is associated with 4.7 more patient visits to the urgent care center (p<0.0001). Cross-correlation function analysis demonstrated that OTC pharmaceutical sales are significantly associated with patient volume during non-flu season (p<0.0001), but only the sales of cough and cold (p<0.0001) and thermometer (p<0.0001) categories were significant during flu season with a lag of two and one days, respectively. Our study is the first study to demonstrate and measure the relationship between OTC pharmaceutical sales and urgent care center patient volume, and presents strong evidence that OTC sales predict urgent care center patient volume year round.

Cough induced by mechanical stimulation of the upper airway in humans.

PubMed

Lee, Patrick; Eccles, Ronald

2004-08-01

Cough has previously been induced in animals by means of mechanical stimulation of the upper airway but this method has not previously been applied to humans. The aims of this study were to determine if cough could be induced in humans on mechanical stimulation of the upper airway and to see if this mechanically induced cough was reproducible. We also wished to investigate if there was any difference in cough sensitivity between healthy subjects and those with acute upper respiratory tract infection (URTI). In the first investigation, 2 groups were studied: 15 healthy subjects and 30 subjects with URTI with a mean age of 20 years. Cough was induced by vibration of the airway at the level of the trachea using a modified men's shaver. In the second investigation to determine the reproducibility of this mechanically induced cough, two groups from a different population were studied: 15 healthy subjects and 29 subjects with URTI with a mean age of 20.3 years. Cough was induced by airway vibration before and after a 90-min rest period. In the first investigation it was demonstrated that cough can be induced within 2 s of vibration; subjects with URTI are more sensitive to cough induction and cough approximately five times more than healthy subjects; cough increases with repeated stimulation and reaches a maximum after three periods of vibration; the cough response may be mediated by rapidly adapting airway sensory receptors. In the second investigation there was no significant difference in mean cough counts before and after a 90-min rest period in both groups, which demonstrates that the mechanically induced cough is reproducible. This is the first study to elicit cough in humans by mechanical stimulation of the upper airway. This new method of inducing cough in subjects with URTI may be useful for studying both the mechanism of cough and the effects of antitussive medicines.

Colds and the Flu

MedlinePlus

... bulb syringe to suction mucus out of your baby or child’s nose. What over-the-counter medicines can I ... Well-Being Mental Health Sex and Birth Control Sex and Sexuality Birth Control Family Health Infants and Toddlers Kids and Teens Pregnancy and Childbirth ...

Pain Medicines (Analgesics)

MedlinePlus

... take? Nonsteroidal anti-inflammatory drugs (NSAIDs) are a specific group of pain relievers. Some NSAIDs are available over the counter. This includes different brands of ibuprofen, naproxen sodium and ketoprofen. NSAIDs are usually safe for occasional use when taken as directed, but if you have ...

Homeopathic Medications as Clinical Alternatives for Symptomatic Care of Acute Otitis Media and Upper Respiratory Infections in Children

PubMed Central

Boyer, Nancy N

2013-01-01

The public health and individual risks of inappropriate antibiotic prescribing and conventional over-the-counter symptomatic drugs in pediatric treatment of acute otitis media (AOM) and upper respiratory infections (URIs) are significant. Clinical research suggests that over-the-counter homeopathic medicines offer pragmatic treatment alternatives to conventional drugs for symptom relief in children with uncomplicated AOM or URIs. Homeopathy is a controversial but demonstrably safe and effective 200-year-old whole system of complementary and alternative medicine used worldwide. Numerous clinical studies demonstrate that homeopathy accelerates early symptom relief in acute illnesses at much lower risk than conventional drug approaches. Evidence-based advantages for homeopathy include lower antibiotic fill rates during watchful waiting in otitis media, fewer and less serious side effects, absence of drug-drug interactions, and reduced parental sick leave from work. Emerging evidence from basic and preclinical science research counter the skeptics' claims that homeopathic remedies are biologically inert placebos. Consumers already accept and use homeopathic medicines for self care, as evidenced by annual US consumer expenditures of $2.9 billion on homeopathic remedies. Homeopathy appears equivalent to and safer than conventional standard care in comparative effectiveness trials, but additional well-designed efficacy trials are indicated. Nonetheless, the existing research evidence on safety supports pragmatic use of homeopathy in order to “first do no harm” in the early symptom management of otherwise uncomplicated AOM and URIs in children. PMID:24381823

Homeopathic medications as clinical alternatives for symptomatic care of acute otitis media and upper respiratory infections in children.

PubMed

Bell, Iris R; Boyer, Nancy N

2013-01-01

The public health and individual risks of inappropriate antibiotic prescribing and conventional over-the-counter symptomatic drugs in pediatric treatment of acute otitis media (AOM) and upper respiratory infections (URIs) are significant. Clinical research suggests that over-the-counter homeopathic medicines offer pragmatic treatment alternatives to conventional drugs for symptom relief in children with uncomplicated AOM or URIs. Homeopathy is a controversial but demonstrably safe and effective 200-year-old whole system of complementary and alternative medicine used worldwide. Numerous clinical studies demonstrate that homeopathy accelerates early symptom relief in acute illnesses at much lower risk than conventional drug approaches. Evidence-based advantages for homeopathy include lower antibiotic fill rates during watchful waiting in otitis media, fewer and less serious side effects, absence of drug-drug interactions, and reduced parental sick leave from work. Emerging evidence from basic and preclinical science research counter the skeptics' claims that homeopathic remedies are biologically inert placebos. Consumers already accept and use homeopathic medicines for self care, as evidenced by annual US consumer expenditures of $2.9 billion on homeopathic remedies. Homeopathy appears equivalent to and safer than conventional standard care in comparative effectiveness trials, but additional well-designed efficacy trials are indicated. Nonetheless, the existing research evidence on safety supports pragmatic use of homeopathy in order to "first do no harm" in the early symptom management of otherwise uncomplicated AOM and URIs in children.

Functional brain imaging in respiratory medicine.

PubMed

Pattinson, Kyle

2015-06-01

Discordance of clinical symptoms with markers of disease severity remains a conundrum in a variety of respiratory conditions. The breathlessness of chronic lung disease correlates poorly with spirometry, yet is a better predictor of mortality. In chronic cough, symptoms are often evident without clear physical cause. In asthma, the terms 'over perceivers' and 'under perceivers' are common parlance. In all these examples, aberrant brain mechanisms may explain the mismatch between symptoms and pathology. Functional MRI is a non-invasive method of measuring brain function. It has recently become significantly advanced enough to be useful in clinical research and to address these potential mechanisms. This article explains how FMRI works, current understanding from FMRI in breathlessness, cough and asthma and suggests possibilities for future research. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Patients' Preferences for Generic and Branded Over-the-Counter Medicines: An Adaptive Conjoint Analysis Approach.

PubMed

Halme, Merja; Linden, Kari; Kääriä, Kimmo

2009-12-01

: Despite increased use of generic medicines, little is known about either the attitudes of patients towards them or the decision-making process surrounding them. Young adults use over-the-counter (OTC) analgesics relatively often. : To assess the preferences of patients for generic and branded OTC pain medicines, to identify clusters with different preference structures, and to estimate the price elasticity of a generic alternative among university students. : Finnish university students (n = 256; students in courses at the Helsinki School of Economics) responded to an adaptive conjoint analysis (ACA) questionnaire on the choice between branded and generic OTC ibuprofen products. Product attributes of price, brand, onset time of effect, place of purchase and source of information were included in the questionnaire on the basis of the literature, a focus group and a previous pilot study. Several socioeconomic and health behavior descriptors were employed. Individual-level utility functions were estimated, preference clusters were identified, and the price elasticity of the generic medicine was assessed. : Five clusters with characteristic individual-level preferences and price elasticity but few differences in socioeconomic background were detected. Approximately half of the respondents were strongly price sensitive while the others had other preferences such as brand or an opportunity to buy the medicine at a pharmacy or to have a physician or a pharmacist as an information source. : The study provided new information on the concomitant effects of brand, price and other essential product attributes on the choice by patients between branded and generic medicines.

Developing a HER3 Vaccine to Prevent Resistance to Endocrine Therapy

DTIC Science & Technology

2014-10-01

Medicine , Duke University Amy Hobeika, PhD, Assistant Research Professor, Department of Surgery, Duke University H. Kim Lyerly, MD, Professor...Department of Surgery, Duke University William Gwin, MD, Fellow, Department of Medicine , Duke University Bruce Burnett, PhD, Director of Regulatory Affairs... herbal products, over- the-counter (OTC) drugs, vitamins, natural remedies, and alcohol that you are taking before you start the study and before

Efficacy and tolerability of a polysaccharide-resin-honey based cough syrup as compared to carbocysteine syrup for children with colds: a randomized, single-blinded, multicenter study.

PubMed

Cohen, Herman Avner; Hoshen, Moshe; Gur, Shmuel; Bahir, Arie; Laks, Yoseph; Blau, Hannah

2017-02-01

Available pediatric treatments for acute cough are limited by lack of demonstrated efficacy. The objective of this trial is to compare the effects of a polysaccharide-resin-honey based cough syrup, and carbocysteine syrups on nocturnal and daytime cough associated with childhood upper respiratory tract infections (URIs). Using a single-blind randomization design, the study recruited children from 4 general pediatric community clinics. Participants included 150 children aged 2 to 5 years with an URI, nocturnal and daytime cough and illness duration of ≤7 days. To be eligible, children had to be free of medication on the day before presentation. A survey was administered to parents on 4 consecutive days beginning from the day of presentation in clinic. Children received the study preparation on the first evening and then 3 times per day for 3 further days. Main outcome measures were cough frequency, cough severity, bothersome nature of cough, and quality of sleep for both child and parent. Both preparations were well tolerated and cough improved over the study period. After one night and on all survey days, there was a significantly better result for polysaccharide-resin-honey (P<0.05) for all the main outcome measures. The trend of improvement over the 4 days was steeper for polysaccharide-resin-honey (P<0.05) with regards to all cough parameters. Both polysaccharide-resin-honey and carbocysteine cough syrups were well tolerated in children over 2 years of age. The polysaccharide-resin-honey syrup was associated with a more rapid and greater improvement in all clinical cough symptoms measured, beginning from the first night of therapy. Both nocturnal and daytime cough improved, as did sleep quality for both children and parents.

Pharmacy student decision making in over-the-counter medicine supply: A critical incident study.

PubMed

McMillan, Sara S; Thangarajah, Thachaayini; Anderson, Claire; Kelly, Fiona

2017-09-28

Various factors influence decision making in over-the-counter (OTC) medicine consultations, yet limited studies have focused, in-depth, on the thought process of pharmacy staff. This includes pharmacy students as pharmacists-in-training. To explore the factors that influence pharmacy students' decisions in relation to OTC consultations and choice of OTC medicine/s. Semi-structured interviews using the critical incident technique were undertaken with ten pharmacy students in Australia, who also worked as part-time pharmacy staff. Nine key themes were identified to influence pharmacy student decision making in OTC consultations, including customer response, confidence and scope of practice. Product requests were reported as more challenging due to customer expectations and experiences in other pharmacies, states or countries. Although negative customer response influenced some students to supply medicines in contradiction of evidence, an overarching concern for safety meant that a medicine was only supplied if unlikely to cause harm. Students reported developing confidence in OTC decision making more from real-life practice than university training; greater confidence was identified for inquiries more frequently experienced in the pharmacy. Students perceived that customers had assumptions around support staff, and were happier to talk to students than assistants. This study further identified that OTC decision making is a complex process for pharmacy students. Additional opportunities for experiential learning within this area are suggested, such as work-based placements or in-class activities such as role-plays with simulated patients. Copyright © 2017 Elsevier Inc. All rights reserved.

The influence of evidence-based medicine training on decision-making in relation to over-the-counter medicines: a qualitative study.

PubMed

Hanna, Lezley-Anne; Hughes, Carmel

2012-12-01

To explore the role of evidence of effectiveness when making decisions about over-the-counter (OTC) medication and to ascertain whether evidence-based medicine training raised awareness in decision-making. Additionally, this work aimed to complement the findings of a previous study because all participants in this current study had received training in evidence-based medicine (unlike the previous participants). Following ethical approval and an e-mailed invitation, face-to-face, semi-structured interviews were conducted with newly registered pharmacists (who had received training in evidence-based medicine as part of their MPharm degree) to discuss the role of evidence of effectiveness with OTC medicines. Interviews were recorded and transcribed verbatim. Following transcription, all data were entered into the NVivo software package (version 8). Data were coded and analysed using a constant comparison approach. Twenty-five pharmacists (7 males and 18 females; registered for less than 4 months) were recruited and all participated in the study. Their primary focus with OTC medicines was safety; sales of products (including those that lack evidence of effectiveness) were justified provided they did no harm. Meeting patient expectation was also an important consideration and often superseded evidence. Despite knowledge of the concept, and an awareness of ethical requirements, an evidence-based approach was not routinely implemented by these pharmacists. Pharmacists did not routinely utilize evidence-based resources when making decisions about OTC medicines and some felt uncomfortable discussing the evidence-base for OTC products with patients. The evidence-based medicine training that these pharmacists received appeared to have limited influence on OTC decision-making. More work could be conducted to ensure that an evidence-based approach is routinely implemented in practice. © 2012 The Authors. IJPP © 2012 Royal Pharmaceutical Society.

Cough

MedlinePlus

... of Respiratory Medicine . 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 30. Kraft M. Approach to the patient with respiratory disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 83. Review Date 5/21/2017 ...

An ethnozoological study in the adjoining areas of Mount Abu wildlife sanctuary, India

PubMed Central

2010-01-01

Background There is evidence that human beings are familiar with use of animals for food, cloth, medicine, etc. since ancient times. Enormous work has been done on ethnobotany and traditional medicine. Like plants, animal and their products are also possessing medicinal properties that can be exploited for the benefit of human beings. In India, many ethnic communities are dispersed all over the country and these people are still totally depended on local traditional medicinal system for their health care. India is gifted with faunal and floral biodiversity, Mount Abu wildlife sanctuary is also one of them, and thus the aim of this work was to take an ethnozoological field survey among Garasiya people (main tribal group of this area) in the adjoining areas of this sanctuary. Method In order to document the ethnozoological information about animal and their products prevalent among these people in the adjoining area of Mount Abu wildlife sanctuary, a study was carried out from January, 2008 to April, 2008. Data were collected through semi-structured questionnaire and open interview with 25 (16 male and 9 female) selected Garasiya people. The name of animal and other ethnozoological information were documented. Photographs and discussion were also recorded with the help of camera and voice recorder. Result A total of 24 animal species were used in 35 different medicinal purposes including asthma, weakness, tuberculosis, cough, paralysis and blister and for other religious purposes. It has been find out that animal used by Garasiya, consist of fourteen mammals, five birds, three reptiles, one arthropods and one amphibian. The meat of Cynopterus sphinx used to relieved fever and cough has the highest FL (96%) although flesh of Sus scrofa and tooth of Elephas maximus have the lowest FL (12%). Some protected species such as Elephas maximus (elephant), Semnopithecus priam (monkey), Cervus unicolor (sambhar) were also mentioned as important medicinal resources. We also found that cough, asthma and other respiratory diseases are the most frequently cited disease, as such, a number of traditional medicine are available for the treatment. Conclusion The present work indicates that 24 animal species were being used to treat 34 various ailments in the surroundings areas of Mount Abu wildlife sanctuary. The results show that ethnozoological practices are an important alternative medicinal practice for the Garasiya people. This study also indicates the very rich ethnozoological knowledge of these people in relation to traditional medicine. So there is an urgent need to properly document to keep a record of the ethnozoological information. We hope that this information will be useful for further research in the field of ethnozoology, ethnopharmacology and conservation point of view. PMID:20144243

An ethnozoological study in the adjoining areas of Mount Abu wildlife sanctuary, India.

PubMed

Jaroli, D P; Mahawar, Madan Mohan; Vyas, Nitin

2010-02-10

There is evidence that human beings are familiar with use of animals for food, cloth, medicine, etc. since ancient times. Enormous work has been done on ethnobotany and traditional medicine. Like plants, animal and their products are also possessing medicinal properties that can be exploited for the benefit of human beings. In India, many ethnic communities are dispersed all over the country and these people are still totally depended on local traditional medicinal system for their health care. India is gifted with faunal and floral biodiversity, Mount Abu wildlife sanctuary is also one of them, and thus the aim of this work was to take an ethnozoological field survey among Garasiya people (main tribal group of this area) in the adjoining areas of this sanctuary. In order to document the ethnozoological information about animal and their products prevalent among these people in the adjoining area of Mount Abu wildlife sanctuary, a study was carried out from January, 2008 to April, 2008. Data were collected through semi-structured questionnaire and open interview with 25 (16 male and 9 female) selected Garasiya people. The name of animal and other ethnozoological information were documented. Photographs and discussion were also recorded with the help of camera and voice recorder. A total of 24 animal species were used in 35 different medicinal purposes including asthma, weakness, tuberculosis, cough, paralysis and blister and for other religious purposes. It has been find out that animal used by Garasiya, consist of fourteen mammals, five birds, three reptiles, one arthropods and one amphibian. The meat of Cynopterus sphinx used to relieved fever and cough has the highest FL (96%) although flesh of Sus scrofa and tooth of Elephas maximus have the lowest FL (12%). Some protected species such as Elephas maximus (elephant), Semnopithecus priam (monkey), Cervus unicolor (sambhar) were also mentioned as important medicinal resources. We also found that cough, asthma and other respiratory diseases are the most frequently cited disease, as such, a number of traditional medicine are available for the treatment. The present work indicates that 24 animal species were being used to treat 34 various ailments in the surroundings areas of Mount Abu wildlife sanctuary. The results show that ethnozoological practices are an important alternative medicinal practice for the Garasiya people. This study also indicates the very rich ethnozoological knowledge of these people in relation to traditional medicine. So there is an urgent need to properly document to keep a record of the ethnozoological information. We hope that this information will be useful for further research in the field of ethnozoology, ethnopharmacology and conservation point of view.

A list of nuclear medicine radionuclides and potential contaminants for operators of in-vivo counters.

PubMed

Stabin, M; Schlafke-Stelson, A

1991-09-01

Operators of in-vivo counters often encounter unusual photopeaks, some of which may be attributed to nuclear medicine radiopharmaceuticals recently received by the subject. This article lists the most common radiopharmaceuticals used in nuclear medicine, their common uses, their half-lives and principal decay energies, and the half-lives and decay energies of any contaminants or daughter products they may contain. The purpose is to help the in-vivo counter operator track down and eliminate causes of such unusual photopeaks.

Aspirin for Reducing Your Risk of Heart Attack and Stroke: Know the Facts

MedlinePlus

... the medicines (prescription and over-the-counter) and dietary supplements, including vitamins and herbals, that you use — even if only occasionally. FACT: Aspirin is a drug If you are at risk for heart attack or stroke your doctor may ...

Talking with Your Healthcare Provider | NIH MedlinePlus the Magazine

MedlinePlus

... Provider Will Want to Know About Your Pain History When did your pain start? What brings on ... your pain? Include prescription and over-the-counter drugs, as well as non-medicine ... of impending addiction or related problems. Explanations of where to find ...

Cough Suppressant and Pharmacologic Protussive Therapy

PubMed Central

Bolser, Donald C.

2011-01-01

Background Cough-suppressant therapy, previously termed nonspecific antitussive therapy, incorporates the use of pharmacologic agents with mucolytic effects and/or inhibitory effects on the cough reflex itself. The intent of this type of therapy is to reduce the frequency and/or intensity of coughing on a short-term basis. Methods Data for this review were obtained from several National Library of Medicine (PubMed) searches (from 1960 to 2004), which were performed between May and September 2004, of the literature published in the English language, limited to human studies, using combinations of the search terms “cough,” “double-blind placebo-controlled,” “antitussive,” “mucolytic,” “cough clearance,” “common cold,” “protussive,” “guaifenesin,” “glycerol,” and “zinc.” Results Mucolytic agents are not consistently effective in ameliorating cough in patients with bronchitis, although they may be of benefit to this population in other ways. Peripheral and central antitussive agents can be useful in patients with chronic bronchitis, but can have little efficacy in patients with cough due to upper respiratory infection. Some protussive agents are effective in increasing cough clearance, but their long-term effectiveness has not been established. DNase is not effective as a protussive agent in patients with cystic fibrosis. Inhaled mannitol is acutely effective in this patient population, but its therapeutic potential must be investigated further. Conclusions These findings suggest that suppressant therapy is most effective when used for the short-term reduction of coughing. Relatively few drugs are effective as cough suppressants. PMID:16428717

Understanding Medications and What They Do

MedlinePlus

... cough, and chickenpox are given by injection. No one thinks shots are fun. But the diseases they prevent can ... may react differently to the same medicine (for example, if the person has an allergy to one of the components of the medicine). If you' ...

Ocular Safety of Topical Naltrexone

DTIC Science & Technology

2013-04-01

prescription medicines , vitamins and herbal supplements. Especially tell your doctor if you take any opioid-containing medicines for pain, cough, or...squamous cell carcinoma. International Journal of Molecular Medicine 2000;5:191-6. 13. Zagon IS, McLaughlin PJ. Naloxone prolongs the survival time of mice...human pancreatic adenocarcinoma. International Journal of Molecular Medicine 2000;5:77-84. 18 35. Zagon IS, Verderame MF, Zimmer WE, McLaughlin PJ

Traditional plant-based therapies for respiratory diseases found in North Jeolla Province, Korea.

PubMed

Kim, Hyun; Song, Mi-Jang

2012-03-01

This study aims to record and conserve orally transmitted traditional plant-based therapies for respiratory diseases in North Jeolla Province, Korea. Data were collected with semistructured questionnaires through the participatory rural appraisal method. This study reveals that overall, 14 respiratory diseases have been treated with a total of 43 species of medicinal plants belonging to 40 genera in 26 families. This study also reports 149 different modes of plant-based therapeutic application of medicinal material. The informant consensus factor for the common cold is 0.84, the highest among 14 different respiratory ailments, followed by whooping cough, asthma, nosebleed, bronchitis, cough, and so on. Medicinal plants used to treat seven respiratory ailments had a 100% fidelity level. This study can help to preserve the traditional knowledge and local health traditions of North Jeolla Province amid rapid industrialization and urbanization. The findings of this study warrant follow-up clinical research to determine the most effective traditional remedies toward development of herbal medicinal products for integration into the Korean health care system.

Management of acute cough by Zataria multiflora Boiss as an alternative treatment.

PubMed

Mahboubi, Mohaddese

2018-01-01

Cough, as a defensive reflux mechanism, removes foreign objects and secretions from bronchi and bronchioles of airways. Zataria multiflora is a popular plant for treatment of cough in Iranian traditional medicine. The aim of this review was to evaluate the potency of Z. multiflora as an alternative treatment in management of acute cough and its possible mechanisms of action. Here the authors compiled information about Z. multiflora in the treatment of cough from all accessible resources and books. The results of this investigation showed that there were five clinical studies that evaluated the efficacy of Z. multiflora essential oil or extract alone (n = 1), in combination with Althaea officinalis (n = 2) or Foeniculum vulgare essential oil (n = 1), in the form of syrup (n = 3), oral drop (n = 1) and soft capsule (n = 1), for the treatment of acute cough in comparison with placebo or synthetic drugs (bromhexine, dextromethorphan and clobutinol). All clinical studies confirmed the efficacy of Z. multiflora in the amelioration of acute cough in pediatric (n = 1) and adult patients (n = 4) without any adverse effects. Different mechanisms, such as anti-inflammatory, analgesic, antimicrobial, relaxant and immune-enhancement, may be responsible for the efficacy of Z. multiflora in cough relief. Other clinical trials can be performed with Z. multiflora in combination with ivy leaf extract or primrose root extract on patients with cough. Copyright © 2017 Shanghai Changhai Hospital. Published by Elsevier B.V. All rights reserved.

Impact of pharmacy worker training and deployment on access to essential medicines for children under five in Malawi: a cluster quasi-experimental evaluation.

PubMed

Babigumira, Joseph B; Lubinga, Solomon J; Jenny, Alisa M; Larsen-Cooper, Erin; Crawford, Jessica; Matemba, Charles; Stergachis, Andy

2017-09-11

Poor access to essential medicines is common in many low- and middle-income countries, partly due to an insufficient and inadequately trained workforce to manage the medicines supply chain. We conducted a prospective impact evaluation of the training and deployment of pharmacy assistants (PAs) to rural health centers in Malawi. A quasi-experimental design was used to compare access to medicines in two districts where newly trained PAs were deployed to health centers (intervention) and two districts with no trained PAs at health centers (comparison). A baseline household survey and two annual post-intervention household surveys were conducted. We studied children under five years with a history of fever, cough and difficulty in breathing, and diarrhea in the previous two weeks. We collected data on access to antimalarials, antibiotics and oral rehydration salts (ORS) during the childrens' symptomatic periods. We used difference-in-differences regression models to estimate the impact of PA training and deployment on access to medicines. We included 3974 children across the three rounds of annual surveys: 1840 (46%) in the districts with PAs deployed at health centers and 2096 (53%) in districts with no PAs deployed at health centers. Approximately 80% of children had a fever, nearly 30% had a cough, and 43% had diarrhea in the previous two weeks. In the first year of the program, the presence of a PA led to a significant 74% increase in the odds of access to any antimalarial, and a significant 49% increase in the odds of access to artemisinin combination therapies. This effect was restricted to the first year post-intervention. There was no effect of presence of a PA on access to antibiotics or ORS. The training and deployment of pharmacy assistants to rural health centers in Malawi increased access to antimalarial medications over the first year, but the effect was attenuated over the second year. Pharmacy assistants training and deployment demonstrated no impact on access to antibiotics for pneumonia or oral rehydration salts for diarrhea.

Military Health Care System and Tricare: An Economic Analysis Indicates the Occurrence of Self-selection

DTIC Science & Technology

2006-06-01

unconventional medicine in the past year. People remaining in the FFS plan also made more health care visits than MCO enrollees (14.6 versus 9.1 per...system. To accommodate this demand, the system uses state-of-the-art medicine and highly trained personnel to provide high quality care to its...Marrow Transplants for Treatment of Ovarian Cancer Orthomolecular Psychiatric Therapy Camps Over-the-counter Drugs Christian Science "Absent Treatment

Mechanical induction of cough in Idiopathic Pulmonary Fibrosis

PubMed Central

2011-01-01

Background Patients with idiopathic pulmonary fibrosis (IPF) frequently develop a dry, irritating cough which often proves refractory to anti-tussive therapies. The precise pathogenetic mechanisms responsible for this cough are unknown. We hypothesised that changes in nerves modulating mechanical sensitivity in areas of interstitial fibrosis might lead to enhanced cough response to mechanical stimulation of the chest in IPF. Methods We studied 27 non-smoking subjects with IPF (63% male), mean (SD) age 71.7 (7) years and 30 healthy non-smokers. Quality of life (Leicester Cough Questionnaire), cough symptom scores and cough severity scores (visual analog scales) were recorded. Percussion stimulation was applied over the posterior lung base, upper anterior chest and manubrium sternum at sequential frequencies (20 Hertz (Hz), 40 Hz and 60 Hz) for up to 60 seconds and repeated twice at two minute intervals. The number of subjects achieving two and five-cough responses, total cough counts and cough latency were recorded. In separate experiments, the effect of mechanical stimulation on the pattern of breathing was determined in eight IPF subjects and five control subjects. Results In patients with IPF, we demonstrated strong correlations between subjective cough measurements, particularly the cough symptom score and Leicester Cough Questionnaire (r = -0.86; p < 0.001). Mechanical percussion induced a true cough reflex in 23/27 (85%) IPF subjects, but only 5/30 (17%) controls (p < 0.001). More patients with IPF reached the two-cough response at a lower frequency (20 Hz) posteriorly than at other positions. Highest mean cough totals were seen with stimulation at or above 40 Hz. Mechanical stimulation had no effect on respiratory rate but increased tidal volume in four (50%) subjects with IPF, particularly at higher frequencies. It was associated with increased urge to cough followed by a true cough reflex. Conclusions This study demonstrates that patients with IPF show enhanced cough reflex sensitivity to mechanical stimulation of the chest wall whilst normal individuals show little or no response. The observation that low frequency stimulation over the lung base, where fibrosis is most extensive, induces cough in more patients than at other sites supports the hypothesis that lung distortion contributes to the pathogenesis of cough in IPF. PMID:21477349

Medicine reclassification processes and regulations for proper use of over-the-counter self-care medicines in Japan.

PubMed

Nomura, Kaori; Kitagawa, Yuki; Yuda, Yasukatsu; Takano-Ohmuro, Hiromi

2016-01-01

Japan has actively reclassified substances ranging from prescription drugs to over-the-counter (OTC) drugs in recent years. The sale of most OTC drugs was deregulated several times and pharmacists' supervision was deemed no longer mandatory. Japan established a new OTC evaluation system in 2015 to hear opinions from various stakeholders regarding medicine types to be reclassified. This study aimed to examine the new framework to identify candidate substances for reclassification. Moreover, we examined how to manage the safe, self-care use of OTC drugs in Japan. The necessary regulatory information on OTC approvals as of January 2015 was collected using an Internet search and relevant databases. To highlight the characteristics of OTC drugs in Japan, the UK was selected as a comparison country because it too was actively promoting the reclassification of medicines from prescription to nonprescription status, and because of economic similarity. Japan and the UK have a risk-based classification for nonprescription medicines. Japan has made OTC drugs available with mandatory pharmacists' supervision, face-to-face with pharmacists, or online instruction, which is similar to the "pharmacy medicine" practiced in the UK. Japan recently reformed the reclassification process to involve physicians and the public in the process; some interactions were back to "prescription-only medicine" in the UK. It is expected that the opinion of marketers, medical professionals, and the public will improve the discussion that will greatly contribute to the safe use of drugs. Monitoring the new system will be noteworthy to ensure that OTC drug users are managing their self-care properly and visiting a doctor only when necessary. The supply methods are similar in Japan and the UK; however, the expected growth in the Japanese OTC market by the Cabinet and the industry is still uncertain.

Evidence-based medicine and the anecdote: Uneasy bedfellows or ideal couple?

PubMed Central

Kosko, Jilleen; Klassen, Terry P; Bishop, Ted; Hartling, Lisa

2006-01-01

Over the past 30 years, there has been a resurgence in the use of storytelling and narrative in medicine. At first glance, the trend to incorporate art forms into medicine appears to run counter to the rise of the more objective and positivist evidence-based medicine movement. In the present article, the authors provide examples of the use of storytelling and narrative in medicine, describe their origins, and contrast this approach with evidence-based medicine. The authors suggest that storytelling and narrative offer a complement to the science of evidence-based medicine. Finally, the authors describe a program of research to develop and evaluate the use of storytelling as a communication tool between physicians and parents/caregivers of children presenting to the emergency department. PMID:19030250

Case report: anaphylactic reaction to guaifenesin.

PubMed

Ray, Manujendra; Faltay, Bela; Haller, Nairmeen Awad

2009-12-01

Adverse drug reactions lead to a significant number of hospital admissions each year and thus contribute to the overall financial burden of health care. Some of these drug reactions are allergic responses. As the overall predictability of allergic responses to drugs remains low, efforts to improve our understanding of the processes underlying these responses continue as we strive toward the ultimate goal of primary prevention. Allergic reactions range from mild pruritic to severe systemic anaphylactic responses. We report a case of a young healthy man who developed an anaphylactic reaction to an over-the-counter expectorant. A skin test showed that the patient had an immunoglobulin E-mediated allergic response to guaifenesin, one of the components of commonly available cough medications. Our review of published literature showed that this is the first report of a severe allergic response to guaifenesin.

Taking an alternative risk.

PubMed

Sveska, K J

1998-01-01

Pharmacists and other health care providers that recommend "alternative medicines" could be exposed to malpractice as well as product liability claims in the event a patient is either injured by or has treatment inappropriately delayed based on their recommendation of such medicine. For purposes of this article, it is assumed that alternative medicines are nonprescription (over-the-counter [OTC]) food supplements, vitamins, herbs or other substances contained in commercially available products. Many of these products are sold in pharmacies or health food stores and have not been clinically tested or do not have a scientific basis for the use for which they are recommended.

Medicine use by Finnish female conscripts during voluntary military service.

PubMed

Linden, Kari; Jormanainen, Vesa; Pietilä, Kirsi; Sahi, Timo

2006-08-01

The goal was to assess the prevalence of prescribed and nonprescribed medicine use, use predictors, and origin of medicines for Finnish female conscripts during their voluntary military service. An anonymous mail survey was conducted in April 1999 among all Finnish female conscripts on duty. Of the respondents (N = 177; response rate, 68%), 61% had used at least one medicine in the 2 weeks preceding the study, 44% prescribed and 31% nonprescribed medicines. Most of the prescribed medicines were provided by Finnish Defence Forces health care, whereas most of the nonprescribed medicines were of civilian origin. The consumption of prescribed and nonprescribed medicines was differently related to respondents' background variables. Common overall medicine use and use of over-the-counter analgesics and stimulants and their association with potentially negative health behaviors may contribute to inappropriate medicine use. Finnish female conscripts commonly use prescribed and nonprescribed medicines. The importance of sufficient medication information for female conscripts is emphasized.

Manipulation of prescriptions by patients - what must a doctor do?

PubMed

DeSousa, Avinash

2016-01-01

Over-the-counter use of medication via chemists, including the use of psychiatric medication, has always been a cause of worry in the Indian subcontinent. Over the last two years, the rules on dispensing psychiatric medication have become stringent and chemists have to dispense the exact amount of medicine written on the prescription for the time duration mentioned. The chemist also stamps the prescription with the amount of medicine dispensed so that the patient does not use the prescription at another chemist's or counter to obtain more than the amount prescribed. This means that patients must follow up with the psychiatrist regularly, have themselves evaluated, and get a fresh prescription that must be signed by the doctor and also carry his seal. There are many patients who do not adhere to this rule. Many a time, chemists who have known a patient over the years tend to continue dispensing medication to the patient for durations which far exceed that prescribed by the doctor. This is rather dangerous as the patient may end up taking antidepressants, antipsychotics and sedatives for months or at times, years, without a valid prescription. They may also develop side-effects that could ensue under unsupervised consumption.

Association of Over-The-Counter Pharmaceutical Sales with Influenza-Like-Illnesses to Patient Volume in an Urgent Care Setting

PubMed Central

Liu, Timothy Y.; Sanders, Jason L.; Tsui, Fu-Chiang; Espino, Jeremy U.; Dato, Virginia M.; Suyama, Joe

2013-01-01

We studied the association between OTC pharmaceutical sales and volume of patients with influenza-like-illnesses (ILI) at an urgent care center over one year. OTC pharmaceutical sales explain 36% of the variance in the patient volume, and each standard deviation increase is associated with 4.7 more patient visits to the urgent care center (p<0.0001). Cross-correlation function analysis demonstrated that OTC pharmaceutical sales are significantly associated with patient volume during non-flu season (p<0.0001), but only the sales of cough and cold (p<0.0001) and thermometer (p<0.0001) categories were significant during flu season with a lag of two and one days, respectively. Our study is the first study to demonstrate and measure the relationship between OTC pharmaceutical sales and urgent care center patient volume, and presents strong evidence that OTC sales predict urgent care center patient volume year round. PMID:23555647

Cough Recognition Based on Mel Frequency Cepstral Coefficients and Dynamic Time Warping

NASA Astrophysics Data System (ADS)

Zhu, Chunmei; Liu, Baojun; Li, Ping

Cough recognition provides important clinical information for the treatment of many respiratory diseases, but the assessment of cough frequency over a long period of time remains unsatisfied for either clinical or research purpose. In this paper, according to the advantage of dynamic time warping (DTW) and the characteristic of cough recognition, an attempt is made to adapt DTW as the recognition algorithm for cough recognition. The process of cough recognition based on mel frequency cepstral coefficients (MFCC) and DTW is introduced. Experiment results of testing samples from 3 subjects show that acceptable performances of cough recognition are obtained by DTW with a small training set.

[Factors related to purchasing over-the-counter medications online].

PubMed

Kishimoto, Keiko; Yoshida, Takeshi; Fukushima, Noriko

2009-09-01

We conducted a Web-based survey of approximately 40,000 Internet users on the purchase of over-the-counter (OTC) medications online in March 2009. The valid response rate was 97.8% and the number of responses was 39,208. The number of people who had purchased OTC medications online was 4,653 (11.9%), prescription medicines 792 (2.0%), and medical contact lenses 1,993 (5.1%). As a result of the multiple logistic regression analysis, independent variables with odds ratios (ORs) >1.5 were experience of purchasing prescription-only medicine online (OR=4.997, 95%CI=4.288-5.824), regular supplement use (OR=2.384, 95%CI=2.233-2.548), experience of purchasing colored contact lenses online (OR=2.206, 95%CI=1.632-2.983), no time to visit drugstores (OR=2.092, 95%CI=1.928-2.270), usage of Web sites of uncertain reliability (OR=1.992, 95%CI=1.857-2.137), and experience of purchasing therapeutic contact lenses online (OR=1.796, 95%CI=1.597-2.020). As some people have purchased prescription-only medicine or medical devices and had problems with drug information sources, the development of awareness of medical and pharmaceutical supplies and health and medical information literacy are key priorities to ensure safe OTC medication sales systems.

Experience of Soviet Medicine in a Great Patriotic War, 1941-1945. Volume 16, Section 2.

DTIC Science & Technology

1980-10-22

presented the first complaints, to the constraint in tue breast and the pain during the respiration, cough and impossibility to clear the throat. Soon to...masticatory and mimic musculature and spasm of different groups of muscles. Frequently the attacks/seizures/paroxysms of cough were accompanied by the...80093615 PAGE Cure of tetanus to a conserable degree was daterained by the manifestation of the clinical phenomena: the heavier there were these

Indoles: Industrial, Agricultural and Over-the-Counter Uses

NASA Astrophysics Data System (ADS)

Barden, Timothy C.

Indole-containing compounds are best known for their medicinal properties in the pharmaceutical industry. Although to a lesser degree, the indole motif none-the-less appears in many significant products across the entire chemical industry. This chapter describes the role that indole plays in a more commodity setting and provides examples illustrating these uses.

Clinical Pharmacology in Sleep Medicine

PubMed Central

Proctor, Ashley; Bianchi, Matt T.

2012-01-01

The basic treatment goals of pharmacological therapies in sleep medicine are to improve waking function by either improving sleep or by increasing energy during wakefulness. Stimulants to improve waking function include amphetamine derivatives, modafinil, and caffeine. Sleep aids encompass several classes, from benzodiazepine hypnotics to over-the-counter antihistamines. Other medications used in sleep medicine include those initially used in other disorders, such as epilepsy, Parkinson's disease, and psychiatric disorders. As these medications are prescribed or encountered by providers in diverse fields of medicine, it is important to recognize the distribution of adverse effects, drug interaction profiles, metabolism, and cytochrome substrate activity. In this paper, we review the pharmacological armamentarium in the field of sleep medicine to provide a framework for risk-benefit considerations in clinical practice. PMID:23213564

Coughs and Colds: Medicines or Home Remedies?

MedlinePlus

... Healthy Living Healthy Living Healthy Living Nutrition Fitness Sports Oral Health Emotional Wellness Growing Healthy Sleep Safety & Prevention Safety & Prevention Safety and Prevention Immunizations ...

Dextromethorphan overdose

MedlinePlus

... this page: //medlineplus.gov/ency/article/002628.htm Dextromethorphan overdose To use the sharing features on this page, please enable JavaScript. Dextromethorphan is a medicine that helps stop coughing. It ...

The extent that health professionals suspect and address addiction to medicines in primary care: Findings from a survey in Northwest England.

PubMed

Bates, Geoff; Cochrane, Madeleine; Mackridge, Adam John

2017-01-01

Addiction to medicines available over the counter or via prescription is of growing international concern. The authors of the current article ran an online survey of health professionals in general medical practice and community pharmacy settings in Northwest England to explore the frequency of suspecting and responding to addiction to medicines. Health professionals reported frequently identifying addiction to medicines among patients including those with long-term pain, mental health problems, sleep disorders, and other substance use disorders, but that these addictions often go unchallenged. This adds to the evidence indicating the under-diagnosis of addiction to medicines in the United Kingdom. Strategies to improve diagnosis and treatment should recognize the diversity of individuals with addiction to medicines.

Description of nighttime cough epochs in patients with stable COPD GOLD II-IV.

PubMed

Fischer, Patrick; Gross, Volker; Kroenig, Johannes; Weissflog, Andreas; Hildebrandt, Olaf; Sohrabi, Keywan; Koehler, Ulrich

Chronic cough is one of the main symptoms of COPD. Ambulatory objective monitoring provides novel insights into the determinants and characteristics of nighttime cough in COPD. Nighttime cough was monitored objectively by LEOSound lung sound monitor in patients with stable COPD II-IV. In 30 patients, with 10 patients in each stage group, nighttime cough was analyzed for epoch frequency, epoch severity (epoch length and coughs per epoch), and pattern (productive or nonproductive). Cough was found in all patients ranging from 1 to 294 events over the recording period. In 29 patients, cough epochs were monitored, ranging from 1 to 75 epochs. The highest amount of cough epochs was found in patients with COPD stage III. Active smokers had significantly more productive cough epochs (61%) than nonsmokers (24%). We found a high rate of nighttime cough epochs in patients with COPD, especially in those in stage III. Productive cough was predominantly found in patients with persistent smoking. LEOSound lung sound monitor offers a practical and valuable opportunity to evaluate cough objectively.

What, where and when? Using Google Trends and Google to investigate patient needs and inform pharmacy practice.

PubMed

Hanna, Alan; Hanna, Lezley-Anne

2018-03-30

The aim was to provide a comprehensive overview (using pertinent examples) of the various ways that Google Trends and Google data could inform pharmacy practice. The objectives were to: examine what type of information people search for in relation to a common class of medicines; ascertain where people are directed to (websites) following an initial search for a medicine or medical condition; and establish information about when they search. The methodology differed depending on whether Google Trends or Google was being interrogated, but the search domain was always limited to the United Kingdom. Google Trends was queried, typically for a 5-year time frame, and data downloaded for many search inputs relating to medical conditions (self-treatable and non-self-treatable) and medicines (bought over-the-counter and prescribed). Google was queried and data collected for searches related to 'antibiotics'. Google Trends revealed a previously unknown seasonality pattern for irritable bowel syndrome. Related searches for 'antibiotics' revealed a high level of interest in the appropriateness of concomitant alcohol consumption and queries about what antibiotics are. Largely, people were being directed to reputable websites following their initial search input about a prescription-only medicine. However, searches for over-the-counter medicines were more likely to lead to commercial domains. This is one of the first studies to investigate use of Google Trends and Google in a pharmacy-specific context. It is relevant for practice as it could inform marketing strategies, public health policy and help tailor patient advice and counselling. © 2018 Royal Pharmaceutical Society.

Determination of Dextromethorphan in Oral Fluid by LC-MS-MS.

PubMed

Amaratunga, Piyadarsha; Clothier, Morgan; Lorenz Lemberg, Bridget; Lemberg, Dave

2016-06-01

Dextromethorphan (DXM) is an antitussive drug found in commonly used nonprescription cold and cough medications. At low doses, DXM is a safe drug that does not produce adverse reactions. However, abuse of DXM has been reported among adolescents and young adults using the drug at higher doses. DXM is not a scheduled drug in the USA, and the primary reason for its abuse is the ease of availability. DXM is available to purchase in the form of over-the-counter cough medications, such as Robitussin(®) and Coricidin(®), or it can be purchased over the Internet in the form of a powder. In this research work, we developed an LC-MS-MS method that can quantify DXM and dextrorphan (DXO) in oral fluid in a high-throughput toxicology laboratory setting. The developed method was validated according to the Scientific Working Group for Forensic Toxicology guidelines. The linear dynamic range was 5-100 ng/mL with a lowest limit of quantitation (LLOQ) of 5.0 ng/mL for DXM and DXO. Overall, the results of the accuracy and the precision values were within the acceptance criteria for both drugs. In addition, selectivity, matrix effect and recovery were calculated for the LC-MS-MS method. Authentic samples (n = 59) were tested to evaluate the applicability of the method. Thirty samples were found to be positive for DXM and DXO and two samples were found to be positive for DXM only. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Determinants of self medication practices among pregnant women in Ibadan, Nigeria.

PubMed

Yusuff, Kazeem B; Omarusehe, Louis-Domeih

2011-10-01

To assess the frequency and evaluate the factors underlining self-medication with orthodox and herbal medicines among pregnant women in Ibadan, Nigeria. Setting Antenatal clinics at the major antenatal care facility in Ibadan, south-western Nigeria. A prospective cross-sectional study with a pre-tested 15-item structured questionnaire over a 12 week period among 1,650 pregnant women who attended antenatal clinics at a major antenatal care facility in Ibadan, south-western Nigeria. Data analysis was done with Chi-square, multivariate logistic regression and summary statistics. Frequency and major factors associated with self-medication in pregnancy. The response and completion rate was 96.6% (1,594) [mean age ± SD 27 ± 5.3 years]. The majority of the respondents were literate (92.6%), self-employed (61.5%) and in the third trimester (49.5%). A significant majority (63.8%) used self-medication (orthodox and herbal medicines) as their first response to perceived ill-health (P < 0.001). Self-medication in pregnancy was strongly associated with self-employment (OR: 3.8 (2.6-4.7), unemployment (OR: 2.6 (1.4-4.2) and third trimester of pregnancy (OR: 4.2 (3.1-5.6). The major over-the-counter medicines and potentially harmful prescription medicines kept at home for self-medication were Paracetamol, vitamins and haematinics; and piroxicam, dipyrone, chloramphenicol and Diazepam respectively. About one-third of the respondents who self-medicated (1,017) used local herbs (31.2%). The most frequent source of the medicines purchased during self-medication was patent medicine stores (55%). Mothers-in-law and relatives (41.3%) were the most frequently cited sources of advice during self-medication. Miscarriage/bleeding (44.3%) was the most frequently cited potential adverse effect that could occur with the use of certain medicines during pregnancy. Only 32% of respondents could identify medicines that are potentially harmful in pregnancy. Poorly guided self-medication with prescription, over-the-counter and herbal medicines is pervasive and significantly associated with gestational age and occupational pattern among pregnant women in Ibadan, south-western. A majority lacked the knowledge of potential adverse outcomes associated with the use of certain medicines, and the potentially harmful medicines to avoid during pregnancy.

Bulk muscles, loose cables

PubMed Central

Liyanage, Chamari R D G; Kodali, Venkata

2014-01-01

The accessibility and usage of body building supplements is on the rise with stronger internet marketing strategies by the industry. The dangers posed by the ingredients in them are underestimated. A healthy young man came to the emergency room with palpitations and feeling unwell. Initial history and clinical examination were non-contributory to find the cause. ECG showed atrial fibrillation. A detailed history for any over the counter or herbal medicine use confirmed that he was taking supplements to bulk muscle. One of the components in these supplements is yohimbine; the onset of symptoms coincided with the ingestion of this product and the patient is symptom free after stopping it. This report highlights the dangers to the public of consuming over the counter products with unknown ingredients and the consequential detrimental impact on health. PMID:25326558

Bulk muscles, loose cables.

PubMed

Liyanage, Chamari R D G; Kodali, Venkata

2014-10-17

The accessibility and usage of body building supplements is on the rise with stronger internet marketing strategies by the industry. The dangers posed by the ingredients in them are underestimated. A healthy young man came to the emergency room with palpitations and feeling unwell. Initial history and clinical examination were non-contributory to find the cause. ECG showed atrial fibrillation. A detailed history for any over the counter or herbal medicine use confirmed that he was taking supplements to bulk muscle. One of the components in these supplements is yohimbine; the onset of symptoms coincided with the ingestion of this product and the patient is symptom free after stopping it. This report highlights the dangers to the public of consuming over the counter products with unknown ingredients and the consequential detrimental impact on health. 2014 BMJ Publishing Group Ltd.

Risk factors for respiratory morbidity in infancy after very premature birth.

PubMed

Greenough, A; Limb, E; Marston, L; Marlow, N; Calvert, S; Peacock, J

2005-07-01

To determine the occurrence of respiratory morbidity during infancy after very premature birth and to identify risk factors. Prospective follow up study. The United Kingdom oscillation study. 492 infants, all born before 29 weeks gestation. Structured questionnaires were completed by local paediatricians when the infants were seen in outpatients at 6 and 12 months of age corrected for prematurity. Cough, wheeze, and treatment requirements and the composite measure of respiratory morbidity (cough, frequent cough, cough without infection, wheeze, frequent wheeze, wheeze without infection, and use of chest medicine) and their relation to 13 possible explanatory variables. At 6 and 12 months of corrected age, 27% of the infants coughed and 6% had frequent (more than once a week) cough, and 20% and 3% respectively had wheeze or frequent wheeze. At 6 and 12 months, 14% of infants had taken bronchodilators and 8% inhaled steroids. After adjustment for multiple outcome testing, four factors were associated with increased respiratory morbidity: male sex, oxygen dependency at 36 weeks postmenstrual age, having older siblings aged less than 5 years, and living in rented accommodation. Male infants are particularly vulnerable to respiratory morbidity in infancy after very premature birth. It is important to identify a safe and effective strategy to prevent chronic oxygen dependency.

Medicines for sleep

MedlinePlus

Benzodiazepines; Sedatives; Hypnotics; Sleeping pills; Insomnia - medicines; Sleep disorder - medicines ... the-counter (OTC) sleeping pills contain antihistamines. These medicines are commonly used to treat allergies. While these ...

Pregnant? Drugs and Alcohol Can Hurt Your Unborn Baby.

ERIC Educational Resources Information Center

Department of Agriculture, Washington, DC.

This brochure, directed towards pregnant women, describes the dangers of alcohol, street drugs, smoking, and prescription drugs or over-the-counter medicines. It presents a story (in the mother's words) of a woman who took drugs to get high while pregnant and the ill effects on her son. The brochure claims being drug free means being a better…

Volitional control of reflex cough

PubMed Central

Bolser, Donald C.; Davenport, Paul W.

2012-01-01

Multiple studies suggest a role for the cerebral cortex in the generation of reflex cough in awake humans. Reflex cough is preceded by detection of an urge to cough; strokes specifically within the cerebral cortex can affect parameters of reflex cough, and reflex cough can be voluntarily suppressed. However, it is not known to what extent healthy, awake humans can volitionally modulate the cough reflex, aside from suppression. The aims of this study were to determine whether conscious humans can volitionally modify their reflexive cough and, if so, to determine what parameters of the cough waveform and corresponding muscle activity can be modified. Twenty adults (18–40 yr, 4 men) volunteered for study participation and gave verbal and written informed consent. Participants were seated and outfitted with a facemask and pneumotacograph, and two surface EMG electrodes were positioned over expiratory muscles. Capsaicin (200 μM) was delivered via dosimeter and one-way (inspiratory) valve attached to a side port between the facemask and pneumotachograph. Cough airflow and surface EMG activity were recorded across tasks including 1) baseline, 2) small cough (cough smaller or softer than normal), 3) long cough (cough longer or louder than normal), and 4) not cough (alternative behavior). All participants coughed in response to 200 μM capsaicin and were able to modify the cough. Variables exhibiting changes include those related to the peak airflow during the expiratory phase. Results demonstrate that it is possible to volitionally modify cough motor output characteristics. PMID:22492938

Validation of a digital audio recording method for the objective assessment of cough in the horse.

PubMed

Duz, M; Whittaker, A G; Love, S; Parkin, T D H; Hughes, K J

2010-10-01

To validate the use of digital audio recording and analysis for quantification of coughing in horses. Part A: Nine simultaneous digital audio and video recordings were collected individually from seven stabled horses over a 1 h period using a digital audio recorder attached to the halter. Audio files were analysed using audio analysis software. Video and audio recordings were analysed for cough count and timing by two blinded operators on two occasions using a randomised study design for determination of intra-operator and inter-operator agreement. Part B: Seventy-eight hours of audio recordings obtained from nine horses were analysed once by two blinded operators to assess inter-operator repeatability on a larger sample. Part A: There was complete agreement between audio and video analyses and inter- and intra-operator analyses. Part B: There was >97% agreement between operators on number and timing of 727 coughs recorded over 78 h. The results of this study suggest that the cough monitor methodology used has excellent sensitivity and specificity for the objective assessment of cough in horses and intra- and inter-operator variability of recorded coughs is minimal. Crown Copyright 2010. Published by Elsevier India Pvt Ltd. All rights reserved.

Developing alternative over-the-counter medicine label formats: How do they compare when evaluated by consumers?

PubMed

Tong, Vivien; Raynor, David K; Aslani, Parisa

2018-03-01

In recent years, the Australian Therapeutic Goods Administration (TGA) has proposed implementing a standardized over-the-counter (OTC) medicine label. However, there were mixed consumer opinions regarding a label proposed in 2012 and limited evidence demonstrating the usability of the revised (2014) format. To develop and examine the usability of alternative OTC medicine label formats for standardization, and explore consumer perspectives on the labels. Four alternative labels were developed for the exemplar medicine diclofenac. One was based on the Medicine Information label proposed by the TGA ('Medicine Information'), one was based on the U.S. Drug Facts label ('Drug Facts'), and two were based on suggestions proposed by consumers in the earlier needs analysis phase of this research (referred to as the 'Medicine Facts' and 'Consumer Desires' label formats). Five cohorts of 10 participants were recruited. Each cohort was assigned to user test one of the alternative labels or an existing label for a proprietary diclofenac product (which acted as a comparator) for diagnostic purposes. Each participant then provided feedback on all 5 labels. Each interview consisted of the administration of a user testing questionnaire, measuring consumers' ability to find and understand key points of information, and a semi-structured interview exploring consumer perspectives. Overall, all 4 alternative label formats supported consumers' ability to find and understand key points. The existing comparator label was the poorer label with respect to participants' ability to find and understand key points. Factors such as perceived usability, color, design, content, and/or content ordering impacted consumer preferences. The 'Consumer Desires' or 'Drug Facts' label formats were most often preferred by consumers for use as the standardized OTC label over the TGA proposed format. All alternative label formats demonstrated satisfactory usability and could be considered for use in OTC label standardization. User testing of OTC labels and consumer feedback received as part of the testing process can assist in the refinement of OTC labeling to ensure that implemented policies are evidence-based. Copyright © 2017 Elsevier Inc. All rights reserved.

Cough & Cold Medicine Abuse

MedlinePlus

... people take too much DXM, they might have hallucinations and "out-of-body" sensations. DXM also depresses ... heart function. Taking a lot of DXM causes hallucinations and out-of-body sensations similar to the ...

Slippery Elm

MedlinePlus

Slippery elm is a tree that is native to eastern Canada and the eastern and central United States. ... whole bark) is used as medicine. People take slippery elm by mouth for coughs, sore throat, colic, diarrhea, ...

An Atypical Case of Methemoglobinemia due to Self-Administered Benzocaine.

PubMed

Nappe, Thomas M; Pacelli, Anthony M; Katz, Kenneth

2015-01-01

Acquired methemoglobinemia is an uncommon hemoglobinopathy that results from exposure to oxidizing agents, such as chemicals or medications. Although, as reported in the adult population, it happens most often due to prescribed medication or procedural anesthesia and not due to easily accessed over-the-counter medications, the authors will describe an otherwise healthy male adult with no known medical history and no prescribed medications, who presented to the emergency department reporting generalized weakness, shortness of breath, headache, dizziness, and pale gray skin. In addition, the patient reported that he also had a severe toothache for several days, which he had been self-treating with an over-the-counter oral benzocaine gel. Ultimately, the diagnosis of methemoglobinemia was made by clinical history, physical examination, and the appearance of chocolate-colored blood and arterial blood gas (ABG) with cooximetry. After 2 mg/kg of intravenous methylene blue was administered, the patient had complete resolution of all signs and symptoms. This case illustrates that emergency physicians should be keenly aware of the potential of toxic hemoglobinopathy secondary to over-the-counter, nonprescribed medications. Discussion with patients regarding the dangers of inappropriate use of these medicines is imperative, as such warnings are typically not evident on product labels.

The course of lung inflation alters the central pattern of tracheobronchial cough in cat-The evidence for volume feedback during cough.

PubMed

Poliacek, Ivan; Simera, Michal; Veternik, Marcel; Kotmanova, Zuzana; Pitts, Teresa; Hanacek, Jan; Plevkova, Jana; Machac, Peter; Visnovcova, Nadezda; Misek, Jakub; Jakus, Jan

2016-07-15

The effect of volume-related feedback and output airflow resistance on the cough motor pattern was studied in 17 pentobarbital anesthetized spontaneously-breathing cats. Lung inflation during tracheobronchial cough was ventilator controlled and triggered by the diaphragm electromyographic (EMG) signal. Altered lung inflations during cough resulted in modified cough motor drive and temporal features of coughing. When tidal volume was delivered (via the ventilator) there was a significant increase in the inspiratory and expiratory cough drive (esophageal pressures and EMG amplitudes), inspiratory phase duration (CTI), total cough cycle duration, and the duration of all cough related EMGs (Tactive). When the cough volume was delivered (via the ventilator) during the first half of inspiratory period (at CTI/2-early over inflation), there was a significant reduction in the inspiratory and expiratory EMG amplitude, peak inspiratory esophageal pressure, CTI, and the overlap between inspiratory and expiratory EMG activity. Additionally, there was significant increase in the interval between the maximum inspiratory and expiratory EMG activity and the active portion of the expiratory phase (CTE1). Control inflations coughs and control coughs with additional expiratory resistance had increased maximum expiratory esophageal pressure and prolonged CTE1, the duration of cough abdominal activity, and Tactive. There was no significant difference in control coughing and/or control coughing when sham ventilation was employed. In conclusion, modified lung inflations during coughing and/or additional expiratory airflow resistance altered the spatio-temporal features of cough motor pattern via the volume related feedback mechanism similar to that in breathing. Copyright © 2016. Published by Elsevier B.V.

Direct-to-consumer advertising: Australian pharmacists' experiences with non-prescription medicines.

PubMed

Chaar, Betty; Kwong, Kenelm

2010-02-01

Direct-to-consumer advertising (DTCA) of over-the-counter or prescribed medicines is a highly controversial issue relating to public health care. Advocates highlight the advantages of DTCA in terms of patient awareness and autonomy. Opponents voice concerns about safety and patients' best interests. The views of physicians and consumers about DTCA have been widely investigated. There has been little research, however, in relation to pharmacists' experiences with DTCA and the impact of DTCA on pharmacy practice. The aim of this study was therefore to explore pharmacists' perceptions of DTCA in Australia and its impact on pharmacy practice. A semi-structured in-depth interview was conducted with a purposive convenience sample of retail pharmacists in Sydney, Australia. Interviews were recorded, transcribed ad verbatim and continued until data saturation. Emerging themes were extracted and analysed according to the grounded theory approach. Pharmacists participating in this study reported concern about potential harm to patient health and well-being as a result of the influence of DTCA. DTCA was seen to impede pharmacists in the discharge of their fundamental ethical responsibilities, leading to a strong sense of disempowerment. Pharmacists' gate-keeping role was challenged by DTCA encouraging consumers to self-medicate and inducing a range of drug-seeking behaviours. Although pharmacists acknowledged that DTCA may have a role in promoting patient autonomy, in practice DTCA compromised their role in safeguarding consumers from inappropriate use of medicines. This study highlighted that the impact of DTCA is not restricted to prescription medicines, but extended also to over-the-counter, pharmacist-only and other pharmacy-related products. Pharmacists perceived that DTCA disempowered them, compromising their role in safeguarding the community from inappropriate medicine use.

Misunderstanding and Potential Unintended Misuse of Acetaminophen among Adolescents and Young Adults

PubMed Central

Shone, Laura P.; King, Jennifer P.; Doane, Cindy; Wilson, Karen M.; Wolf, Michael S.

2013-01-01

Purpose Acetaminophen is highly accessible yet potentially dangerous when used incorrectly. In attempts to address concerns about acetaminophen, The U.S. Food and Drug Administration (FDA) has identified gaps in evidence about unintentional misuse among adolescents. Therefore, our objectives were to assess: adolescents’: 1) health literacy; 2) knowledge about acetaminophen; 3) recent use of over-the-counter (OTC) medicines; 4) and use of medication dosing instructions to understand the medicine and how to use it (‘acetaminophen skills’). Methods Subjects and Setting: We conducted a cross-sectional survey of adolescents and young adults (ages 16–23 years) recruited from education settings and health care sites in Monroe County, New York, from 11/08–9/09. Measures: Using structured in-person interviews, we assessed acetaminophen knowledge and recent use of over-the-counter (OTC) medicines. We assessed participants’ ability to identify acetaminophen in OTC products and answer questions about instructions for acetaminophen use through role-plays of everyday health scenarios. We measured health literacy with the Rapid Estimate of Adult Literacy in Medicine (REALM) for participants >18, and the REALM-Teen for those <18. Results Confusion about acetaminophen and its use was common. Limited health literacy was an independent risk factor for poor knowledge, misunderstanding, and potential unsafe use of acetaminophen-containing medicines, however, most participants at all health literacy levels erred dangerously in ‘unsafe’ understanding of acetaminophen use from label instructions. Conclusions Individuals with limited health literacy may face disproportionate risk of unsafe use of acetaminophen due to confusion and misunderstanding of label information. Better labeling, public health programs, and educational efforts could facilitate safer use of acetaminophen. PMID:21951256

Customer interest in and experience with various types of pharmacy counselling - a qualitative study.

PubMed

Kaae, Susanne; Traulsen, Janine M; Nørgaard, Lotte S

2014-12-01

Despite pharmacists' extensive knowledge in the optimization of patients' medical treatments, community pharmacies are still fighting to earn patients' trust with respect to medicinal counselling at the counter. The aim was to investigate how patients perceive pharmacy counselling at the present time, in order to develop the patient-pharmacy relationship for the benefit of both patients and pharmacies. Short semi-structured interviews were carried out with pharmacy customers by pharmacy internship students. One hundred and eight customers in 35 independent pharmacies across Denmark were interviewed during the spring of 2011. Customers were interviewed about their expectations of pharmacies in general and their experiences with medical counselling in particular. Customers perceive community pharmacies very differently in terms of both expectations of and positive experiences with counselling. They appear to be in favour of pharmacy counselling with respect to over-the-counter medicine and first-time prescription medicine in contrast to refills. Customers find it difficult to express the health-care role of pharmacies even when experiencing and appreciating it. Lack of appreciation of pharmacy counselling for refill prescription medicine and the difficulty in defining the role of pharmacies might stem from the difficulties that customers have in understanding medicine and thus the role of counselling services with respect to medicine. The pharmacy staff does not seem to realize these barriers. For pharmacies to encourage customer interest in pharmacy counselling, the staff should start taking the identified barriers into account when planning communication strategies. © 2012 John Wiley & Sons Ltd.

School and Family Life

MedlinePlus

... With Your Preteen Cough and Cold Medicine Abuse Cyberbullying Date Rape Depressants: What Parents Need to Know ... Tempers Teaching Your Child Tolerance Teens Talk About Bullying (Video) Teens Talk About Stress (Video) Telling a ...

Correlation between voluntary cough and laryngeal cough reflex flows in patients with traumatic brain injury.

PubMed

Lee, Sang Chul; Kang, Seong-Woong; Kim, Min Tae; Kim, Yong Kyun; Chang, Won Hyuk; Im, Sang Hee

2013-08-01

To correlate voluntary cough and laryngeal cough reflex (LCR) flows in patients with traumatic brain injury (TBI). Cross-sectional study. University rehabilitation hospital. Patients with TBI (n=25) and healthy controls (n=48). Not applicable. Peak cough flows (PCFs) and LCR flows were measured using a peak flow meter at the oral-nasal interface. The largest value of 3 attempts was recorded for PCF and LCR, respectively. LCR was elicited by 20% solution of pharmaceutic-grade citric acid dissolved in sterile .15M NaCl solution that was inhaled from a nebulizer. PCF was 447.4 ± 99.0 L/min in the control group and 211.7 ± 58.2 L/min in the patient group. LCR was 209.2 ± 63.8L/min in the control group and 170.0 ± 59.7 L/min in the patient group. Both PCF (P=.000) and LCR (P=.013) were significantly reduced in patients with TBI compared to that of the control group. LCR was strongly related to the PCF in both control (R=.645; P=.000) and patient (R=.711; P=.000) groups. As LCR can be measured as a numerical value and significantly correlates with PCF, LCR can be used to estimate cough ability of patients with TBI who cannot cooperate with PCF measurement. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Prevalence of homeopathy use by the general population worldwide: a systematic review.

PubMed

Relton, Clare; Cooper, Katy; Viksveen, Petter; Fibert, Philippa; Thomas, Kate

2017-05-01

To systematically review surveys of 12-month prevalence of homeopathy use by the general population worldwide. Studies were identified via database searches to October 2015. Study quality was assessed using a six-item tool. All estimates were in the context of a survey which also reported prevalence of any complementary and alternative medicine use. A total of 36 surveys were included. Of these, 67% met four of six quality criteria. Twelve-month prevalence of treatment by a homeopath was reported in 24 surveys of adults (median 1.5%, range 0.2-8.2%). Estimates for children were similar to those for adults. Rates in the USA, UK, Australia and Canada all ranged from 0.2% to 2.9% and remained stable over the years surveyed (1986-2012). Twelve-month prevalence of all use of homeopathy (purchase of over-the-counter homeopathic medicines and treatment by a homeopath) was reported in 10 surveys of adults (median 3.9%, range 0.7-9.8%) while a further 11 surveys which did not define the type of homeopathy use reported similar data. Rates in the USA and Australia ranged from 1.7% to 4.4% and remained stable over the years surveyed. The highest use was reported by a survey in Switzerland where homeopathy is covered by mandatory health insurance. This review summarises 12-month prevalence of homeopathy use from surveys conducted in eleven countries (USA, UK, Australia, Israel, Canada, Switzerland, Norway, Germany, South Korea, Japan and Singapore). Each year a small but significant percentage of these general populations use homeopathy. This includes visits to homeopaths as well as purchase of over-the-counter homeopathic medicines. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Dittany of Crete: a botanical and ethnopharmacological review.

PubMed

Liolios, Christos C; Graikou, Konstantia; Skaltsa, Eleni; Chinou, Ioanna

2010-09-15

Origanum dictamnus (Lamiaceae family), an endemic plant of the Greek island of Crete, is widely used as a traditional medicine since antiquity, all over Europe. The aim of the present review is to present comprehensive information of the plant's botanical taxonomy and morphology, as well as of the chemical constituents, biological and pharmacological research on O. dictamnus, which will be presented and critically evaluated. The paper also highlights particularly interesting aspects and common medicinal uses not previously described in the specific ethnobotanical literature. An increasing number of chemical and pharmacological studies have been reported recently, some of which strongly support its traditional medicinal uses against various illnesses such as sore throat, cough and gastric ulcer. A variety of compounds, including flavonoids, lipids and terpenoids (mainly carvacrol and thymol) have been identified from the plant. Current studies have showed that the extracts, the essential oil, as well as their active principles possess several pharmacological properties, like antimicrobial, antioxidant and anti-ulcer ones. The recent scientific data and the rich historical evidence of its medicinal uses could support further research as well as its use as a safe herbal medicinal product. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

Effect of conventional and sugar free pediatric syrup formulations on primary tooth enamel hardness: An in vitro study.

PubMed

Mali, Gaurao Vasant; Dodamani, Arun Suresh; Karibasappa, Gundabaktha Nagappa; Kumar, Prashanth Vishwakarma; Jain, Vardhaman Mulchand

2015-01-01

To assess and compare the effect of conventional and sugar free pediatric syrup formulations on primary tooth enamel hardness over a period of 14 days. An in vitro study was done on 40 noncarious deciduous teeth. 10 teeth in each group were dipped in 4 pediatric medicinal syrups (1 sugarfree and 3 conventional) for 1 min thrice daily for 14 days and the enamel surface micro hardness was checked at baseline, 7 th day and 14 th day by Vickers hardness testing machine. The pH, titratable acidity and buffering capacity of the syrups were assessed. The pH of syrups were above critical pH for demineralization of the tooth but tiratable acidity and buffering capacity differed. ANOVA test indicated that the reduction in mean micro hardness was maximum in Group D (Conventional Analgesic syrup) and least in Group A (Sugarfree cough syrup) on 7 th and 14 th day. On intergroup comparison there was no difference (P > 0.05) in micro hardness between Group B (Conventional Cough syrup) and Group C (Conventional Antibiotic). However, highly significant (P < 0.01) difference between the either pair of Group B with Group D, and Group C with Group D on 14 th day. The percentage reduction in micro hardness on 14 th day was maximum for Group D (24.4 ± 2.2) and minimum for Group A (14.0 ± 1.3) which was statistically significant (P < 0.01). Sugar free pediatric medicines can be effective in reducing dental erosion and efforts should be made to incorporate sugar substitutes in formulation of pediatric medicines.

Arsenic content of homeopathic medicines

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kerr, H.D.; Saryan, L.A.

1986-01-01

In order to test the widely held assumption that homeopathic medicines contain negligible quantities of their major ingredients, six such medicines labeled in Latin as containing arsenic were purchased over the counter and by mail order and their arsenic contents measured. Values determined were similar to those expected from label information in only two of six and were markedly at variance in the remaining four. Arsenic was present in notable quantities in two preparations. Most sales personnel interviewed could not identify arsenic as being an ingredient in these preparations and were therefore incapable of warning the general public of possiblemore » dangers from ingestion. No such warnings appeared on the labels.« less

New non-invasive automatic cough counting program based on 6 types of classified cough sounds.

PubMed

Murata, Akira; Ohota, Nao; Shibuya, Atsuo; Ono, Hiroshi; Kudoh, Shoji

2006-01-01

Cough consisting of an initial deep inspiration, glottal closure, and an explosive expiration accompanied by a sound is one of the most common symptoms of respiratory disease. Despite its clinical importance, standard methods for objective cough analysis have yet to be established. We investigated the characteristics of cough sounds acoustically, designed a program to discriminate cough sounds from other sounds, and finally developed a new objective method of non-invasive cough counting. In addition, we evaluated the clinical efficacy of that program. We recorded cough sounds using a memory stick IC recorder in free-field from 2 patients and analyzed the intensity of 534 recorded coughs acoustically according to time domain. First we squared the sound waveform of recorded cough sounds, which was then smoothed out over a 20 ms window. The 5 parameters and some definitions to discriminate the cough sounds from other noise were identified and the cough sounds were classified into 6 groups. Next, we applied this method to develop a new automatic cough count program. Finally, to evaluate the accuracy and clinical usefulness of this program, we counted cough sounds collected from another 10 patients using our program and conventional manual counting. And the sensitivity, specificity and discriminative rate of the program were analyzed. This program successfully discriminated recorded cough sounds out of 1902 sound events collected from 10 patients at a rate of 93.1%. The sensitivity was 90.2% and the specificity was 96.5%. Our new cough counting program can be sufficiently useful for clinical studies.

Understanding the relative roles of pharmacogenetics and ontogeny in pediatric drug development and regulatory science.

PubMed

Leeder, J Steven; Kearns, Gregory L; Spielberg, Stephen P; van den Anker, John

2010-12-01

Understanding the dose-exposure-response relationship across the pediatric age spectrum from preterm and term newborns to infants, children, adolescents, and adults is a major challenge for clinicians, pharmaceutical companies, and regulatory agencies. Over the past 3 decades, clinical investigations of many drugs commonly used in pediatric therapeutics have provided valuable insights into age-associated differences in drug disposition and action. However, our understanding of the contribution of genetic variation to variability in drug disposition and response in children generally has lagged behind that of adults. This article proposes a systematic approach that can be used to assess the relative contributions of ontogeny and genetic variation for a given compound. Application of the strategy is illustrated using the current regulatory dilemma posed by the safety and effectiveness of over-the-counter cough and cold remedies as an example. The results of the analysis can be used to aid in the design of studies to yield maximally informative data in pediatric populations of different ages and developmental stages and thereby improve the efficiency of study design.

Views and experiences of healthcare professionals towards the use of African traditional, complementary and alternative medicines among patients with HIV infection: the case of eThekwini health district, South Africa.

PubMed

Nlooto, Manimbulu

2015-06-06

Many patients with human immunodeficiency virus infection use traditional, complementary, and alternative medicines and other practices to combat the disease, with some also using prescribed antiretroviral therapy provided by the public health sector. This study aimed to establish the awareness of public sector biomedical health care providers on the use of traditional, complementary and alternative medicines by HIV-infected patients who also used highly active antiretroviral therapy, and to determine whether this was based on patients seen or cases being reported to them. Potential risks of interactions between the prescribed antiretroviral and non-prescribed medication therapies may pose safety and effectiveness issues in patients using both types of treatment. A descriptive cross-sectional study, using a researcher administered semi-structured questionnaire, was conducted from June to August 2013 at ten public sector antiretroviral clinics in five regional, three specialised and two district hospitals in eThekwini Health District, South Africa. Questionnaires were administered through face-to face interview to 120 eligible participants consisting of doctors, nurses, pharmacists and post-basic pharmacist assistants in HIV clinical practice. The results are presented as percent or proportion with standard error (SE), or as frequency. Ninety-four respondents completed the questionnaire, yielding a response rate of 78.3 %. Almost half (48/94) were aware of patients using African traditional herbal medicines, over-the-counter supplements, unnamed complementary Ayurveda medicines and acupuncture. Twenty-three of the 94 respondents (24.4 %) said they had consulted patients who were using both antiretroviral therapy and certain types of non-prescribed medication in the previous three months. Awareness among healthcare providers on patient use of traditional, complementary and alternative medicines was relatively high. Few respondents had seen patients who used mostly African traditional medicines, over-the counter supplements, and negligible complementary Ayurveda medicines and acupuncture, with caution being advised in the interpretation of the former. Further research is needed to investigate communication between healthcare providers and patients in this regard, and levels of acceptance of traditional, complementary and alternative medicines by biomedical health care workers in HIV public sector practice.

Cough and Cold Medicine (DXM and Codeine Syrup)

MedlinePlus

... View Online Download PDF Monitoring the Future 2017 Survey Results Published: December 12, 2017 This infographic of ... View Online Download PDF Monitoring the Future 2016 Survey Results Published: December 13, 2016 This infographic of ...

The effect of pH on citric acid cough challenge: A randomised control trial in chronic cough and healthy volunteers.

PubMed

Rai, Z L; Fowles, H E; Wright, C; Howard, Joseph; Morice, A H

2018-03-06

Citric acid has been used for over six decades to induce cough; however the mechanism of its pro-tussive effect is still not fully understood. We assessed the response to inhalation of citric acid at varying levels of acidity to determine if the pH of the solution plays a role in the induction of cough. Data was collected from both healthy volunteers and patients with chronic cough. 20 chronic cough patients and 20 healthy volunteers were recruited and underwent three cough challenges on separate days. Each visit involved 5 repeated one second inhalations of 300 mM citric acid solution. The concentration of the citrate cation remained constant, but the pH of the solution altered by the addition of sodium bicarbonate to 3, 5 and 6, representing the pK a values of the individual acid moieties. The total number of coughs elicited was recorded for each inhalation. Two subjects withdrew and were not included in the analysis. Participants were gender matched, each group consisting of 12 females. 74% of chronic coughers coughed at pH 3 (mean coughs 16), 89% coughed at pH 5 (18) and 63% coughed at pH 6 (7). In healthy volunteers, 60% of subjects coughed at pH 3 (9), 30% of subjects coughed at pH 5 (3), and 10% of subjects coughed at pH 6 (0). Thus chronic cough patients coughed more than healthy volunteers and did not exhibit a clear pH concentration response. There was also a greater variability in their response to individual challenges. Copyright © 2018 Elsevier B.V. All rights reserved.

Continuous Cough Monitoring Using Ambient Sound Recording During Convalescence from a COPD Exacerbation.

PubMed

Crooks, Michael G; den Brinker, Albertus; Hayman, Yvette; Williamson, James D; Innes, Andrew; Wright, Caroline E; Hill, Peter; Morice, Alyn H

2017-06-01

Cough is common in chronic obstructive pulmonary disease (COPD) and is associated with frequent exacerbations and increased mortality. Cough increases during acute exacerbations (AE-COPD), representing a possible metric of clinical deterioration. Conventional cough monitors accurately report cough counts over short time periods. We describe a novel monitoring system which we used to record cough continuously for up to 45 days during AE-COPD convalescence. This is a longitudinal, observational study of cough monitoring in AE-COPD patients discharged from a single teaching hospital. Ambient sound was recorded from two sites in the domestic environment and analysed using novel cough classifier software. For comparison, the validated hybrid HACC/LCM cough monitoring system was used on days 1, 5, 20 and 45. Patients were asked to record symptoms daily using diaries. Cough monitoring data were available for 16 subjects with a total of 568 monitored days. Daily cough count fell significantly from mean ± SEM 272.7 ± 54.5 on day 1 to 110.9 ± 26.3 on day 9 (p < 0.01) before plateauing. The absolute cough count detected by the continuous monitoring system was significantly lower than detected by the hybrid HACC/LCM system but normalised counts strongly correlated (r = 0.88, p < 0.01) demonstrating an ability to detect trends. Objective cough count and subjective cough scores modestly correlated (r = 0.46). Cough frequency declines significantly following AE-COPD and the reducing trend can be detected using continuous ambient sound recording and novel cough classifier software. Objective measurement of cough frequency has the potential to enhance our ability to monitor the clinical state in patients with COPD.

Treatment of Chronic Cough.

PubMed

Soni, Resha S; Ebersole, Barbara; Jamal, Nausheen

2017-01-01

Objective Chronic cough remains a challenging condition, especially in cases where it persists despite comprehensive medical management. For these particular patients, there appears to be an emerging role for behavior modification therapy. We report a series of patients with refractory chronic cough to assess if there is any benefit of adding behavioral therapy to their treatment regimen. Study Design A case series with planned chart review of patients treated for chronic cough. Setting The review was performed with an outpatient electronic health record system at a tertiary care center. Subjects and Methods The charts of all patients treated for chronic cough by a single laryngologist over a 30-month period were analyzed. Patients' response to treatment and rate of cough improvement were assessed for those with refractory chronic cough who underwent behavior modification therapy. Results Thirty-eight patients with chronic cough were initially treated empirically for the most common causes of cough, of which 32% experienced improvement. Nineteen patients who did not significantly improve with medical management underwent behavior modification therapy with a speech-language pathologist. Of these patients, 84% experienced resolution or marked improvement of their symptoms. Conclusion Behavioral therapy may be underutilized in practice and could lead to improvement of otherwise recalcitrant cough.

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

PubMed Central

Balbani, Aracy Pereira Silveira

2012-01-01

Summary 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 anti-cough 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. PMID:25991944

Emergency contraception: Focus on the facts.

PubMed

Najera, Deanna Bridge

2016-01-01

Significant progress on contraception, and in particular emergency contraception, has been made in the past decade. Emergency contraception was first introduced as a stand-alone prescription in 1998, and the interaction of politics and medicine meant a tumultuous course to the drug becoming available over the counter. This article reviews how emergency contraception works, the effectiveness of different methods, pros and cons, and the history of emergency contraception.

Effect of a Hypocretin/Orexin Antagonist on Neurocognitive Performance

DTIC Science & Technology

2013-12-18

9.28MARCH2013 AE Adverse Event AASM American Academv of Sleep Medicine BzRAs B enzo diazepine Receptor A goni sts CRC Clinical Research Center CCRC University...medical conditions; 12.) Current use of statins, ketoconazole, prescription or over- the-counter medications or herbal supplements containing...medications or herbal supplements containing psychoactive properties or stimulants in the judgment of the Investigator-Sponsor or Medical Monitor; 13

“Just Advil”: Harm reduction and identity construction in the consumption of Over-The-Counter medication for chronic pain Social Science & Medicine

PubMed Central

2015-01-01

Direct-to-consumer marketing has sparked ongoing debate concerning whether ads empower consumers to be agents of their own care or shift greater control to the pharmaceutical industry. Ads for over-the-counter (OTC) medications in particular portend to offer simple, harmless solutions for meeting the demands of social life. Rather than join the longstanding debate between consumer agency and social control in pharmaceutical advertising, I approach self-medication with over-the-counter (OTC) analgesics using Harm Reduction as a framework. From this perspective, consumption of OTC analgesics by chronic pain sufferers is a means of seeking some level of relief while also avoiding the stigma associated with prescription pain medication. Qualitative methods are used to analyze data from two sources: (1) semi-structured qualitative interviews with 95 participants in a trial examining the effectiveness of Traditional Chinese Medicine for Temporomandibular Disorders (TMD) from 2006 to 2011 in Tucson, AZ and Portland, OR; and (2) print, online, and television advertisements for three major brands of OTC pain medication. Participants described their use of OTC medications as minimal, responsible, and justified by the severity of their pain. OTC medication advertising, while ostensibly ambiguous and targeting all forms of pain, effectively lends support to the consumption of these medication as part of the self-projects of chronic pain sufferers, allowing them to reconcile conflicting demands for pain relief while being stoic and maintaining a positive moral identity. Describing OTC medication as “just over-the-counter” or “not real pain medication,” sufferers engage in ideological harm reduction, distinguishing themselves from “those people who like taking pain medication” while still seeking relief. Justifying one’s use of OTC medication as minimal and “normal,” regardless of intake, avoids association with the addictive potential of prescription pain medications and aligns the identity of the chronic pain sufferer with a culturally sanctioned identity as stoic bearer of pain. PMID:26517291

What do Cochrane systematic reviews say about new practices on integrative medicine?

PubMed

Riera, Rachel; Braga, Vinícius Lopes; Rocha, Luana Pompeu Dos Santos; Bernardo, Daniel Damasceno; Andrade, Luísa Avelar Fernandes de; Hsu, Jessica Chiu; Silva, Luciana Di Giovanni Marques da; Suetsugu, Rodrigo Cesar de Sá; Dittrich, Nicole Hosni; Lima, Lucas Riguete Pereira de; Silveira, Vicente Penido da; Kruglensky, Barbara Caon; Leonel, Letícia de Freitas; Barros, Edivando de Moura; Costa, Anderson Adriano Leal Freitas da; Quintella, Miguel Lins; Pacheco, Rafael Leite; Cruz, Carolina de Oliveira; Martimbianco, Ana Luiza Cabrera; Pachito, Daniela Vianna; Mozetic, Vania; Teixeira, Tatiana de Bruyn Ferraz; Torloni, Maria Regina; Atallah, Alvaro Nagib

2018-06-25

This study identified and summarized all Cochrane systematic reviews (SRs) on the effects of ten integrative practices that were recently added to the Brazilian public healthcare system (SUS). Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp). Review of Cochrane SRs on the following interventions were identified, summarized and critically assessed: apitherapy, aromatherapy, bioenergetics, family constellation, flower therapy, chromotherapy, geotherapy, hypnotherapy, hand imposition or ozone therapy. We included a total of 16 SRs: 4 on apitherapy, 4 on aromatherapy, 6 on hypnotherapy and 2 on ozone therapy. No Cochrane SR was found regarding bioenergetics, family constellation, chromotherapy, clay therapy, flower therapy or hand imposition. The only high-quality evidence was in relation to the potential benefit of apitherapy, specifically regarding some benefits from honey dressings for partial healing of burn wounds, for reduction of coughing among children with acute coughs and for preventing allergic reactions to insect stings. Except for some specific uses of apitherapy (honey for burn wounds and for acute coughs and bee venom for allergic reactions to insect stings), the use of ten integrative practices that have recently been incorporated into SUS does not seem to be supported by evidence from Cochrane SRs.

Hernias

MedlinePlus

... induce hernias: obesity or sudden weight gain lifting heavy objects diarrhea or constipation persistent coughing or sneezing ... might include pain when you cough, lift something heavy, or bend over. These types of hernias require ...

Survey of medical ethnobotanicals for dental and oral medicine conditions and pathologies.

PubMed

Colvard, Michael D; Cordell, Geoffrey A; Villalobos, Rodrigo; Sancho, Gina; Soejarto, Doel D; Pestle, William; Echeverri, Tatiana Lobo; Perkowitz, Kathleen M; Michel, Joanna

2006-08-11

Ethnomedical questionnaires were distributed in Chicago, Costa Rica, and Colombia to identify the most common over-the-counter (OTC) plant or plant-based products advocated for treating oral pain, ulcerative conditions, and cancer within these locations. Over 100 plants or plant-based herbal preparations and commercial products, purchased from local botanical markets and pharmacies, were advocated for the treatment of oral medicine conditions. Locally familiar and common language names were attributed to the plant products at the time of purchase. Plant products or plant-based commercial products containing plant-based essential oils, anesthetic constituents, and or chemical compounds recommended as OTC oral medicine preparations were systematized, tabulated, and correlated with the published phytotherapeutic literature. Though pharmacognostic research is available for some of the species collected, further ethnographic research is needed to correlate common names with the accurate taxonomic identification for each plant species. Furthermore, epidemiological research is needed to verify the use and standardized dosage for OTC ethnomedicine preparations for oral medicine conditions. Pharmacognostic research and clinical trails which can verify taxonomy, dose, safety, active principles, and efficacy of these OTC oral medicine products must be enhanced in order to verify the claimed validity in contemporary, global, oral medicine practice.

Novel insights in cough and breathing patterns of patients with idiopathic pulmonary fibrosis performing repeated 24-hour-respiratory polygraphies.

PubMed

Schertel, Anke; Funke-Chambour, Manuela; Geiser, Thomas; Brill, Anne-Kathrin

2017-11-13

The main symptoms of patients with idiopathic pulmonary fibrosis (IPF) are cough and dyspnea. IPF leads to a restrictive lung disorder impacting daytime and nocturnal breathing patterns. In this pilot study we assessed the course of day- and nighttime respiration, oxygenation, and cough over a period of 8 months as well as differences between wakefulness and sleep in IPF patients. Repetitive 24-h respiratory polygraphies (RP) and pulmonary function tests were performed at baseline and after 3, 4, 7 and 8 months. Cough-index, oxygenation parameters (SpO2, time with SpO2 < 90%, desaturation index), respiratory rate and heart rate were assessed for differences between wakefulness and sleep. The first and the last RP were compared to identify changes of these parameters over time. Statistical analyses were performed with Wilcoxon signed rank tests. Nine IPF patients (8 male, median age 67 years (IQR 60, 77) with 37 valid 24-h RPs were included. Eight patients (88.9%) received antifibrotic treatment. Cough was more prevalent during wakefulness with a median cough-index of 14.8/h (IQR 10.9, 16.8) and 1.6/h (IQR 1.3-2.8) during sleep, p = 0.0039. Oxygenation parameters showed no difference, while respiratory- and heart rate were significantly higher during wakefulness. Despite stable pulmonary function tests over 8 months, the initially elevated respiratory rate increased further during wakefulness (baseline RR median 25.7/min (IQR 19.8, 26.6) vs. RR median 32.2/min (IQR 26.5, 40.9) at follow-up, p = 0.0273). The other respiratory parameters remained stable over time. Cough in IPF patients is more prevalent during wakefulness than during sleep. Further studies with a larger sample size and longer a follow-up period are needed to evaluate the role of the respiratory rate during wakefulness as a potential clinical follow up parameter in IPF.

Herbal remedies and clinical biochemistry.

PubMed

Corns, Cathryn M

2003-09-01

The use of herbal products in the UK is increasing, and over-the-counter herbal supplements are perceived by the public as 'safe' and 'harmless'. Although the majority of them are safe, some herbal medicines carry risks. Heavy metal contamination, adulteration with Western pharmaceuticals and inclusion of prohibited animal and plant ingredients are regularly reported in ethnic medicines. Other herbs are hepato- or nephrotoxic and some interact with prescription medicines. Doctors should be made aware of the need to take a herbal as well as a drug history, and the clinical laboratory has a role in helping understanding of how herbal products may affect laboratory tests and in suggesting relevant lines of investigation in patients whose symptoms may be linked to the use of herbal products.

The Abuse of Dextromethorphan-Based Cough Syrup: A Pilot Study of the Community of Waynesboro, Pennsylvania.

ERIC Educational Resources Information Center

Momodou, N. Darboe; And Others

1996-01-01

Discusses the emergence of a new type of abused drug, dextromethorphan, which is used in cough syrup. Presents the results of the first phase of a comprehensive investigation of this phenomenon in the Waynesboro, Pa. school district. Survey data indicate abuse of cough syrup has increased over the years and is increasingly perceived as a problem…

How do Danish community pharmacies vary in engaging customers in medicine dialogues at the counter - an observational study.

PubMed

Kaae, Susanne; Saleem, Sahdia; Kristiansen, Maria

2014-07-01

Counter counseling is an important part of community pharmacies service delivery. Difficulties arise because customers appear less interested than the staff in discussing their medicine. It is unclear how individual pharmacies differ with regard to overcoming these obstacles. This study explores differences in the communication practices of pharmacies with regard to engaging customers in medicine dialogues. The work of Stevenson et al. describing five types of interaction scenarios at the counter was used for structured overt non-participant observations of 100 encounters in each of five Danish pharmacies. Variation in pharmacies success in engaging customers in medicine dialogues were calculated using descriptive statistics, and the statistical significance of observed differences across pharmacies was analyzed using odds ratios (OR). Considerable differences between the pharmacies were identified. Differences exist in how often pharmacy staff attempts to encourage customers to participate in medication dialogues and how often they succeed. The pharmacies serving the most customers per day were the most successful. A possible link between a low number of refill customers offered counseling and 'success rate' was identified. The pharmacies showed considerable variation in attempts to engage customers in medication dialogues at the counter and success in doing so. The reasons for the identified patterns are unclear.

How do Danish community pharmacies vary in engaging customers in medicine dialogues at the counter – an observational study

PubMed Central

Kaae, Susanne; Saleem, Sahdia; Kristiansen, Maria

2014-01-01

Background Counter counseling is an important part of community pharmacies service delivery. Difficulties arise because customers appear less interested than the staff in discussing their medicine. It is unclear how individual pharmacies differ with regard to overcoming these obstacles. Objective This study explores differences in the communication practices of pharmacies with regard to engaging customers in medicine dialogues. Methods The work of Stevenson et al. describing five types of interaction scenarios at the counter was used for structured overt non-participant observations of 100 encounters in each of five Danish pharmacies. Variation in pharmacies success in engaging customers in medicine dialogues were calculated using descriptive statistics, and the statistical significance of observed differences across pharmacies was analyzed using odds ratios (OR). Results Considerable differences between the pharmacies were identified. Differences exist in how often pharmacy staff attempts to encourage customers to participate in medication dialogues and how often they succeed. The pharmacies serving the most customers per day were the most successful. A possible link between a low number of refill customers offered counseling and ‘success rate’ was identified. Conclusions The pharmacies showed considerable variation in attempts to engage customers in medication dialogues at the counter and success in doing so. The reasons for the identified patterns are unclear. PMID:25243031

Factors that influence Italian consumers' understanding of over-the-counter medicines and risk perception.

PubMed

Calamusa, Andrea; Di Marzio, Alessandra; Cristofani, Renza; Arrighetti, Paola; Santaniello, Vincenzo; Alfani, Simona; Carducci, Annalaura

2012-06-01

To evaluate information needs for safe self-medication we explored the Italian consumers' functional health literacy, specific knowledge and risk awareness about over-the-counter (OTC) medicines. A survey was conducted in the health sections of six large super stores. Data were collected from a convenience sample of 1.206 adults aged 18 years and older through a self-administered questionnaire. Around 42% confused the concept of "contraindications" with that of "side effects" and were unable to calculate simple dosages. Most respondents were aware of the OTC general potential for side effects but 64.3% did not know that people with high blood pressure should use painkillers with cautions and 14.0% and 20.0% were unaware of the risks of long-term use of laxatives and nasal decongestants respectively. Higher total scores were obtained from women, highly educated people and those citing package leaflets as information sources. The study, the first of this type in Italy, showed an incomplete awareness of several risk areas, with regard to drug interactions and misuse/abuse. The results of this study were the basis of a following intervention plan tailored to the observed consumer needs and including information tools for customers and courses for the retail pharmacists. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Barriers and Facilitators for Information Exchange during Over-The-Counter Consultations in Community Pharmacy: A Focus Group Study

PubMed Central

Seubert, Liza J; Boeni, Fabienne; Hattingh, Laetitia; Clifford, Rhonda M

2017-01-01

Consumers are confident managing minor ailments through self-care, often self-medicating from a range of over-the-counter (OTC) medicines available from community pharmacies. To minimise risks, pharmacy personnel endeavour to engage in a consultation when consumers present with OTC enquiries however they find consumers resistant. The aim was to determine stakeholder perspectives regarding barriers and facilitators for information exchange during OTC consultations in community pharmacies and to understand the elicited themes in behavioural terms. Focus groups were undertaken with community pharmacist, pharmacy assistant and consumer participants. Independent duplicate analysis of transcription data was conducted using inductive and framework methods. Eight focus groups involving 60 participants were conducted. Themes that emerged indicated consumers did not understand pharmacists’ professional role, they were less likely to exchange information if asking for a specific product than if asking about symptom treatment, and they wanted privacy. Consumers were confident to self-diagnose and did not understand OTC medicine risks. Pharmacy personnel felt a duty of care to ensure consumer safety, and that with experience communication skills developed to better engage consumers in consultations. They also identified the need for privacy. Consumers need education about community pharmacists’ role and responsibilities to motivate them to engage in OTC consultations. They also require privacy when doing so. PMID:29211054

Don’t Ask, Don’t Tell: Parental Nondisclosure of Complementary and Alternative Medicine and Over-the-Counter Medication Use in Children’s Asthma Management

PubMed Central

Sidora-Arcoleo, Kimberly; Yoos, H. Lorrie; Kitzman, Harriet; McMullen, Ann; Anson, Elizabeth

2008-01-01

Background Parent-healthcare provider (HCP) communication is an important component of pediatric asthma management. Given the high prevalence of complementary and alternative medicine (CAM) and over-the-counter (OTC) medication use among this population, it is important to examine parental nondisclosure of these asthma management strategies. Method One-time interview and one-year retrospective medical record review with 228 parents of 5–12 year old children with asthma enrolled from 6 pediatric primary care practices examining parental nondisclosure of CAM and OTC medication use, reasons for nondisclosure, medical record documentation of CAM usage, and association between parent-HCP relationship and nondisclosure. Results Seventy-one percent of parents reported using CAM and/or OTC medication for children’s asthma management and 54% of those parents did not disclose usage. Seventy-five percent “did not think” to discuss it. Better parent-HCP relationship led to decreased nondisclosure. Discussion HCPs can play an important role in creating an environment where parents feel comfortable sharing information about their children’s asthma management strategies in order to arrive at a shared asthma management plan for the child leading to improved asthma health outcomes. PMID:18590866

Chronic cough postacute respiratory illness in children: a cohort study.

PubMed

O'Grady, Kerry-Ann F; Drescher, Benjamin J; Goyal, Vikas; Phillips, Natalie; Acworth, Jason; Marchant, Julie M; Chang, Anne B

2017-11-01

Data on the aetiology of persistent cough at the transitional stage from subacute to chronic cough (>4 weeks duration) are scarce. We aimed to (1) identify the prevalence of chronic cough following acute respiratory illness (ARI) and (2) determine the diagnostic outcomes of children with chronic cough. Prospective cohort study. A paediatric emergency department (ED) in Brisbane, Australia. Children aged <15 years presenting with an ARI with cough. Children were followed weekly for 28 days;those with a persistent cough at day 28 were reviewed by a paediatric pulmonologist. Cough persistence at day 28 and pulmonologist diagnosis. 2586 children were screened and 776 (30%) were ineligible; 839 children (median age=2.3 years, range=0.5 months to 14.7 years, 60% male) were enrolled over 2 years. Most children (n=627, 74.8%) had cough duration of <7 days at enrolment. At day 28, 171/839 (20.4%, 95% CI 17.7 to 23.1) children had persistent cough irrespective of cough duration at enrolment. The cough was wet in 59/171 (34.5%), dry in 45/171 (26.4%) and variable in 28/171 (16.1%). Of these 117 children , 117 (68.4%) were reviewed by a paediatric pulmonologist. A new and serious chronic lung disease was diagnosed in 36/117 (30.8%) children; 55/117 (47.0%) were diagnosed with protracted bacterial bronchitis. When chronic cough develops post-ARI, clinical review is warranted, particularly if parents report a history of prolonged or recurrent cough. Parents of children presenting acutely to ED with cough should be counselled about the development of chronic cough, as an underlying respiratory condition is not uncommon. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Multiwire Gamma Camera for Radionuclide and Radiographic Imaging in the Space environment

NASA Technical Reports Server (NTRS)

Lacy, Jeffrey L.

1985-01-01

Unique multiwire proportional counter technology has been developed at the Johnson Space Center over the past several years. The technology will be described and how it may apply both in near- and long-term NASA efforts. In the near-term, I feel that the technology will provide a significant tool for the cardiovascular research area. In particular, low-dose nuclear medicine and tissue densitometry techniques of expanded scope will be supplied. In the longer term, the multiwire technique can provide a general purpose radiology and nuclear medicine facility for use in the space station which would be difficult and costly to provide by other means.

Influences on participant reporting in the World Health Organisation drugs exposure pregnancy registry; a qualitative study.

PubMed

Allen, Elizabeth N; Gomes, Melba; Yevoo, Lucy; Egesah, Omar; Clerk, Christine; Byamugisha, Josaphat; Mbonye, Anthony; Were, Edwin; Mehta, Ushma; Atuyambe, Lynn M

2014-10-31

The World Health Organisation has designed a pregnancy registry to investigate the effect of maternal drug use on pregnancy outcomes in resource-limited settings. In this sentinel surveillance system, detailed health and drug use data are prospectively collected from the first antenatal clinic visit until delivery. Over and above other clinical records, the registry relies on accurate participant reports about the drugs they use. Qualitative methods were incorporated into a pilot registry study during 2010 and 2011 to examine barriers to women reporting these drugs and other exposures at antenatal clinics, and how they might be overcome. Twenty-seven focus group discussions were conducted in Ghana, Kenya and Uganda with a total of 208 women either enrolled in the registry or from its source communities. A question guide was designed to uncover the types of exposure data under- or inaccurately reported at antenatal clinics, the underlying reasons, and how women prefer to be asked questions. Transcripts were analysed thematically. Women said it was important for them to report everything they had used during pregnancy. However, they expressed reservations about revealing their consumption of traditional, over-the-counter medicines and alcohol to antenatal staff because of anticipated negative reactions. Some enrolled participants' improved relationship with registry staff facilitated information sharing and the registry tools helped overcome problems with recall and naming of medicines. Decisions about where women sought care, which influenced medicines used and antenatal clinic attendance, were influenced by pressure within and outside of the formal healthcare system to conform to conflicting behaviours. Conversations also reflected women's responsibilities for producing a healthy baby. Women in this study commonly take traditional medicines in pregnancy, and to a lesser extent over-the-counter medicines and alcohol. The World Health Organisation pregnancy registry shows potential to enhance their reporting of these substances at the antenatal clinic. However, more work is needed to find optimal techniques for eliciting accurate reports, especially where the detail of constituents may never be known. It will also be important to find ways of sustaining such drug exposure surveillance systems in busy antenatal clinics.

Medicine reclassification processes and regulations for proper use of over-the-counter self-care medicines in Japan

PubMed Central

Nomura, Kaori; Kitagawa, Yuki; Yuda, Yasukatsu; Takano-Ohmuro, Hiromi

2016-01-01

Objectives Japan has actively reclassified substances ranging from prescription drugs to over-the-counter (OTC) drugs in recent years. The sale of most OTC drugs was deregulated several times and pharmacists’ supervision was deemed no longer mandatory. Japan established a new OTC evaluation system in 2015 to hear opinions from various stakeholders regarding medicine types to be reclassified. This study aimed to examine the new framework to identify candidate substances for reclassification. Moreover, we examined how to manage the safe, self-care use of OTC drugs in Japan. Methods The necessary regulatory information on OTC approvals as of January 2015 was collected using an Internet search and relevant databases. To highlight the characteristics of OTC drugs in Japan, the UK was selected as a comparison country because it too was actively promoting the reclassification of medicines from prescription to nonprescription status, and because of economic similarity. Results Japan and the UK have a risk-based classification for nonprescription medicines. Japan has made OTC drugs available with mandatory pharmacists’ supervision, face-to-face with pharmacists, or online instruction, which is similar to the “pharmacy medicine” practiced in the UK. Japan recently reformed the reclassification process to involve physicians and the public in the process; some interactions were back to “prescription-only medicine” in the UK. Conclusion It is expected that the opinion of marketers, medical professionals, and the public will improve the discussion that will greatly contribute to the safe use of drugs. Monitoring the new system will be noteworthy to ensure that OTC drug users are managing their self-care properly and visiting a doctor only when necessary. The supply methods are similar in Japan and the UK; however, the expected growth in the Japanese OTC market by the Cabinet and the industry is still uncertain. PMID:27555801

Responding to cough presentations: an interview study with Cambodian pharmacies participating in a National Tuberculosis Referral Program.

PubMed

Bell, Carolyn A; Pichenda, Koeut; Ilomäki, Jenni; Duncan, Gregory J; Eang, Mao Tan; Saini, Bandana

2016-04-01

Asia-Pacific carries a high burden of respiratory-related mortality. Timely referral and detection of tuberculosis cases optimizes patient and public health outcomes. Registered private pharmacies in Cambodia participate in a National Tuberculosis Referral Program to refer clients with cough suggestive of tuberculosis to public sector clinics for diagnosis and care. The objective of this study was to investigate clinical intentions of pharmacy staff when presented with a hypothetical case of a client with prolonged cough suggestive of tuberculosis. A random sample of 180 pharmacies was selected. Trained interviewers administered a hypothetical case scenario to trained pharmacy staff. Participants provided 'yes'/'no' responses to five clinical actions presented in the scenario. Actions were not mutually exclusive. Data were tabulated and compared using chi-square tests or Fisher's exact tests. Overall, 156 (92%) participants would have referred the symptomatic client in the case scenario. Participants who would have referred the client were less likely to sell a cough medicine (42% vs. 100%, P < 0.001) and less likely to sell an antibiotic (19% vs. 79%, P < 0.001) than those who would not have referred the client. Involving pharmacies in a Referral Program may have introduced concepts of appropriate clinical care when responding to clients presenting with cough suggestive of tuberculosis. However, results showed enhancing clinical competence among all referral programme participants particularly among non-referring pharmacies and those making concurrent sales of cough-related products would optimize pharmacy-initiated referral. Further research into actual clinical practices at Referral Program pharmacies would be justified. © 2015 John Wiley & Sons, Ltd.

Prolonged Cough in Pediatric Population First Line Care, Belgian Guidelines

PubMed Central

Leconte, Sophie; Valentin, Stéphanie; Dromelet, Estelle; De Jonghe, Michel

2017-01-01

Background: The clinical approach to a prolonged cough, i.e. a cough lasting more than three weeks, is challenging for general practitioners as well for primary care pediatricians. What the recommended clinical approach in primary care is, how cough duration or cough characteristics impact the diagnosis, and what the efficiency and safety of antibiotics or symptomatic treatments are remain in question for primary care physicians. Objective: The last Belgian guidelines were published in 2006 and needed to be reviewed. Those background questions were used to conduct our guideline updating procedure. Methods: We systematically performed a pyramidal literature search between the periods 2006-2014 in order to write evidence based guidelines. The data of the literature was summarized, discussed by the authors, experts and the Belgian primary care guidelines committee. Recommendations were formulated and scored following the GRADE classification. Results: The consultation history as well as the physical examination should be directed towards searching for warning signs (GRADE 1B) and towards the common etiologies depending on cough duration (GRADE 2C). If the cough lasts for more than eight weeks, chest radiography and spirometry should be considered (GRADE 2C). An antibiotic is recommended for a prolonged wet cough (over eight weeks) if prolonged bacterial bronchitis is suspected (GRADE 1B). In the absence of clinical signs of a specific etiology of a cough, no drug can be recommended (GRADE 1B). For all cases, it is initially suggested to avoid irritants (GRADE 1C) as well as to take into account the concerns of parents and inform them about the natural development of a cough. Conclusions: More research is needed to provide evidence on the clinical pathway on prolonged cough for primary care. Cough duration of more than eight weeks and prolonged wet cough are the most useful cough characteristics. Regarding a specific cough treatment, no medication has proved any effect greater than placebo. Attention to environmental triggers and patient-centered care remain the keystones of interventions PMID:29081858

[Treatment of cough in respiratory tract infections - the effect of combining the natural active compounds with thymol].

PubMed

Schönknecht, Karina; Krauss, Hanna; Jambor, Jerzy; Fal, Andrzej M

Cough is one of the characteristic symptoms of upper respiratory tract infections (URI). Herbal medicines are often used in the treatment of the cough associated with infection and to accelerate recovery or support the immune system. An example of such products are extracts of thyme and primrose, and also their combination with thymol. Thymus vulgaris is a spasmolytic, antimicrobial, anti-inflammatory, immunomodulatory and antioxidant agent. The most important component responsible for the activity of thyme is thymol contained in the volatile thyme oil. Primrose is, most of all, a saponine agent with expectorant and secretolytic activity, showing also spasmolytic, anti-inflammatory and antimicrobial effects. Because of the additive effects of the mentioned extracts and their wide activity profile they are often used as a combination drug. The use of this combination was assessed in the URI with the effects of alleviation of cough and dyspnea, and shortening the length of the disease. The effectiveness of the drug containing the extracts of thyme and primrose with the addition of thymol (Bronchosol®) was comparable to synthetic ambroxol and its safety has been proved. Moreover, the in-vitro antibacterial and antifungal effects of this drug have been evaluated.

How the elderly and young adults differ in the decision making process of nonprescription medication purchases.

PubMed

Sansgiry, S S; Cady, P S

1996-01-01

The study compared elderly and young adults in their behavior and involvement in the decision making process of over-the-counter (OTC) medication purchases. Elderly subjects were more involved in the decision making process to purchase OTC medications compared to young adults. The elderly not only purchase and spend more money on medications but also read OTC labels completely. They requested help from the pharmacist more frequently than young adults. Needs of the elderly in making an OTC medication purchase were different compared to young adults. The two age groups differed on importance rating for several attributes regarding OTC medications, such as; ease of opening the package, child resistant package, side effects of medicine, manufacturer of medicine, print size on package labels, and greater choice of medicine.

Therapeutic-diagnostic Evaluation of Chronic Cough Amongst Adults: Causes, Symptoms and Management at the Primary Care Level, Malaysia.

PubMed

Nantha, Yogarabindranath Swarna

2014-07-01

Patients presenting with chronic cough pose a common diagnostic dilemma during routine consultations at public primary care clinics in Malaysia. To date, there has been little attempt at designing a standardized model or algorithm to facilitate an accurate diagnosis of chronic cough. This study proposes a clinical method to detect the causes of chronic cough in a primary care setting in Malaysia. A total of 117 patients aged above 18 at an urban primary care clinic were tracked over a span of 5 months to diagnose the cause of chronic cough. A therapeutic-diagnostic method was employed to help identify the causes of chronic cough. Subsequently, the demographic details of patients, the prevalence of the different causes of chronic cough and the relationship between history and diagnosis were analyzed statistically. Chronic cough had a slightly higher male preponderance (51.3% vs. 48.7%). Patients within the 'above 60' age category had the highest frequency of chronic cough. The most common cause of chronic cough was post-infectious cough (n = 42, 35.9%), followed closely by angiotensin-converting enzyme-inhibitor related cough (n = 14, 12%). Majority of patients had the symptom of phlegm production (n = 41, 54%). 33 patients (29.2%) had recent upper respiratory tract infection (<2 weeks ago) prior to the diagnosis of chronic cough. There were poor association between symptoms and the various entities comprising chronic cough. The exceptions were the following associations: (1) Bronchial asthma and itchiness of throat (P = 0021), (2) gastroesophageal reflux disease and heartburn (P < 0.001), (3) upper airway cough syndrome and running nose (P = 0.016) and (4) pulmonary tuberculosis and absence of weight loss (P = 0.004). This study demonstrates that the effectiveness of a therapeutic-diagnostic technique in the diagnosis of chronic cough. Consistent with previous studies, there was poor association between most symptoms and the causes of chronic cough. A study involving a larger primary care population is required to confirm the findings found in this analysis.

An acute cough-specific quality-of-life questionnaire for children: Development and validation.

PubMed

Anderson-James, Sophie; Newcombe, Peter A; Marchant, Julie M; O'Grady, Kerry-Ann F; Acworth, Jason P; Stone, D Grant; Turner, Catherine T; Chang, Anne B

2015-05-01

Patient-relevant outcome measures are essential for high-quality clinical research, and quality-of-life (QoL) tools are the current standard. Currently, there is no validated children's acute cough-specific QoL questionnaire. The objective of this study was to develop and validate the Parent-proxy Children's Acute Cough-specific QoL Questionnaire (PAC-QoL). Using focus groups, a 48-item PAC-QoL questionnaire was developed and later reduced to 16 items by using the clinical impact method. Parents of children with a current acute cough (<2 weeks) at enrollment completed 2 validated cough score measures, the preliminary 48-item PAC-QoL, and 3 other questionnaires (the State Trait Anxiety Inventory [STAI], the Short-Form 8-item 24-hour recall Health Survey [SF-8], and the Depression, Anxiety, and Stress 21-item Scale [DASS21]). All measures were repeated on days 3 and 14. The median age of the 155 children enrolled was 2.3 years (interquartile range, 1.3-4.6). Median cough duration at enrollment was 3 days (interquartile range, 2-5). The reduced 16-item scale had high internal consistency (Cronbach α = 0.95). Evidence for repeatability and criterion validity was shown by significant correlations between the domains and total PAC-QoL scores and the SF-8 (r = -0.36 and -0.51), STAI (r = -0.27 and -0.39), and DASS21 (r = -0.32 and -0.41) scales on days 0 and 3, respectively. The final PAC-QoL questionnaire was sensitive to change over time, with changes significantly relating to changes in cough score measures (P < .001). The 16-item PAC-QoL is a reliable and valid outcome measure that assesses QoL related to childhood acute cough at a given time point and reflects changes in acute cough-specific QoL over time. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Improved Cough and Cough-Specific Quality of Life in Patients Treated for Scleroderma-Related Interstitial Lung Disease: Results of Scleroderma Lung Study II.

PubMed

Tashkin, Donald P; Volkmann, Elizabeth R; Tseng, Chi-Hong; Roth, Michael D; Khanna, Dinesh; Furst, Daniel E; Clements, Philip J; Theodore, Arthur; Kafaja, Suzanne; Kim, Grace Hyun; Goldin, Jonathan; Ariolla, Edgar; Elashoff, Robert M

2017-04-01

Cough is a common symptom of scleroderma-related interstitial lung disease (SSc-ILD), but its relationship to other characteristics of SSc-ILD, impact on cough-specific quality of life (QoL), and response to therapy for SSc-ILD have not been well studied. We investigated frequent cough (FC) in patients with SSc-ILD (N = 142) enrolled in the Scleroderma Lung Study II, a randomized controlled trial comparing mycophenolate mofetil (MMF) and oral cyclophosphamide (CYC) as treatments for interstitial lung disease (ILD). We determined the impact of FC on QoL (Leicester Cough Questionnaire [LCQ]), evaluated the change in FC in response to treatment for SSc-ILD, and examined the relationship between gastroesophageal reflux disease (GERD) and cough during the trial. Study participants who reported FC at baseline (61.3%) reported significantly more dyspnea, exhibited more extensive ILD on high-resolution CT, had a lower diffusing capacity for carbon monoxide, and reported more GERD symptoms than did those without FC. Cough-specific QoL was modestly impaired in patients with FC (total LCQ score, 15.4 ± 3.7; normal range, 3-21 [higher scores indicate worse QoL]). The proportion of patients with FC at baseline declined by 44% and 41% over 2 years in the CYC and MMF treatment arms, respectively, and this decline was significantly related to changes in GERD and ILD severity. FC occurs commonly in SSc-ILD, correlates with both the presence and severity of GERD and ILD at baseline, and declines in parallel with improvements in both ILD and GERD over a 2-year course of therapy. Frequent cough might serve as a useful surrogate marker of treatment response in SSc-ILD trials. ClinicalTrials.gov; No.: NCT00883129; URL: www.clinicaltrials.gov. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Weather and headache onset: a large-scale study of headache medicine purchases

NASA Astrophysics Data System (ADS)

Ozeki, Kayoko; Noda, Tatsuya; Nakamura, Mieko; Ojima, Toshiyuki

2015-04-01

It is widely recognized that weather changes can trigger headache onset. Most people who develop headaches choose to self-medicate rather than visit a hospital or clinic. We investigated the association between weather and headache onset using large-sample sales of the headache medicine, loxoprofen. We collected daily sales figures of loxoprofen and over-the-counter drugs over a 1-year period from a drugstore chain in western Shizuoka prefecture, Japan. To adjust for changes in daily sales of loxoprofen due to social environmental factors, we calculated a proportion of loxoprofen daily sales to over-the-counter drug daily sales. At the same time, we obtained weather data for the study region from the website of the Japan Meteorological Agency. We performed linear regression analysis to ascertain the association between weather conditions and the loxoprofen daily sales proportion. We also conducted a separate questionnaire survey at the same drugstores to determine the reason why people purchased loxoprofen. Over the study period, we surveyed the sale of hundreds of thousands of loxoprofen tablets. Most people purchased loxoprofen because they had a headache. We found that the sales proportion of loxoprofen increased when average barometric pressure decreased, and that precipitation, average humidity, and minimum humidity increased on loxoprofen purchase days compared to the previous day of purchases. This study, performed using a large dataset that was easy-to-collect and representative of the general population, revealed that sales of loxoprofen, which can represent the onset and aggravation of headache, significantly increased with worsening weather conditions.

Methods of recording and analysing cough sounds.

PubMed

Subburaj, S; Parvez, L; Rajagopalan, T G

1996-01-01

Efforts have been directed to evolve a computerized system for acquisition and multi-dimensional analysis of the cough sound. The system consists of a PC-AT486 computer with an ADC board having 12 bit resolution. The audio cough sound is acquired using a sensitive miniature microphone at a sampling rate of 8 kHz in the computer and simultaneously recorded in real time using a digital audio tape recorder which also serves as a back up. Analysis of the cough sound is done in time and frequency domains using the digitized data which provide numerical values for key parameters like cough counts, bouts, their intensity and latency. In addition, the duration of each event and cough patterns provide a unique tool which allows objective evaluation of antitussive and expectorant drugs. Both on-line and off-line checks ensure error-free performance over long periods of time. The entire system has been evaluated for sensitivity, accuracy, precision and reliability. Successful use of this system in clinical studies has established what perhaps is the first integrated approach for the objective evaluation of cough.

Correlates of Abusing and Misusing Over-the-Counter Pain Relievers Among Adult Population of Wrocław (Poland).

PubMed

Wójta-Kempa, Monika; Krzyżanowski, Dominik M

2016-01-01

Almost 90% of households in Poland buy medicines on their own initiative. The most popular OTC medicines bought by Polish consumers are painkillers and non-steroid-anti-inflammatory drugs. The aim of this article was to recognize and describe the most important predictive factors of the abuse and misuse of over-the-counter pain relievers among adults in Wrocław (Poland). The groups of users were selected and described. Some examples of misuse were analyzed. Three hundred eighty six adult inhabitants of Wrocław took part in the survey. The quota sample was representative referring to the most important socio-demographic factors (sex and median age). Almost 91% of participants declare taking OTC pain relievers, and 1.3% of them are their daily users. Only 6.2% of adult inhabitants of Wrocław never take OTC pain relievers. The category of "heavy users" embraces 11% of participants. The most important risk factors of overusing OTC pain relievers are sex (female), age over 55 years and the low health status. Only half of participants read the box label regularly and 25% of users admit they have modified recommended doses. Over 60% shortened recommended intervals between doses and 16% took two or more different pain medications (containing different substances). The non-medical purposes of using OTC pain relievers were: tiredness (7%), stressful situations (5.4%), and discomfort (18.4%). Some users take pain medications to cure hangovers (26%), or instead of the appropriate medicine (7%). About 20% take pain medications without a doctor's advice for longer than the recommended 3 days, and 10% never consult taking such medications with doctors. Pain should be treated aggressively and successfully, especially among chronically ill patients. We should monitor the consumption of OTC pain relievers and limit their current excessively supply and high availability.

Don't Double Up on Acetaminophen

MedlinePlus

... re at the store deciding which product to buy, check the 'Drug Facts' label of OTC cold, cough and flu ... If you’re still not sure which to buy, ask the pharmacist for advice. FDA has an ... medicines containing acetaminophen accounted for nearly half of all ...

Liquid chromatography/quadrupole-time-of-flight mass spectrometry with metabolic profiling of human urine as a tool for environmental analysis of dextromethorphan.

PubMed

Thurman, E Michael; Ferrer, Imma

2012-10-12

We use the combination of liquid chromatography/quadrupole-time-of-flight mass spectrometry (LC/Q-TOF-MS) and urine metabolic profiling to find and identify the metabolites of dextromethorphan, a common over-the-counter (OTC) cough suppressant. Next, we use the combination of ion masses, their MS/MS fragmentation, and retention times to determine dextromethorphan and its metabolites in surface water impacted by wastewater. Prior to this study, neither dextromethorphan nor its metabolites have been reported in surface water; in spite of its common use in over 100 various OTC medications. We found that the concentration of the dextrorphan metabolite in surface water greatly exceeded the parent compound by factors of 5-10 times, which reflects the urine profile, where parent compound is approximately <2% of the total excreted drug based on ion intensities. Urine profiling also indicated that glucuronide metabolites are major phase 2 products (92% of the total) in urine and then are completely hydrolyzed in wastewater to dextrorphan and N-demethyldextrorphan, which are phase 1 metabolites-a "kind of reversal" of human metabolism. Copyright © 2012 Elsevier B.V. All rights reserved.

Medicine use practices in management of symptoms of acute upper respiratory tract infections in children (≤12 years) in Kampala city, Uganda.

PubMed

Ocan, Moses; Aono, Mary; Bukirwa, Clare; Luyinda, Emmanuel; Ochwo, Cathy; Nsambu, Elastus; Namugonza, Stella; Makoba, Joseph; Kandaruku, Enock; Muyende, Hannington; Nakawunde, Aida

2017-09-21

Medicines are commonly accessed and used for management of illness in children without a prescription. This potentially increases the risk of unwanted treatment outcomes. We investigated medicine use practices in management of symptoms of acute upper respiratory tract infections among children (≤12 years) in households in Nakawa division, Kampala city. This was a cross-sectional study conducted among 390 randomly selected children. Data on use of medicines in children (≤12 years) during recent episode of acute upper respiratory tract infection was collected from their care takers using an interviewer administered questionnaire. A recall period of two weeks (14 days) was used in during data collection. The prevalence of giving children non-prescription antimicrobial medicines was 44.8% (38.3-52.2). The most common disease symptoms that the children reportedly had included flu, 84.9% (331/390), cough, 83.1% (324/390), and undefined fever, 69.7% (272/390). Medicines commonly given to children included, paracetamol 53.1% (207/390), Coartem 29.7% (116/390), cough linctus 20.8% (81/390), amoxicillin 18.9% (74/390), Co-trimoxazole 18.5% (72/390), and diphenhydramine 15.4% (60/390). The major sources of medicines given to the children was hospital/clinic, 57.26% (223/390). Most of the children, 81% were given more than one medicine at a time. The majority, 62.3% (243/390) of the care takers who gave the children medicine during the recent illness were not aware of any medicine (s) that should not be given to children. The predictors of non-prescription use of antimicrobial medicines in managing symptoms of acute upper respiratory tract infections in children included, medicines obtained from drug shop (PR: 1.45, CI: 1.14-1.85), medicines at home (PR: 1.8, CI: 0.83-1.198) and type of medicine (antimalarial) (PR: 2.8, CI: 1.17-6.68). Children are commonly given multiple medicines during episodes of acute upper respiratory tract infections with most antimicrobial agents accessed and used without a prescription in Kampala city, Uganda.

Pertussis-induced cough.

PubMed

Wang, Kay; Harnden, Anthony

2011-06-01

Pertussis (whooping cough) is one of the commonest vaccine preventable diseases in the UK, despite vaccination coverage being maintained for the last 15 years at over 90% among infants and the addition of a pre-school booster to the UK national immunisation programme in 2001. However, it is known that pertussis vaccine does not confer long-term immunity to clinical infection. Evidence of pertussis infection has been reported in 37% of children presenting in UK primary care and 20% of adolescents and adults presenting in Canadian health centres with persistent cough. In children and adults with persistent cough, paroxysmal coughing is the most sensitive indicator of pertussis, but has poor specificity and limited diagnostic value. Vomiting and whooping, particularly in combination, are stronger predictors of pertussis. Cough duration is longer in children than in adults with pertussis (median cough duration 112 days versus 42 days); individuals may take even longer to recover fully and regain previous levels of exercise tolerance. A diagnosis of pertussis may be confirmed by culture, Polymerase Chain Reaction (PCR) or serology. Single estimates of anti-pertussis toxin (PT) antibody titres in blood or oral fluid samples are highly specific. There are currently no proven efficacious treatments for pertussis-induced cough. Treatment with macrolide antibiotics reduces the duration of an individual's infectious period, but does not alter the duration of cough. Further research is needed to re-examine the epidemiology of pertussis in countries with different vaccination schedules, find efficacious treatments and develop methods of measuring cough frequency and severity in patients with pertussis-induced cough. Copyright © 2010. Published by Elsevier Ltd.

A brief review on the application of nanoparticle enclosed herbal medicine for the treatment of infective endocarditis.

PubMed

Namdari, Mehrdad; Eatemadi, Ali; Soleimaninejad, Maryam; Hammed, Aiyelabegan T

2017-03-01

Herbal medicines have been routinely employed all over the world dated back from the ancient time and have been identified by patients and physicians for their excellent therapeutic value as they have lower adverse effects when compared with the modern medicines. Phytotherapeutics requires a scientific technique to deliver the active herbal extract in a controlled manner to avoid repeated administration and increase patient compliance. This can be reached by fabricating a novel drug delivery systems (NDDS) for herbal components. NDDSs does not only decrease the repeated dose to overcome ineffectiveness, but also help to increase potency by decreasing toxicity and elevating drug bioavailability. Nano-sized DDS of herbal drugs have a potential application for improving the activity and countering the problems related to herbal medicines. Hence, application of nanocarriers as an NDDS in the traditional herbal medicine system is important to treat more chronic diseases like infectious endocarditis. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Worldwide withdrawal of medicinal products because of adverse drug reactions: a systematic review and analysis.

PubMed

Onakpoya, Igho J; Heneghan, Carl J; Aronson, Jeffrey K

2016-07-01

We have systematically identified medicinal products withdrawn worldwide because of adverse drug reactions, assessed the level of evidence used for making the withdrawal decisions, and explored the patterns of withdrawals over time. We searched PubMed, the WHO database of withdrawn products, and selected texts. We included products that were withdrawn after launch from 1950 onwards, excluding non-human and over-the-counter medicines. We assessed the levels of evidence on which withdrawals were based using the Oxford Center for Evidence Based Medicine Levels of Evidence. Of 353 medicinal products withdrawn from any country, only 40 were withdrawn worldwide. Anecdotal reports were cited as evidence for withdrawal in 30 (75%) and deaths occurred in 27 (68%). Hepatic, cardiac, and nervous system toxicity accounted for over 60% of withdrawals. In 28 cases, the first withdrawal was initiated by the manufacturer. The median interval between the first report of an adverse drug reaction that led to withdrawal and the first withdrawal was 1 year (range 0-43 years). Worldwide withdrawals occurred within 1 year after the first withdrawal in any country. In conclusion, the time it takes for drugs to be withdrawn worldwide after reports of adverse drug reactions has shortened over time. However, there are inconsistencies in current withdrawal procedures when adverse drug reactions are suspected. A uniform method for establishing worldwide withdrawal of approved medicinal products when adverse drug reactions are suspected should be developed, to facilitate global withdrawals. Rapid synthesis of the evidence on harms should be a priority when serious adverse reactions are suspected.

Drug Safety - Multiple Languages

MedlinePlus

... Expand Section Guide to Over the Counter Medications - English PDF Guide to Over the Counter Medications - Amarɨñña / ... Information Translations Guide to Over the Counter Medications - English PDF Guide to Over the Counter Medications - العربية ( ...

Reassessment of Occupational Health Among U.S. Air Force Remotely Piloted Aircraft (Drone) Operators

DTIC Science & Technology

2017-04-05

As a result, the U.S. Air Force (USAF) School of Aerospace Medicine was requested to conduct a field survey to assess for general areas of health...services; and reasons for increased prescription and over-the-counter medication usage ). The purpose of this study was to reevaluate for changes in...major commands within the continental United States completed the web-based survey , resulting in an estimated 40% response rate. Statistical analyses

Clinical Diagnosis of Bordetella Pertussis Infection: A Systematic Review.

PubMed

Ebell, Mark H; Marchello, Christian; Callahan, Maria

2017-01-01

Bordetella pertussis (BP) is a common cause of prolonged cough. Our objective was to perform an updated systematic review of the clinical diagnosis of BP without restriction by patient age. We identified prospective cohort studies of patients with cough or suspected pertussis and assessed study quality using QUADAS-2. We performed bivariate meta-analysis to calculate summary estimates of accuracy and created summary receiver operating characteristic curves to explore heterogeneity by vaccination status and age. Of 381 studies initially identified, 22 met our inclusion criteria, of which 14 had a low risk of bias. The overall clinical impression was the most accurate predictor of BP (positive likelihood ratio [LR+], 3.3; negative likelihood ratio [LR-], 0.63). The presence of whooping cough (LR+, 2.1) and posttussive vomiting (LR+, 1.7) somewhat increased the likelihood of BP, whereas the absence of paroxysmal cough (LR-, 0.58) and the absence of sputum (LR-, 0.63) decreased it. Whooping cough and posttussive vomiting have lower sensitivity in adults. Clinical criteria defined by the Centers for Disease Control and Prevention were sensitive (0.90) but nonspecific. Typical signs and symptoms of BP may be more sensitive but less specific in vaccinated patients. The clinician's overall impression was the most accurate way to determine the likelihood of BP infection when a patient initially presented. Clinical decision rules that combine signs, symptoms, and point-of-care tests have not yet been developed or validated. © Copyright 2017 by the American Board of Family Medicine.

Detecting paroxysmal coughing from pertussis cases using voice recognition technology.

PubMed

Parker, Danny; Picone, Joseph; Harati, Amir; Lu, Shuang; Jenkyns, Marion H; Polgreen, Philip M

2013-01-01

Pertussis is highly contagious; thus, prompt identification of cases is essential to control outbreaks. Clinicians experienced with the disease can easily identify classic cases, where patients have bursts of rapid coughing followed by gasps, and a characteristic whooping sound. However, many clinicians have never seen a case, and thus may miss initial cases during an outbreak. The purpose of this project was to use voice-recognition software to distinguish pertussis coughs from croup and other coughs. We collected a series of recordings representing pertussis, croup and miscellaneous coughing by children. We manually categorized coughs as either pertussis or non-pertussis, and extracted features for each category. We used Mel-frequency cepstral coefficients (MFCC), a sampling rate of 16 KHz, a frame Duration of 25 msec, and a frame rate of 10 msec. The coughs were filtered. Each cough was divided into 3 sections of proportion 3-4-3. The average of the 13 MFCCs for each section was computed and made into a 39-element feature vector used for the classification. We used the following machine learning algorithms: Neural Networks, K-Nearest Neighbor (KNN), and a 200 tree Random Forest (RF). Data were reserved for cross-validation of the KNN and RF. The Neural Network was trained 100 times, and the averaged results are presented. After categorization, we had 16 examples of non-pertussis coughs and 31 examples of pertussis coughs. Over 90% of all pertussis coughs were properly classified as pertussis. The error rates were: Type I errors of 7%, 12%, and 25% and Type II errors of 8%, 0%, and 0%, using the Neural Network, Random Forest, and KNN, respectively. Our results suggest that we can build a robust classifier to assist clinicians and the public to help identify pertussis cases in children presenting with typical symptoms.

[Prescription of systemic cold and cough drugs to children 0-13 years old. An unresolved problem].

PubMed

Cano Garcinuño, A; Casares Alonso, I; Rodríguez Barbero, J; Pérez García, I; Blanco Quirós, A

2013-01-01

Upper respiratory tract infections are the most common cause of paediatric consultation, generating a high volume of prescriptions of drugs with unfavourable risk-benefit ratio. The aim of this study is to describe the prescription of systemic cough and cold medicines to children under 14 years of age in Castilla y León and analyse its variability. A count was made of the prescriptions for the R05 therapeutic subgroup (antitussives and mucolytics) and the R01B pharmacological therapeutic subgroup (nasal decongestants for systemic use), prescribed for children under the age of 14 in the Public Health System between 2005-2010. The number of prescriptions was analysed as crude and age-adjusted rates, as well as a a multivariate analysis (Poisson regression) of the variability associated with health area, the urban/rural environment, age, and year of prescription. There were 806,785 prescriptions for systemic cough and cold drugs given to an exposed population of 1,580,229 person-years. Prescription rates (per 100 person-years) were 20.7 (antitussives), 7.0 (sympathomimetic) and 23.4 (mucolytics). These drugs were employed more often in children <4 years. The prescription of mucolytics and sympathomimetics was highest at age of 1 year (rates=41.9 and 18.7, respectively) and of antitussives at 3 years (35.7). Multivariate analysis showed that in rural areas the prescription was higher than in urban areas, and that there were also significant differences between health areas. Between 2005 and 2010 there was a high prescription of systemic cough and cold medicines, especially in children under 2 years old, and often outside the recommended conditions of use, and there was a high geographic variabilty. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier España. All rights reserved.

Self-medication in Central Saudi Arabia. Community pharmacy consumers' perspectives.

PubMed

Aljadhey, Hisham; Assiri, Ghada A; Mahmoud, Mansour A; Al-Aqeel, Sinaa; Murray, Michael

2015-03-01

To determine the prevalence of self-medication and assess the knowledge, attitudes, and perception of consumers toward self-medication. This cross-sectional survey was conducted over 4 weeks in May 2011 in Riyadh city, Kingdom of Saudi Arabia. Community pharmacies within 5 areas of the city (North, South, West, East, and Middle) were randomly selected for the study. All consumers were approached to participate in the study, with the exception of those buying cosmetic and medicinal equipments. A validated self-administered questionnaire was used to collect the data. A total of 538 out of 707 consumers attending community pharmacies in Riyadh city, agreed to participate in the study. Most responders were male (73%), 23-33 years old (35%), and college graduates (42%). A total of 285 medications were bought without a prescription. Of these, 149 (49%) medications should be dispensed by prescription only, and 155 (51%) were over the counter medications. The most common prescription medications dispensed without prescriptions were antibiotics (22%) and analgesics/antipyretics (19%). The most common reasons for buying medications without a prescription were that the symptoms were too minor to visit a doctor (54%), time saving (40%), and minor illnesses for which the participants knew the required treatment (40%). Overall, most participants had poor knowledge, and negative perceptions regarding self-medication. More than 68% of participants did not know whether the medicine they bought is a prescription-only or over the counter medication. Irresponsible self-medication is common in Saudi Arabia. Future studies should focus on improving the consumers' awareness of self-medication and the proper use of medications.

"Just Advil": Harm reduction and identity construction in the consumption of over-the-counter medication for chronic pain.

PubMed

Eaves, Emery R

2015-12-01

Direct-to-consumer marketing has sparked ongoing debate concerning whether ads empower consumers to be agents of their own care or shift greater control to the pharmaceutical industry. Ads for over-the-counter (OTC) medications in particular portend to offer simple, harmless solutions for meeting the demands of social life. Rather than join the longstanding debate between consumer agency and social control in pharmaceutical advertising, I approach self-medication with over-the-counter (OTC) analgesics using Harm Reduction as a framework. From this perspective, consumption of OTC analgesics by chronic pain sufferers is a means of seeking some level of relief while also avoiding the stigma associated with prescription pain medication. Qualitative methods are used to analyze data from two sources: (1) semi-structured qualitative interviews with 95 participants in a trial examining the effectiveness of Traditional Chinese Medicine for Temporomandibular Disorders (TMD) from 2006 to 2011 in Tucson, AZ and Portland, OR; and (2) print, online, and television advertisements for three major brands of OTC pain medication. Participants described their use of OTC medications as minimal, responsible, and justified by the severity of their pain. OTC medication advertising, while ostensibly ambiguous and targeting all forms of pain, effectively lends support to the consumption of these medications as part of the self-projects of chronic pain sufferers, allowing them to reconcile conflicting demands for pain relief while being stoic and maintaining a positive moral identity. Describing OTC medication as "just over-the-counter" or "not real pain medication," sufferers engage in ideological harm reduction, distinguishing themselves from "those people who like taking pain medication" while still seeking relief. Justifying one's use of OTC medication as minimal and "normal," regardless of intake, avoids association with the addictive potential of prescription pain medications and aligns the identity of the chronic pain sufferer with a culturally sanctioned identity as stoic bearer of pain. Copyright © 2015 Elsevier Ltd. All rights reserved.

Severity of notified whooping cough.

PubMed Central

Miller, C L; Fletcher, W B

1976-01-01

An analysis was made of the severity of over 8000 cases of whooping cough notified from October 1974 to March 1975. Ten per cent of these patients were admitted to hospital and there were 10 deaths. Severity was directly related to age, the disease being most severe in children under 1 year, especially those under 6 months. There was some evidence that previous vaccination reduced the severity of the disease, but the vaccination programme does not cover very young children, and for them whooping cough is a dangerous disease. PMID:1247740

Over-the-counter Acne Treatments

PubMed Central

Graber, Emmy M.

2012-01-01

Acne is a common dermatological disorder that most frequently affects adolescents; however, individuals may be affected at all ages. Many people who suffer from acne seek treatment from both prescription and over-the-counter acne medications. Due to convenience, lower cost, and difficulty getting an appointment with a dermatologist, the use of over-the-counter acne treatments is on the rise. As the plethora of over-the-counter acne treatment options can be overwhelming, it is important that dermatologists are well-versed on this subject to provide appropriate information about treatment regimens and potential drug interactions and that their patients see them as well-informed. This article reviews the efficacy of various over-the-counter acne treatments based on the current literature. A thorough literature review revealed there are many types of over-the-counter acne treatments and each are designed to target at least one of the pathogenic pathways that are reported to be involved in the development of acne lesions. Many of the key over-the-counter ingredients are incorporated in different formulations to broaden the spectrum and consumer appeal of available products. Unfortunately, many over-the-counter products are not well-supported by clinical studies, with a conspicuous absence of double-blind or investigator-blind, randomized, vehicle-controlled studies. Most studies that do exist on over-the-counter acne products are often funded by the manufacturer. Use of over-the-counter acne treatments is a mainstay in our society and it is important that dermatologists are knowledgeable about the different options, including potential benefits and limitations. Overall, over-the-counter acne therapies can be classified into the following five major groups: cleansers, leave-on products, mechanical treatments, essential oils, and vitamins. PMID:22808307

Irrational prescribing of over-the-counter (OTC) medicines in general practice: testing the feasibility of an educational intervention among physicians in five European countries

PubMed Central

2014-01-01

Background Irrational prescribing of over-the-counter (OTC) medicines in general practice is common in Southern Europe. Recent findings from a research project funded by the European Commission (FP7), the “OTC SOCIOMED”, conducted in seven European countries, indicate that physicians in countries in the Mediterranean Europe region prescribe medicines to a higher degree in comparison to physicians in other participating European countries. In light of these findings, a feasibility study has been designed to explore the acceptance of a pilot educational intervention targeting physicians in general practice in various settings in the Mediterranean Europe region. Methods This feasibility study utilized an educational intervention was designed using the Theory of Planned Behaviour (TPB). It took place in geographically-defined primary care areas in Cyprus, France, Greece, Malta, and Turkey. General Practitioners (GPs) were recruited in each country and randomly assigned into two study groups in each of the participating countries. The intervention included a one-day intensive training programme, a poster presentation, and regular visits of trained professionals to the workplaces of participants. Reminder messages and email messages were, also, sent to participants over a 4-week period. A pre- and post-test evaluation study design with quantitative and qualitative data was employed. The primary outcome of this feasibility pilot intervention was to reduce GPs’ intention to provide medicines following the educational intervention, and its secondary outcomes included a reduction of prescribed medicines following the intervention, as well as an assessment of its practicality and acceptance by the participating GPs. Results Median intention scores in the intervention groups were reduced, following the educational intervention, in comparison to the control group. Descriptive analysis of related questions indicated a high overall acceptance and perceived practicality of the intervention programme by GPs, with median scores above 5 on a 7-point Likert scale. Conclusions Evidence from this intervention will estimate the parameters required to design a larger study aimed at assessing the effectiveness of such educational interventions. In addition, it could also help inform health policy makers and decision makers regarding the management of behavioural changes in the prescribing patterns of physicians in Mediterranean Europe, particularly in Southern European countries. PMID:24533792

Over-the-counter medications containing diphenhydramine and doxylamine used by older adults to improve sleep.

PubMed

Abraham, Olufunmilola; Schleiden, Loren; Albert, Steven M

2017-08-01

Background The unintentional misuse of over-the-counter sleep aids among older adults is an important public health problem and a focus of Healthy People 2020. Accordingly, the 2015 Beers Criteria for Potentially Inappropriate Medication Use in Older Adults recommends that individuals 65 years or older avoid use of diphenhydramine and doxylamine; however, many over-the-counter sleep products contain these active ingredients. Objective To identify the proportion of older adults using an over-the-counter medication containing diphenhydramine or doxylamine, and compare their characteristics with older adults using an over-the-counter medication that does not contain these ingredients. Setting Study participants were recruited from the Community Registry of the Pittsburgh Claude D. Pepper Older Americans Independence Center. Method The study sample was taken from a larger survey of 1025 participants on sleep health and over-the-counter sleep medication use conducted from February to April 2015. A subset of 169 participants aged 65 and older reporting taking at least one over-the-counter product to improve sleep within the past 30 days (16.5%) were selected for our analysis on associations between participant characteristics and potentially inappropriate use of over-the-counter sleep medications. Main outcome measure The proportion and characteristics of older adults taking at least one over-the-counter medication containing diphenhydramine or doxylamine. Results Of the 223 over-the-counter sleep medications listed by participants, 115 (52%) contained diphenhydramine or doxylamine. Using the Beers Criteria, we found that more than half of participants (59%) had used a potentially inappropriate over-the-counter medication containing diphenhydramine or doxylamine to improve sleep within the past 30 days. Participants taking at least one diphenhydramine or doxylamine containing medication were less likely to be aware of any safety risks in taking over-the-counter sleep medications than participants not taking these products (38 vs 49%, p = 0.016). Conclusion A majority of older adults in a limited sample from the United States taking an over-the-counter medication to improve sleep are taking a product containing diphenhydramine or doxylamine, both of which are classified as potentially inappropriate for older adults. Awareness of the safety risks of over-the-counter medications and addressing conditions that impact sleep quality could be facilitated through consultation with pharmacists and other healthcare providers.

Effects of a novel sodium channel blocker, GSK2339345, in patients with refractory chronic cough
.

PubMed

Smith, Jaclyn A; McGarvey, Lorcan P A; Badri, Huda; Satia, Imran; Warren, Francis; Siederer, Sarah; Liefaard, Lia; Murdoch, Robert D; Povey, Kathryn; Marks-Konczalik, Joanna

2017-09-01

Voltage-gated sodium channels (VGSC) are important in the initiation and propagation of action potentials in afferent sensory nerve fibers responsible for evoking cough. This study investigated the efficacy of GSK2339345, a VGSC inhibitor, in the treatment of refractory chronic cough (RCC). A three-part randomized, double-blind, placebo-controlled, cross-over study was conducted in the UK. In part A, patients with RCC received two inhaled doses of either GSK2339345 or placebo, 4 hours apart during three study periods. Patients were monitored for cough for 8 hours post-first dose using the VitaloJAK, ambulatory cough monitor. In parts B and C, patients underwent full dose-response cough challenges with capsaicin and citric acid respectively following single doses of randomly assigned GSK2339345 or placebo (4 study days). Part A was analyzed using a mixed effects model and parts B and C using population non-linear mixed effects models. Of 16 enrolled patients, 11 completed the study. 8-hour cough counts increased following GSK2339345 treatment compared with placebo (GSK2339345/placebo ratio of adjusted geometric means: 1.26 (90% credible interval 1.10, 1.44), associated with GSK2339345-evoked coughing, recorded during the 2 minutes post-dose. This was not observed with placebo. The effect of GSK2339345 on cough responses during cough challenges was inconclusive. GSK2339345 was well tolerated. While these data could not determine if GSK2339345 reached the target VGSC, they strongly suggest that GSK2339345 has no anti-tussive effect despite reaching airway sensory nerves as evidenced by the evoked transient cough.
.

Over-the-Counter Medicines - Multiple Languages

MedlinePlus

... this page, please enable JavaScript. Amharic (Amarɨñña / አማርኛ ) Arabic (العربية) Burmese (myanma bhasa) Dari (دری) Farsi (فارسی) Karen (S’gaw Karen) Kinyarwanda (Rwanda) Levantine (Arabic dialect) (الـلَّـهْـجَـةُ الـشَّـامِـيَّـة) Pashto (Pax̌tō / پښتو ) Somali (Af- ...

Factors associated with efficacy of an ibuprofen/pseudoephedrine combination drug in pharmacy customers with common cold symptoms.

PubMed

Klimek, Ludger; Schumacher, Helmut; Schütt, Tanja; Gräter, Heidemarie; Mueck, Tobias; Michel, Martin C

2017-02-01

The aim of this study was to explore factors affecting efficacy of treatment of common cold symptoms with an over-the-counter ibuprofen/pseudoephedrine combination product. Data from an anonymous survey among 1770 pharmacy customers purchasing the combination product for treatment of own common cold symptoms underwent post-hoc descriptive analysis. Scores of symptoms typically responsive to ibuprofen (headache, pharyngeal pain, joint pain and fever), typically responsive to pseudoephedrine (congested nose, congested sinus and runny nose), considered non-specific (sneezing, fatigue, dry cough, cough with expectoration) and comprising all 11 symptoms were analysed. Multiple regression analysis was applied to explore factors associated with greater reduction in symptom intensity or greater probability of experiencing a symptom reduction of at least 50%. After intake of first dose of medication, typically ibuprofen-sensitive, pseudoephedrine-responsive, non-specific and total symptoms were reduced by 60.0%, 46.3%, 45.4% and 52.8%, respectively. A symptom reduction of at least 50% was reported by 73.6%, 55.1%, 50.9% and 61.6% of participants, respectively. A high baseline score was associated with greater reductions in symptom scores but smaller probability of achieving an improvement of at least 50%. Across both multiple regression approaches, two tablets at first dosing were more effective than one and (except for ibuprofen-sensitive symptoms) starting treatment later than day 2 of the cold was generally less effective. Efficacy of an ibuprofen/pseudoephedrine combination in the treatment of common cold symptoms was dose-dependent and greatest when treatment started within the first 2 days after onset of symptoms. © 2016 The Authors. International Journal of Clinical Practice Published by John Wiley & Sons Ltd.

Olodaterol Attenuates Citric Acid-Induced Cough in Naïve and Ovalbumin-Sensitized and Challenged Guinea Pigs

PubMed Central

Wex, Eva; Bouyssou, Thierry

2015-01-01

Excessive coughing is a common feature of airway diseases. Different G-protein coupled receptors, including β2-adrenergic receptors (β2-AR), have been implicated in the molecular mechanisms underlying the cough reflex. However, the potential antitussive property of β2-AR agonists in patients with respiratory disease is a matter of ongoing debate. The aim of our study was to test the efficacy of the long-acting β2-AR agonist olodaterol with regard to its antitussive property in a pre-clinical model of citric acid-induced cough in guinea pigs and to compare the results to different clinically relevant β2-AR agonists. In our study β2-AR agonists were intratracheally administered, as dry powder, into the lungs of naïve or ovalbumin-sensitized guinea pigs 15 minutes prior to induction of cough by exposure to citric acid. Cough events were counted over 15 minutes during the citric acid exposure. Olodaterol dose-dependently inhibited the number of cough events in naïve and even more potently and with a greater maximal efficacy in ovalbumin-sensitized guinea pigs (p < 0.01). Formoterol and salmeterol showed a trend towards reducing cough. On the contrary, indacaterol demonstrated pro-tussive properties as it significantly increased the number of coughs, both in naïve and ovalbumin-sensitized animals (p < 0.001). In conclusion, olodaterol, at doses eliciting bronchodilation, showed antitussive properties in a model of citric acid-induced cough in naïve and ovalbumin-sensitized guinea pigs. This is in agreement with pre-clinical and clinical studies showing antitussive efficacy of β2-AR agonists. Indacaterol increased the number of coughs in this model, which concurs with clinical data where a transient cough has been observed after indacaterol inhalation. While the antitussive properties of β2-AR agonists can be explained by their ability to lead to the cAMP-induced hyperpolarization of the neuron membrane thereby inhibiting sensory nerve activation and the cough reflex, the mechanism underlying the pro-tussive property of indacaterol is not known. PMID:25781609

Transient receptor potential ankyrin receptor 1 is a novel target for pro-tussive agents.

PubMed

Andrè, E; Gatti, R; Trevisani, M; Preti, D; Baraldi, P G; Patacchini, R; Geppetti, P

2009-11-01

The transient receptor potential ankyrin receptor 1 (TRPA1) is a cation channel, co-expressed with the pro-tussive transient receptor potential vanilloid type 1 (TRPV1) channel in primary sensory neurons. TRPA1 is activated by a series of irritant exogenous and endogenous alpha,beta-unsaturated aldehydes which seem to play a role in airway diseases. We investigated whether TRPA1 agonists provoke cough in guinea pigs and whether TRPA1 antagonists inhibit this response. Animals were placed in a Perspex box, and cough sounds were recorded and counted by observers unaware of the treatment used. Inhalation of two selective TRPA1 agonists, allyl isothiocyanate and cinnamaldehyde, dose-dependently caused cough in control guinea pigs, but not in those with airway sensory nerves desensitized by capsaicin. Coughs elicited by TRPA1 agonists were reduced by non-selective (camphor and gentamicin) and selective (HC-030031) TRPA1 antagonists, whereas they were unaffected by the TRPV1 antagonist, capsazepine. Acrolein and crotonaldehyde, two alpha,beta-unsaturated aldehydes recently identified as TRPA1 stimulants and contained in cigarette smoke, air pollution or produced endogenously by oxidative stress, caused a remarkable tussive effect, a response that was selectively inhibited by HC-030031. Part of the cough response induced by cigarette smoke inhalation was inhibited by HC-030031, suggesting the involvement of TRPA1. A novel pro-tussive pathway involves the TRPA1 channel, expressed by capsaicin-sensitive airway sensory nerves and is activated by a series of exogenous (cigarette smoke) and endogenous irritants. These results suggest TRPA1 may be a novel target for anti-tussive medicines.

Social suffering and anxiety: deciphering coughs and colds at Akan anti-witchcraft shrines in Paris.

PubMed

Parish, Jane

2011-12-01

In treating illness and suffering, the Akan anti-witchcraft shrine is often presented as a model of unchanging, tightly bounded and antiquated ideals. This fails to acknowledge the extensive repertoire of Ghanaian witchcraft discourses and contemporary divinatory practices uncovered at Akan anti-witchcraft shrines. This paper analyses how one of the most popular Akan anti-witchcraft shrine in Europe, in an eastern banlieue of Paris, diagnoses the seemingly common and innocuous coughs and colds suffered by recently arrived, unskilled female Ghanaian migrants as something more socially and economically malignant, witchcraft. Successful treatment combines divinatory techniques, paracetamol medicines and positive thinking in order to empower clients and present them with the possibility of new social and gainful employment prospects.

Whooping cough: are health-care workers putting children at risk?

PubMed

Peadon, Elizabeth; Cooper, Carolyn

2007-05-01

To explore the attitudes and knowledge of health-care workers (HCW) towards whooping cough and an adult whooping cough booster for HCW. HCW at Fairfield Health Service, who had clinical contact with infants or children, were sent a self-administered questionnaire. Questionnaires were completed by 135 staff, giving a response rate of 74%. Thirty-five per cent were not known to be immunised against whooping cough. Fifty-nine per cent of doctors were known to be immunised, 33% of allied health staff and 28% of nurses. The rates of immunisation between the professional groups were significantly different (chi2 = 8.2 with 2 degrees of freedom; P = 0.017). Thirty-nine per cent of HCW did not know that primary immunisation did not provide lifelong protection. Twenty-seven per cent did not agree that HCW should be offered an adult whooping cough booster. Staff who felt at risk of contracting whooping cough were more likely to recommend that a booster should be offered (OR 2.71; 95% CI 1.22-6.04; P = 0.019). Doctors were less likely to recommend that a booster should be offered (OR 0.36; 95% CI 0.15-0.87; P = 0.028). HCW have low rates of immunity to whooping cough and misconceptions about whooping cough infection and immunisation. Over a quarter of HCW did not agree that a booster should be offered. An ongoing education programme addressing the attitudes and misconceptions identified in this study is a crucial component of the campaign to increase the uptake of adult whooping cough booster immunisation by HCW.

Efficacy and safety of GHX02 in the treatment of acute bronchitis: protocol of a phase II, double-blind, randomised placebo-controlled trial.

PubMed

Lyu, Yee Ran; Yang, Won-Kyung; Park, So Jung; Kim, Seung-Hyeong; Kang, Wee-Chang; Jung, In Chul; Park, Yang Chun

2018-05-14

Acute bronchitis is a self-limiting infection of the large airways; cough is the primary symptom, usually lasting for about 3 weeks. Annually, approximately 5% of adults develop acute bronchitis, and its economic burden is substantial. There are also problems of antibiotic abuse in public health systems and symptomatic therapies are commonly prescribed, for which there is insufficient supporting evidence. GHX02 contains four herbs originating from gwaruhaengryeon-hwan, which has been used in the treatment of patients with acute bronchitis in Korea. The objective is to compare the GHX02 and placebo in terms of efficacy and safety, and to determine the appropriate dosage. We planned a phase II, multicentre, dose-finding, double-blind, randomised placebo-controlled trial of two different doses of GHX02 compared with placebo. A total of 150 patients, aged 19-75 years, with a Bronchitis Severity Score (BSS) ≥5 due to acute bronchitis starting within 2 weeks of study enrolment will be recruited from three university-affiliated hospitals across Korea. Participants will be stratified into three patterns using the Korean Standard Tool of Pattern Identifications of Cough and Sputum and randomly assigned to either a high-dose GHX02 group (1920 mg/day), standard-dose GHX02 group (960 mg/day) or placebo group according to a 1:1:1 allocation ratio. Patients will take medications three times daily for 7 days, with two visiting days. The primary outcome measure is a change in BSS from day 0 to day 7. The secondary outcomes are the Questionnaire of Clinical Symptoms of Cough and Sputum, Leicester Cough Questionnaire, frequency of coughing fits, Integrative Medicine Outcome Scale, Integrative Medicine Patient Satisfaction Scale and withdrawal rate of patients with exacerbation. Safety will be assessed by adverse events, vital signs and laboratory examinations. The study has been approved by our Institutional Review Board (No. DJDSKH-17-DR-14). The trial results will be disseminated via peer-reviewed journals and the Clinical Research Information Service. NCT03310385; Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Establishment of Application Guidance for OTC non-Kampo Crude Drug Extract Products in Japan

PubMed Central

Somekawa, Layla; Maegawa, Hikoichiro; Tsukada, Shinsuke; Nakamura, Takatoshi

2017-01-01

Currently, there are no standardized regulatory systems for herbal medicinal products worldwide. Communication and sharing of knowledge between different regulatory systems will lead to mutual understanding and might help identify topics which deserve further discussion in the establishment of common standards. Regulatory information on traditional herbal medicinal products in Japan is updated by the establishment of Application Guidance for over-the-counter non-Kampo Crude Drug Extract Products. We would like to report on updated regulatory information on the new Application Guidance. Methods for comparison of Crude Drug Extract formulation and standard decoction and criteria for application and the key points to consider for each criterion are indicated in the guidance. Establishment of the guidance contributes to improvements in public health. We hope that the regulatory information about traditional herbal medicinal products in Japan will be of contribution to tackling the challenging task of regulating traditional herbal products worldwide. PMID:28894633

Direct-to-consumer advertising of prescription medicines: a counter argument.

PubMed

Mintzes, Barbara; Mangin, Dee

2009-12-01

Direct-to-consumer advertising of prescription-only medicines is currently only permitted in the USA and New Zealand. Barbara Mintzes and Dee Mangin provide their case against direct-to-consumer advertising of prescription medicines, arguing that its wider introduction would lead to a 'Pharma-knows-best' culture.

Bilateral simultaneous acute angle closure glaucoma precipitated by non-prescription cold and flu medication.

PubMed

Rudkin, Adam K; Gray, Tim L; Awadalla, Mona; Craig, Jamie E

2010-10-01

We present a case of a 63-year-old woman who presented to an ED with bifrontal headache, nausea and vomiting and reduced visual acuity. Examination revealed bilateral elevated intraocular pressures, corneal haze, shallow anterior chambers and poorly reactive, mid-dilated pupils. Diagnosis was made of simultaneous bilateral acute angle closure glaucoma. A complete drug history revealed that she had been using an over-the-counter cold and flu remedy whose active ingredients included atropa belladonna, an herb with anticholinergic properties. It is likely that drug-induced dilatation of the individual's pupils precipitated this angle closure emergency. In the report we discuss the risk factors for angle closure glaucoma, and review the local and systemic drugs known to trigger this sight-threatening emergency. © 2010 The Authors. Emergency Medicine Australasia © 2010 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Angiotensin-converting enzyme inhibitor associated cough: deceptive information from the Physicians' Desk Reference.

PubMed

Bangalore, Sripal; Kumar, Sunil; Messerli, Franz H

2010-11-01

Dry cough is a common, annoying adverse effect of all angiotensin-converting enzyme (ACE) inhibitors. The present study was designed to compare the rate of coughs reported in the literature with reported rates in the Physicians' Desk Reference (PDR)/drug label. We searched MEDLINE/EMBASE/CENTRAL for articles published from 1990 to the present about randomized clinical trials (RCTs) of ACE inhibitors with a sample size of at least 100 patients in the ACE inhibitors arm with follow-up for at least 3 months and reporting the incidence or withdrawal rates due to cough. Baseline characteristics, cohort enrolled, metrics used to assess cough, incidence, and withdrawal rates due to cough were abstracted. One hundred twenty-five studies that satisfied our inclusion criteria enrolled 198,130 patients. The pooled weighted incidence of cough for enalapril was 11.48% (95% confidence interval [CI], 9.54% to 13.41%), which was ninefold greater compared to the reported rate in the PDR/drug label (1.3%). The pooled weighted withdrawal rate due to cough for enalapril was 2.57% (95% CI, 2.40-2.74), which was 31-fold greater compared to the reported rate in the PDR/drug label (0.1%). The incidence of cough has increased progressively over the last 2 decades with accumulating data, but it has been reported consistently several-fold less in the PDR compared to the RCTs. The results were similar for most other ACE inhibitors. The incidence of ACE inhibitor-associated cough and the withdrawal rate (the more objective metric) due to cough is significantly greater in the literature than reported in the PDR/drug label and is likely to be even greater in the real world when compared with the data from RCTs. There exists a gap between the data available from the literature and that which is presented to the consumers (prescribing physicians and patients). Copyright © 2010 Elsevier Inc. All rights reserved.

Detecting Paroxysmal Coughing from Pertussis Cases Using Voice Recognition Technology

PubMed Central

Parker, Danny; Picone, Joseph; Harati, Amir; Lu, Shuang; Jenkyns, Marion H.; Polgreen, Philip M.

2013-01-01

Background Pertussis is highly contagious; thus, prompt identification of cases is essential to control outbreaks. Clinicians experienced with the disease can easily identify classic cases, where patients have bursts of rapid coughing followed by gasps, and a characteristic whooping sound. However, many clinicians have never seen a case, and thus may miss initial cases during an outbreak. The purpose of this project was to use voice-recognition software to distinguish pertussis coughs from croup and other coughs. Methods We collected a series of recordings representing pertussis, croup and miscellaneous coughing by children. We manually categorized coughs as either pertussis or non-pertussis, and extracted features for each category. We used Mel-frequency cepstral coefficients (MFCC), a sampling rate of 16 KHz, a frame Duration of 25 msec, and a frame rate of 10 msec. The coughs were filtered. Each cough was divided into 3 sections of proportion 3-4-3. The average of the 13 MFCCs for each section was computed and made into a 39-element feature vector used for the classification. We used the following machine learning algorithms: Neural Networks, K-Nearest Neighbor (KNN), and a 200 tree Random Forest (RF). Data were reserved for cross-validation of the KNN and RF. The Neural Network was trained 100 times, and the averaged results are presented. Results After categorization, we had 16 examples of non-pertussis coughs and 31 examples of pertussis coughs. Over 90% of all pertussis coughs were properly classified as pertussis. The error rates were: Type I errors of 7%, 12%, and 25% and Type II errors of 8%, 0%, and 0%, using the Neural Network, Random Forest, and KNN, respectively. Conclusion Our results suggest that we can build a robust classifier to assist clinicians and the public to help identify pertussis cases in children presenting with typical symptoms. PMID:24391730

Challenges to counseling customers at the pharmacy counter--why do they exist?

PubMed

Kaae, Susanne; Traulsen, Janine Morgall; Nørgaard, Lotte Stig

2012-01-01

Challenges to engage pharmacy customers in medicine dialogues at the counter have been identified comprising a new and extended clinical role for pharmacists in the health care system. This article seeks to expand understanding of factors involved in successful interaction at the pharmacy counter between customers and pharmacy staff to develop their relationship further. Practical challenges to customer encounters experienced by community pharmacists are discussed using theory from the field of mainly inter-relational communication and particular studies on pharmacy communication. Preconceived expectation of customers, the type of question asked by pharmacy staff, and differences in perception of illness and medicines between staff and customers are discussed. Both staff and customer influence the outcome of attempts by pharmacy staff to engage customers in dialogue about their medicine use through a complex mechanism of interaction. It is recommended that practitioners and researchers begin to distinguish, both theoretically and practically, between the content of a conversation and the underlying relationship when exploring and further developing the therapeutic relationship between pharmacy personnel and customers. Copyright © 2012 Elsevier Inc. All rights reserved.

Long-term follow-up of amitriptyline treatment for idiopathic cough.

PubMed

Ryan, Marisa A; Cohen, Seth M

2016-12-01

To evaluate short- and long-term treatment outcomes of amitriptyline for idiopathic cough. Retrospective chart review and anonymous survey of a patient cohort. We evaluated a cohort of adults treated for cough at the Duke Voice Care Center with amitriptyline over a 2- to 3-year period. We characterized demographics, symptoms, treatment variability, and treatment effects from chart review and survey responses. We performed univariate analysis comparing cough improvement to age, gender, symptoms of throat irritation, cough duration, concurrent speech therapy, and dosage. Eighty-nine percent were taking the medication at the first clinical follow-up at a mean 2.6 months, and overall, 67% reported ≥50% improvement. No statistically significant predictors of cough improvement with medication were identified. At follow-up 2 to 3 years later, overall, 53% reported ≥50% improvement, with only 34% of patients still taking amitriptyline. After 2 to 3 years, 65% of patients had titrated the medication to effect, and 33% restarted the medication. Occurrence of side effects was the most frequent reason for stopping the medication. Amitriptyline can be an effective and well-tolerated part of short- and long-term management of idiopathic cough in adults. Titrating the dose and restarting are often necessary. Larger studies and randomized control trials are needed to better understand the outcomes of using amitriptyline to treat idiopathic cough. 4 Laryngoscope, 126:2758-2763, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

From prescription-only (Rx) to over-the-counter (OTC) status in Germany 2006-2015: pharmacological perspectives on regulatory decisions.

PubMed

Barrenberg, Eva; Garbe, Edeltraut

2017-07-01

Little is known about the extent of switches from prescription-only (Rx) to over-the-counter (OTC) status in Europe and about the pharmacological properties of the switched substances. The objectives of this study were to provide an overview of the substances that were switched from Rx to OTC status in Germany between 2006 and 2015 and to assess their pharmacological properties. Session minutes of the German Expert Advisory Committee for Prescription-Only Issues, changes to the German Ordinance on Prescription-Only Medicines and the Summary of Product Characteristics of the switched substances were analysed. Pharmacological properties were studied in relation to the EU Guideline on Changing the Classification for the Supply of a Medicinal Product for Human Use (the 'EU switch guide'). Between 2006 and 2015, seven substances (almotriptan, omeprazole, benzydamine, ibuprofen/pseudoephedrine, racecadotril, ketotifen and levonorgestrel) were switched from Rx to OTC status in Germany. In all cases, the OTC status was restricted to certain indications, doses, pack sizes, or other limitations. Notwithstanding recommendations of the EU switch guide, some of the switched substances might interact with commonly used drugs potentially resulting in serious adverse drug reactions or have contraindications or warnings regarding substantial parts of the population. The stipulations of the EU switch guide were fully met for only some switches, while this was not completely the case for others. Further development of guidance on balancing risks and benefits of OTC availability is recommended.

Attitudes and experiences of community pharmacists towards paediatric off-label prescribing: a prospective survey

PubMed Central

Stewart, Derek; Rouf, Abdul; Snaith, Ailsa; Elliott, Kathleen; Helms, Peter J; McLay, James S

2007-01-01

What is already known about this subject There are increasing concerns about the safety and efficacy of paediatric off-label medicines. In the UK, each year 26% of children receive an off-label prescription from their general practitioner. The community pharmacist is the final and key professional in the chain, with the responsibility to ensure that medicines are both prescribed and dispensed appropriately. What this study adds The majority of community pharmacists are aware of off-label prescribing, but through work experience rather than undergraduate or postgraduate training or professional development. Community pharmacists, like UK general practitioners, underestimate the levels of paediatric off-label prescribing, and appear unclear as to the most common reasons for a prescription being off label. Most community pharmacists stated that they should inform the prescriber that a medicine was off label; however, when given specific practical examples, less than half would actually appear to do so. The majority of community pharmacists have been asked by the public to sell over-the-counter medicines for paediatric off-label use. Aim To identify community pharmacist experiences of, and attitudes towards paediatric off-label prescribing. Methods A prospective questionnaire-based study, with a 21-item questionnaire issued to 1500 randomly selected community pharmacies throughout the UK during 2005 on three separate occasions. Results Four hundred and eighty-two (32.1%) completed questionnaires were returned. Over 70% of respondents were familiar with the concept of off-label prescribing, primarily through dispensing experience rather than education, although only 40% were aware of having dispensed a paediatric off-label prescription within the previous month. The reasons given for a prescription being off label were younger age than recommended (84.6%, 297/351), primarily for antihistamines, analgesics and β2-agonists, and higher (73.9%, 229/310) or lower than (41%, 103/258) recommended dose, primarily antibiotics and analgesics. Over 60% of respondents had been asked by the public to sell paediatric over-the-counter medicines, such as antihistamines, analgesics and steroid preparations for off-label use. The majority of respondents used the British National Formulary or the Pack Insert rather than specialist formularies or guidelines as a source of specialist paediatric information. Although 78% of respondents believed they had a responsibility to inform the prescriber that a medicine was off label, only 66% believed that they had a similar responsibility to inform parents. Conclusion The community pharmacists who responded to this questionnaire appear to be aware of and concerned by the issues which surround paediatric off-label prescribing. Despite this, most gained relevant knowledge through work experience rather than undergraduate or postgraduate training or professional development. PMID:17324238

A household survey on the extent of home medication storage. A cross-sectional study from rural Crete, Greece.

PubMed

Tsiligianni, Ioanna G; Delgatty, Candida; Alegakis, Athanasios; Lionis, Christos

2012-03-01

Patients often have multiple chronic diseases, use multiple prescriptions and over the counter medications resulting in polypharmacy. Many of them store these medications for future use in their homes, rather than take them as directed by their physician, resulting in a waste of health care resources, and potentially dangerous misuse. This study aimed to investigate the magnitude of medication home hoarding, the exchange of medication with family/friends, families' beliefs about the medication use, source of medication, pharmaceutical class, cost of stored medicine and conditions of storage. A structured questionnaire was administered within the homes in two rural areas in Crete. Forty families participated in the study including 85 individual household members (36 men, and 49 women with an average age of 56.5 ± 24.3 mean ± SD). There were a total of 557 medications recorded, with 324 different medications representing a total value of €8954. The mean quantity of medication boxes stored in each home was 8.5 ± 5.8. Cardiovascular medications accounted for 56% of medications for current use; whereas analgesics (24%), and antibiotics (17%), were the most medications being stored for future use. Exchange of medicine was very common (95%). Beliefs that 'more expensive medication is more effective', and that 'over the counter medications are safe because they were easily available' were expressed. Medications are being stored in large quantities in these rural areas, with a large percentage of them being wasted or misused.

78 FR 19718 - Modifications To Labeling of Nicotine Replacement Therapy Products for Over-the-Counter Human Use

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-02

...] Modifications To Labeling of Nicotine Replacement Therapy Products for Over-the-Counter Human Use AGENCY: Food...-counter nicotine replacement therapy products, related to concomitant use with other nicotine-containing... over-the- counter nicotine replacement therapy products for their approved intended use as aids to...

Protective effect of Lycium Barbarum polysaccharides on dextromethorphan-induced mood impairment and neurogenesis suppression.

PubMed

Po, Kevin Kai-Ting; Leung, Joseph Wai-Hin; Chan, Jackie Ngai-Man; Fung, Timothy Kai-Hang; Sánchez-Vidaña, Dalinda Isabel; Sin, Emily Lok-Lam; So, Kwok-Fai; Lau, Benson Wui-Man; Siu, Andrew Man-Hong

2017-09-01

Dextromethorphan (DXM) is one of the common drugs abused by adolescents. It is the active ingredient found in cough medicine which is used for suppressing cough. High dosage of DXM can induce euphoria, dissociative effects and even hallucinations. Chronic use of DXM may also lead to depressive-related symptoms. Lycium barbarum, commonly known as wolfberry, has been used as a traditional Chinese medicine for the treatment of ageing-related neurodegenerative diseases. A recent study has shown the potential beneficial effect of Lycium barbarum to reduce depression-like behavior. In the present study, we investigated the role of Lycium barbarum polysaccharide (LBP) to alleviate DXM-induced emotional distress. Sprague Dawley rats were divided into 4 groups (n=6 per group), including the normal control (vehicles only), DXM-treated group (40 mg/kg DXM), LBP-treated group (1 mg/kg LBP) and DXM+ LBP-treated group (40 mg/kg DXM and 1 mg/kg LBP). After two-week treatment, the DXM-treated group showed increased depression-like and social anxiety-like behaviors in the forced swim test and social interaction test respectively. On the other hand, the adverse behavioral effects induced by DXM were reduced by LBP treatment. Histological results showed that LBP treatment alone did not promote hippocampal neurogenesis when compared to the normal control, but LBP could lessen the suppression of hippocampal neurogenesis induced by DXM. The findings provide insights for the potential use of wolfberry as an adjunct treatment option for alleviating mood disturbances during rehabilitation of cough syrup abusers. Copyright © 2017 Elsevier Inc. All rights reserved.

Whooping cough and unrecognised postperinatal mortality.

PubMed Central

Nicoll, A; Gardner, A

1988-01-01

Trends in postperinatal infant mortality from respiratory causes and the sudden infant death syndrome in England and Wales for 1968 to 1984 were examined. These were compared by time series analysis with changes in the incidence of specific infective diseases and organisms for the same period. Discontinuity was found in association with the occurrence of whooping cough between 1977 and 1982. Associations with the general incidence of respiratory infections and other specific organisms were less evident. An estimate of excess mortality is 460 to 700 deaths, a substantial increase over the certified mortality from whooping cough. PMID:3126714

Prevalence and predictors of over-the-counter medication use among adolescents in the United Arab Emirates.

PubMed

Barakat-Haddad, Caroline; Siddiqua, Ayesha

2018-01-02

The patterns of over-the-counter medication (OTC) usage among adolescents living in the United Arab Emirates (UAE) remains largely understudied. The objectives of this study are: (1) to determine the profile of OTC use among UAE adolescents; and (2) to determine the biological or physical, psychological or behavioural, and social predictors of OTC use among the UAE adolescent population. Using a cross-sectional study design, data were collected on the prevalence of OTC use for a sample of 6363 adolescents. Overall, 51% of participants in this study reported OTC use. The most common form of OTC used was acetaminophen. Significant predictors of OTC use were: nationality (UAE, GCC, Arab / Middle East, Arab / Africa, Western, other); needed health care but did not receive it; sex (female); age (15-18 years); any medical diagnosis; unconventional drug use; spending more than 5 hours using TV and computer daily; and using prescription medicines. Thus, there is a need to develop public health policies and strategies that promote appropriate use of OTC in the population.

Dry night cough as a marker of allergy in preschool children: the PARIS birth cohort.

PubMed

Rancière, Fanny; Nikasinovic, Lydia; Momas, Isabelle

2013-03-01

Early detection of children at risk for developing allergy is an important challenge. Our first analyses in infants from the Pollution and Asthma Risk: an Infant Study (PARIS) birth cohort suggested that dry night cough was associated with parental-reported allergic disorders. The aim of the present study was to refine this finding by investigating the time course of dry night cough from birth to age 4 yr in relation to blood markers of atopy and allergic morbidity. Health outcomes were regularly assessed by parental self-administered questionnaires. Blood markers of atopy were measured at age 18 months. Children with similar patterns of dry night cough over the first 4 yr of life were grouped together using k-means clustering. Associations with atopy/allergy were studied using multinomial logistic regression. Three trajectories of dry night cough were identified in 1869 children. Besides the never/infrequent pattern (72.4%), the transient pattern (8.8%) was composed of children who coughed in the first year and recovered by age 4 yr, while the rising pattern (18.8%) included all symptomatic children at age 4 yr, whether they were persistent or late coughers. Compared with the never/infrequent pattern, the rising pattern was significantly associated with elevated total immunoglobulin E (IgE) level (odds ratio [OR] = 1.70, 95% confidence interval [CI] = 1.21-2.39) and inhalant allergens sensitization (OR = 2.66, 95% CI = 1.26-5.61) at age 18 months, and with doctor-diagnosed allergic diseases over the first 4 yr such as hay fever (OR = 2.52, 95% CI = 1.49-4.26) and eczema (OR = 1.29, 95% CI = 1.00-1.66). This study provides evidence that persistent/late dry night cough may indicate allergy in preschool children. © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

European medicinal polypores--a modern view on traditional uses.

PubMed

Grienke, Ulrike; Zöll, Margit; Peintner, Ursula; Rollinger, Judith M

2014-07-03

In particular five polypore species, i.e. Laetiporus sulphureus, Fomes fomentarius, Fomitopsis pinicola, Piptoporus betulinus, and Laricifomes officinalis, have been widely used in central European folk medicines for the treatment of various diseases, e.g. dysmenorrhoea, haemorrhoids, bladder disorders, pyretic diseases, treatment of coughs, cancer, and rheumatism. Prehistoric artefacts going back to over 5000 years underline the long tradition of using polypores for various applications ranging from food or tinder material to medicinal-spiritual uses as witnessed by two polypore species found among items of Ötzi, the Iceman. The present paper reviews the traditional uses, phytochemistry, and biological activity of the five mentioned polypores. All available information on the selected polypore taxa used in traditional folk medicine was collected through evaluation of literature in libraries and searches in online databases using SciFinder and Web of Knowledge. Mycochemical studies report the presence of many primary (e.g. polysaccharides) and secondary metabolites (e.g. triterpenes). Crude extracts and isolated compounds show a wide spectrum of biological properties, such as anti-inflammatory, cytotoxic, and antimicrobial activities. The investigated polypores possess a longstanding ethnomycological tradition in Europe. Here, we compile biological results which highlight their therapeutic value. Moreover, this work provides a solid base for further investigations on a molecular level, both compound- and target-wise. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Force and Presence in the World of Medicine

PubMed Central

Bleakley, Alan

2017-01-01

Medicine can not only be read with a poetic imagination, but also configured as a poetic practice, moving beyond the instrumental. The poet Wallace Stevens made a distinction between ‘Force’ and ‘Presence’—the former can be read as combative, the latter as pacific. Modern medicine has been shaped historically by the combative metaphor of a ‘war against disease’, turning medicine into a quasi-militaristic culture fond of hierarchy. This is supplemented by the metaphor of the ‘body as machine’, reducing the complex and unpredictable body to a linear, if complicated, apparatus. The two metaphors align medicine with the modern industrial–military complex that is masculine, heroic, and controlling in character. In an era in which medicine is feminising and expected to be patient-centred, collaborative (inter-professional) and transparent to the public as a democratic gesture, the industrial–military metaphor complex should no longer be shaping medicine—yet its influence is still keenly felt, especially in surgery. This continuing dominance of Force over Presence matters because it is a style running counter to the collaborative, team-based medicine needed for high levels of patient safety. Medicine will authentically democratise only as new, pacific shaping metaphors emerge: those of ‘Presence’, such as ‘hospitality’. Hospitals can once again become places of hospitality.

Factor analysis and cluster analysis research on the relationship between the trace elements of flowers of Gentianaceae plants and the traditional Chinese medicine efficacy from Qinghai-Tibet Plateau

NASA Astrophysics Data System (ADS)

Zhou, Libing

2017-06-01

Flowers of Gentianaceae plants have historically been used in treating gastritis, dysuria, pruritus vulvae and detoxification. Gentianaceae plants have medicinal applications to treat a wide range of diseases such as rheumatic arthritis, pneumonia along with cough, chronic gastritis, et al Therefore, the research on the relationship between human health and trace elements of flowers of Gentianaceae plants is of great significance. These studies provide the scientific base and theoretical foundation for the future large-scale rational relation development of Gentianaceae plants resources as well as the relationship between the race elements of them and traditional Chinese medicine efficacy.

'I had to help my child!': The role of emotions, risk, and trust in use of nasal decongestants in children.

PubMed

Salmane-Kulikovska, Ieva; Mezinska, Signe

2013-03-01

Recent studies suggest that a number of common cold medicines, including nasal decongestants are not suitable for small children. In Latvia nasal decongestants are primarily over-the-counter (OTC) medicines, and patient information leaflets generally permit use of these medicines for small children. The previous studies in Latvia investigating the use of medicines in cases of common cold demonstrated extensive use of decongestants in children less than six years of age, marking a necessity for more profound research. As a result a qualitative study was implemented in 2011 to identify sources of information that offer advice for the use of decongestants in children. The caregivers' perception of risks, trust, and the role of emotions associated with use of these medicines was considered. The study results suggested that emotions have a considerable effect on the decisions of caregivers. Even though caregivers are aware of the risks associated with the use of decongestants, they still frequently administer these medicines for the sake of the comfort of both the child and the caregiver. It is essential to raise a discussion about the inappropriate use of common cold medications in small children in Latvia. © The Author(s) 2012.

Nutritional, Medicinal and Toxicological Attributes of Star-Fruits (Averrhoa carambola L.): A Review

PubMed Central

Muthu, Narmataa; Lee, Su Yin; Phua, Kia Kien; Bhore, Subhash Janardhan

2016-01-01

Plants are very complex organisms that produce medicinally important natural products. The Star-fruit producing plant (Averrhoa carambola L.) is a species of woody plant in the family Oxalidaceae native to the Philippines, Indonesia, Malaysia, Vietnam, India, Bangladesh and Sri Lanka; but, cultivated in many parts of the world. Star-fruits are popular tropical fruits and used commonly in Ayurvedic and Traditional Chinese Medicines (TCM) in India, China, and Brazil to relieve ailments such as chronic headache, fever, cough, gastro-enteritis, diarrhoea, ringworm infections, and skin inflammations. However, this fruit contains high amount of oxalate, which is hazardous for uremic patients, and caramboxin (CBX), which is neurotoxic. The aim of this review is to highlight the nutritional, medicinal and toxicological traits of the star-fruits. PMID:28405126

Nutritional, Medicinal and Toxicological Attributes of Star-Fruits (Averrhoa carambola L.): A Review.

PubMed

Muthu, Narmataa; Lee, Su Yin; Phua, Kia Kien; Bhore, Subhash Janardhan

2016-01-01

Plants are very complex organisms that produce medicinally important natural products. The Star-fruit producing plant (Averrhoa carambola L.) is a species of woody plant in the family Oxalidaceae native to the Philippines, Indonesia, Malaysia, Vietnam, India, Bangladesh and Sri Lanka; but, cultivated in many parts of the world. Star-fruits are popular tropical fruits and used commonly in Ayurvedic and Traditional Chinese Medicines (TCM) in India, China, and Brazil to relieve ailments such as chronic headache, fever, cough, gastro-enteritis, diarrhoea, ringworm infections, and skin inflammations. However, this fruit contains high amount of oxalate, which is hazardous for uremic patients, and caramboxin (CBX), which is neurotoxic. The aim of this review is to highlight the nutritional, medicinal and toxicological traits of the star-fruits.

Consumer attitudes on cough and cold: US (ACHOO) survey results.

PubMed

Blaiss, M S; Dicpinigaitis, P V; Eccles, R; Wingertzahn, M A

2015-08-01

The Attitudes of Consumers Toward Health, Cough, and Cold (ACHOO) survey was developed to better inform health care providers on the natural history and impact of common cold and cough, and related consumer experience and behaviors. Randomly selected US Internet/mobile device users were invited to participate in an online survey (N = 3333) in October 2012. Response quotas modeled upon 2010 US Census data ensured a demographically representative sample. To reduce potential bias from the quota design, 75% of the completed surveys were randomly selected as the primary analysis pool. Survey questions assessed participant demographics, frequency and duration of cough/cold symptoms, impact of symptoms on daily life, treatment preferences, and knowledge about cough/cold pathophysiology. In the past year, 84.6% of respondents had experienced at least one cold. Colds typically started with sore/scratchy throat (39.2%), nasal congestion (9.8%), and runny nose (9.3%) and lasted 3-7 days. Cough, the most common cold symptom (73.1%), had a delayed onset (typically 1-5 days after cold onset) and a long duration (>6 days in 35.2%). Nasal congestion and cough were the most bothersome symptoms. Many respondents waited until symptoms were 'bad enough' (42.6%) or multiple symptoms were present (20.2%) before using nonprescription medications. Drivers of choice included effectiveness in relieving symptoms, safety, and past experience. Respondents rarely consulted clinicians regarding treatment, and more than three-quarters had never received instructions from a clinician on how to choose a nonprescription cough/cold medication. Misperceptions regarding etiology and treatment of the common cold were prevalent. The main limitation is potential recall bias, since respondents had to recall cough/cold episodes over the prior year. The ACHOO survey confirms that cold is a common, bothersome experience and that there are gaps in consumers' knowledge of pathophysiology and appropriate management of cough/cold.

21 CFR 310.540 - Drug products containing active ingredients offered over-the-counter (OTC) for use as stomach...

Code of Federal Regulations, 2013 CFR

2013-04-01

... offered over-the-counter (OTC) for use as stomach acidifiers. 310.540 Section 310.540 Food and Drugs FOOD... ingredients offered over-the-counter (OTC) for use as stomach acidifiers. (a) Betaine hydrochloride, glutamic...-counter (OTC) drug products for use as stomach acidifiers. Because of the lack of adequate data to...

21 CFR 310.540 - Drug products containing active ingredients offered over-the-counter (OTC) for use as stomach...

Code of Federal Regulations, 2014 CFR

2014-04-01

... offered over-the-counter (OTC) for use as stomach acidifiers. 310.540 Section 310.540 Food and Drugs FOOD... ingredients offered over-the-counter (OTC) for use as stomach acidifiers. (a) Betaine hydrochloride, glutamic...-counter (OTC) drug products for use as stomach acidifiers. Because of the lack of adequate data to...

21 CFR 310.540 - Drug products containing active ingredients offered over-the-counter (OTC) for use as stomach...

Code of Federal Regulations, 2012 CFR

2012-04-01

... offered over-the-counter (OTC) for use as stomach acidifiers. 310.540 Section 310.540 Food and Drugs FOOD... ingredients offered over-the-counter (OTC) for use as stomach acidifiers. (a) Betaine hydrochloride, glutamic...-counter (OTC) drug products for use as stomach acidifiers. Because of the lack of adequate data to...

21 CFR 310.540 - Drug products containing active ingredients offered over-the-counter (OTC) for use as stomach...

Code of Federal Regulations, 2011 CFR

2011-04-01

... offered over-the-counter (OTC) for use as stomach acidifiers. 310.540 Section 310.540 Food and Drugs FOOD... ingredients offered over-the-counter (OTC) for use as stomach acidifiers. (a) Betaine hydrochloride, glutamic...-counter (OTC) drug products for use as stomach acidifiers. Because of the lack of adequate data to...

Anticholinergic Toxicity Secondary to Overuse of Topricin Cream, a Homeopathic Medication

PubMed Central

Regina, Angela; Jesin, Raphael C; Deeb, Liliane; Steinberg, Eric; Majlesi, Nima

2018-01-01

Adverse reactions from over-the-counter medications present a challenge to physicians. Homeopathic medicine is an alternative practice, originating in Germany and gaining popularity in the United States. It utilizes dilute preparations of substances in order to treat and cure disease. Patients may potentially suffer serious effects from the use of these products as the contents and concentrations are often unclear. Here, we describe a case of suspected atropine toxicity due to the overuse of a topical homeopathic cream, Topricin, which contains belladonna, a plant containing atropine. PMID:29736357

Application of Toxic Chinese Medicine in Chinese Pharmacopoeia

NASA Astrophysics Data System (ADS)

Zhao, Hui; Feng, Yu; Mao, Mingsan

2018-01-01

Objective: Explore the application characteristics of proprietary Chinese medicine prescriptions containing toxic herbs in pharmacopoeia. Methods: In this paper, according to the clinical application of pharmacopoeia proprietary Chinese medicine is divided into table agent, Qushu agent, diarrhea agent, heat agent, Wen Li agent, cough and asthma agents, resuscitation agent, Gutian agent, Fuzheng agent, Anshen agent, hemostatic agent, The traditional Chinese medicine prescription and the clinical application of the Chinese herbal medicine containing the toxic Chinese medicine were analyzed and sorted out., Summed up the compatibility of toxic herbs and application characteristics. Results: Toxic Chinese herbal medicine in the cure of traditional Chinese medicine to play a long-standing role, through the overall thinking, dialectical thinking, and thinking of toxic Chinese medicine in the analysis of Chinese medicine that [2], toxic Chinese medicine in the application of proprietary Chinese medicine can not lack. Conclusion: Pharmacopoeia included proprietary Chinese medicine not only in the clinical treatment of good, but also the application of its toxic traditional Chinese medicine and its understanding of the enrichment of the toxic characteristics of traditional Chinese medicine and treatment-related disease pathology between the points of contact for patients with clinical applications Based on and theoretical guidance of Chinese medicine [3].

High use of over-the-counter analgesic; possible warnings of reduced quality of life in adolescents - a qualitative study.

PubMed

Skarstein, Siv; Lagerløv, Per; Kvarme, Lisbeth Gravdal; Helseth, Sølvi

2016-01-01

Use of over-the-counter analgesics among adolescents has increased markedly. High consumption of over-the-counter analgesics among adolescents is associated with frequent pain, lower self-esteem, reduced sleep, lower educational ambition, binge drinking, higher caffeine consumption, and part-time employment. Knowledge about life experiences of adolescents who frequently use over-the-counter analgesics may be useful to prevent health problems. The purpose of the study was to increase knowledge about adolescents who suffer from frequent pain and have a high consumption of over-the-counter analgesics. A qualitative study, employing one-on-one, in-depth interviews using a thematic interview guide. Data were collected in Norway in 2013-2014. Three boys and sixteen girls; aged 14-16 years, who continuously consumed over-the-counter analgesics were recruited from ten high schools in urban and suburban districts. Candidate participants were excluded if they were medically diagnosed with an acute or chronic illness, requiring extended use of over-the-counter analgesics within the last year. The interviews were taped, transcribed and analysed as text according to Kvale's three contexts of interpretation: self-understanding, common sense and theory. All participants disclosed unresolved physical and psychosocial distress characterized as pain. Frequent pain from various body parts made everyday life challenging. Methods of pain self-appraisal and over-the-counter analgesics use often mimicked maternal patterns. Participants reported being raised under unpredictable circumstances that contributed to long lasting family conflicts and peer-group problems. Participants wanted to feel appreciated and to be socially and academically successful. However, pain reduced their ability to manage everyday life, hampered experienced possibilities for success, and made social settings difficult. Childhood experiences influence how adolescents experience pain and use over-the-counter analgesics. Coping with difficult situations or attempting to mask symptoms with over-the-counter analgesics can perpetuate and amplify underlying problems. High consumption of over-the-counter analgesics and frequent pain may be warning signs of adolescents with possible health threatening conditions and reduced quality of life. These adolescent might be in need of support from school nurses and General Practitioners. This study identifies new perspectives that may lead to novel approaches to identify, guide, and support adolescents with frequent pain and high consumption of over-the-counter analgesics.

Hispanic youth involvement in over-the-counter drug use: parent, peer, and school factors.

PubMed

Vidourek, Rebecca A; King, Keith A; Fehr, Sara K

2014-01-01

Research on substance use among Hispanic youth is lacking. The purpose of this study was to examine over-the-counter drug use among Hispanic youth. Of Hispanic youth, 23.9% used an over-the-counter drug for the purpose of getting high. Involvement in prosocial behaviors was correlated with decreased over-the-counter use for females and high school students. Involvement in risky behaviors increased the risk of use for males, females, junior high school students, and high school students. Significant differences were found based on parent, peer, teacher, and school factors. Prevention and intervention programs should address over-the-counter drug use among Hispanic youth.

Changing the status of drugs from prescription to over-the-counter availability.

PubMed

Brass, E P

2001-09-13

The availability of drugs on an over-the-counter basis, including those previously available only by prescription, provides patients with improved access to effective therapies. Removal of the requirement for prescriptions saves both the health care professional and the patient time. However, the overall effect on health care costs is complex. One such effect may be that costs shift from third-party payers to patients. In addition, short-term cost savings may be offset over the long term by problems due to inappropriate use or suboptimal therapy. Optimal therapy with an over-the-counter drug requires that the consumer diagnose the underlying condition correctly and use the drug in a manner that minimizes risk. Assessment of the ability of patients to use drugs in this manner is a critical component of the regulatory review of over-the-counter drugs. The available data arouse the concern that without the supervision of a health care professional, some patients may not be able to use over-the-counter drugs appropriately for certain diagnoses or chronic conditions or in high-risk situations. On the other hand, the widespread use of over-the-counter aspirin on a long-term basis for cardiovascular-risk reduction illustrates the potential value of increased drug availability for long-term therapy. Advances in technology may facilitate the growth of over-the-counter drug therapy. For example, the wide availability and acceptance of reliable methods for measuring serum cholesterol in nonmedical settings may eventually contribute to the safety and effectiveness of over-the-counter treatments for hyperlipidemia. Thus, the future promises increases in the number of drugs available over the counter and in the variety of indications for their use.

21 CFR 201.315 - Over-the-counter drugs for minor sore throats; suggested warning.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Over-the-counter drugs for minor sore throats... Drug Products § 201.315 Over-the-counter drugs for minor sore throats; suggested warning. The Food and... counter for the relief of minor irritations of the mouth or throat. It will not object to the labeling of...

21 CFR 201.315 - Over-the-counter drugs for minor sore throats; suggested warning.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 4 2011-04-01 2011-04-01 false Over-the-counter drugs for minor sore throats... Drug Products § 201.315 Over-the-counter drugs for minor sore throats; suggested warning. The Food and... counter for the relief of minor irritations of the mouth or throat. It will not object to the labeling of...

Evaluating availability and price of essential medicines in Boston area (Massachusetts, USA) using WHO/HAI methodology.

PubMed

Sharma, Abhishek; Rorden, Lindsey; Ewen, Margaret; Laing, Richard

2016-01-01

Many patients even those with health insurance pay out-of-pocket for medicines. We investigated the availability and prices of essential medicines in the Boston area. Using the WHO/HAI methodology, availability and undiscounted price data for both originator brand (OB) and lowest price generic (LPG) equivalent versions of 25 essential medicines (14 prescription; 11 over-the-counter (OTC)) were obtained from 17 private pharmacies. The inclusion and prices of 26 essential medicines in seven pharmacy discount programs were also studied. The medicine prices were compared with international reference prices (IRPs). In surveyed pharmacies, the OB medicines were less available as compared to the generics. The OB and LPG versions of OTC medicines were 21.33 and 11.53 times the IRP, respectively. The median prices of prescription medicines were higher, with OB and LPG versions at 158.14 and 38.03 times the IRP, respectively. In studied pharmacy discount programs, the price ratios of surveyed medicines varied from 4.4-13.9. While noting the WHO target that consumers should pay no more than four times the IRPs, medicine prices were considerably higher in the Boston area. The prices for medicines included in the pharmacy discount programs were closest to WHO's target. Consumers should shop around, as medicine inclusion and prices vary across discount programs. In order for consumers to identify meaningful potential savings through comparison shopping, price transparency is needed.

The 'third class' of medications: Sales and purchasing behavior are associated with pharmacist only and pharmacy medicine classifications in Australia.

PubMed

Emmerton, Lynne

2009-01-01

Nonprescription (over-the-counter) medications in Australia are classified as Pharmacist Only Medicines, Pharmacy Medicines, or unscheduled medications. This report characterizes these medication classifications using key sales and purchasing behavior variables. Descriptive, nonexperimental, cross-sectional study. 15 pharmacies in southeast Queensland, Australia, with data recorded over 36 hours per pharmacy in mid-August, 2006. Eligible purchasers (n = 3,470 medication purchases) of all nonprescription medications (including nutritional supplements). Researchers documented details of all observed nonprescription medication sales and interviewed all available patients following the transaction. Incidence of product-related consultation, products purchased (brand, dosage form, classification), and purchasing behavior data (including previous purchase, intended use, intended user, and intention to purchase a particular brand). More restrictive classification of the purchased medication was significantly (P < 0.01) associated with younger purchasers, purchase of a single nonprescription medication, intent to self-use the medication, intent to purchase a particular brand, repeat purchase, brand-switching interventions by pharmacy staff, pharmacy staff influence on first-time purchases, and observed consultation by pharmacists. Legislative compliance issues were identified: Pharmacists consulted in only 54.7% of Pharmacist Only Medicine sales and 13 cases (1.7% of observed sales) occurred in which Pharmacist Only and Pharmacy Medicines had been sourced from publicly accessible areas of the store. Pharmacist Only Medicines received greater levels of professional involvement during their sale than Pharmacy Medicines and unscheduled medications, despite higher levels of product familiarity among patients. To optimize the benefits of this classification system, emphasis on professional guidelines is recommended.

Monitoring over-the-counter medication sales for early detection of disease outbreaks--New York City.

PubMed

Das, Debjani; Metzger, K; Heffernan, R; Balter, S; Weiss, D; Mostashari, F

2005-08-26

Over-the-counter (OTC) medications are frequently used during the initial phase of illness, and increases in their sales might serve as an early indicator of communitywide disease outbreaks. Since August 2002, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) has tracked OTC medication sales to enhance detection of natural and intentional infectious disease outbreaks. This report describes the surveillance system and presents results from retrospective analyses and a comparison between citywide trends in OTC medication sales and emergency department (ED) visits. Sales data transmitted daily to DOHMH are categorized into two groups: influenza-like illness (ILI), which includes cough and influenza medications, and gastrointestinal illness (GI), which includes major brand and generic antidiarrheals. Cyclical, linear regression models were used to identify significant (p<0.05) increases in the daily ratio of ILI to analgesics sales (analgesics are used as a denominator in the absence of total sales). Daily and weekly average ratios of GI to analgesic sales were analyzed. Citywide trends in OTC ILI and GI medication sales were compared with ED visits for fever/influenza and diarrhea syndromes. Citywide ILI drug sales were highest during annual influenza epidemics and elevated during spring and fall allergy seasons, similar to trends in the ED fever/influenza syndrome. ILI sales did not consistently provide earlier warning than the ED system of communitywide influenza. GI drug sales increased during the fall and peaked during early winter and after the blackout of August 2003. Unlike ED diarrheal visits, GI medication sales did not substantially increase during late winter (February-March). Citywide OTC medication sales can provide indications of communitywide illness, including annual influenza epidemics. Antidiarrheal medication sales were more sensitive to increases in GI caused by norovirus and influenza than illness caused by rotavirus. OTC medication sales can be considered as an adjunct syndromic surveillance system but might not be as sensitive as ED systems.

Transitioning the second-generation antihistamines to over-the-counter status: a cost-effectiveness analysis.

PubMed

Sullivan, Patrick W; Follin, Sheryl L; Nichol, Michael B

2003-12-01

A U.S. Food and Drug Administration advisory committee deemed the second-generation antihistamines (SGA) safe for over-the-counter use against the preliminary opposition of the manufacturers. As a result, loratadine is now available over-the-counter. First-generation antihistamines (FGA) are associated with an increased risk of unintentional injuries, fatalities, and reduced productivity. Access to SGA over-the-counter could result in decreased use of FGA, thereby reducing deleterious outcomes. The societal impact of transitioning this class of medications from prescription to over-the-counter status has important policy implications. To examine the cost-effectiveness of transitioning SGA to over-the-counter status from a societal perspective. A simulation model of the decision to transition SGA to over-the-counter status was compared with retaining prescription-only status for a hypothetical cohort of individuals with allergic rhinitis in the United States. Estimates of costs and effectiveness were obtained from the medical literature and national surveys. Sensitivity analysis was performed using a second-order Monte Carlo simulation. Discounted, quality-adjusted life-years saved as a result of amelioration of allergic rhinitis symptoms and avoidance of motor vehicle, occupational, public and home injuries and fatalities; discounted direct and indirect costs. Availability of SGA over-the-counter was associated with annual savings of 4 billion dollars (2.4-5.3 billion dollars) or 100 dollars (64-137 dollars) per allergic rhinitis sufferer and 135,061 time-discounted quality-adjusted life years (84,913-191,802). The sensitivity analysis provides evidence in support of these results. Making SGA available over-the-counter is both cost-saving and more effective for society, largely as a result of reduced adverse outcomes associated with FGA-induced sedation. Further study is needed to determine the differential impact on specific vulnerable populations.

Pre-clinical studies in cough research: Role of Transient Receptor Potential (TRP) channels

PubMed Central

Grace, Megan S.; Dubuis, Eric; Birrell, Mark A.; Belvisi, Maria G.

2013-01-01

Cough is a protective reflex and defence mechanism in healthy individuals, which helps clear excessive secretions and foreign material from the lungs. Cough often presents as the first and most persistent symptom of many respiratory diseases and some non-respiratory disorders, but can also be idiopathic, and is a common respiratory complaint for which medical attention is sought. Chronic cough of various aetiologies is a regular presentation to specialist respiratory clinics, and is reported as a troublesome symptom by a significant proportion of the population. Despite this, the treatment options for cough are limited. The lack of effective anti-tussives likely stems from our incomplete understanding of how the tussive reflex is mediated. However, research over the last decade has begun to shed some light on the mechanisms which provoke cough, and may ultimately provide us with better anti-tussive therapies. This review will focus on the in vitro and in vivo models that are currently used to further our understanding of the sensory innervation of the respiratory tract, and how these nerves are involved in controlling the cough response. Central to this are the Transient Receptor Potential (TRP) ion channels, a family of polymodal receptors that can be activated by such diverse stimuli as chemicals, temperature, osmotic stress, and mechanical perturbation. These ion channels are thought to be molecular pain integrators and targets for novel analgesic agents for the treatment of various pain disorders but some are also being developed as anti-tussives. PMID:23474212

The Genus Spilanthes Ethnopharmacology, Phytochemistry, and Pharmacological Properties: A Review

PubMed Central

Paulraj, Jayaraj; Govindarajan, Raghavan; Palpu, Pushpangadan

2013-01-01

Spilanthes spp. are popular, over-the-counter remedies; they are sold over the internet under various names and are widely used in traditional medicine in various cultures. This review will summarize the important reports on the ethnopharmacology, botany, phytochemistry, and pharmacological properties as described in the literature from recent years (1920 to 2013). Spilanthes spp. are used for more than 60 types of disorders. They are reported to contain a number of biologically active phytochemicals, although a large number of ethnopharmacological uses have been documented; only a few of these species have been investigated for their chemical and biological activities. The studies are carried out mainly on Spilanthes extracts and a few metabolites substantiate the uses of these plants in traditional medicine. Well-conducted pharmacological studies are still needed for several traditional indications, and the mechanisms of action by which the plant extracts and the active compounds exert their pharmacological effects remain to be studied. They are predominantly used as extracts in personal care products, traditional medicines, and the pharmaceutical and culinary areas. Suggestions are made regarding some of the possible mechanisms of action as to how the known compounds may exert their biological activity. PMID:24454346

Community pharmacists' perceptions about pharmaceutical service of over-the-counter traditional Chinese medicine: a survey study in Harbin of China.

PubMed

Song, Menghuan; Ung, Carolina Oi Lam; Lee, Vivian Wing-Yan; Hu, Yuanjia; Zhao, Jing; Li, Peng; Hu, Hao

2017-01-05

This study aims to investigate community pharmacist's perception on the provision of over-the-counter (OTC) traditional Chinese medicine (TCM) pharmaceutical services; focusing on the areas of their attitude, general practice, perceived barriers and suggested improvements. Questionnaire survey targeting community pharmacists in Harbin of China was applied in this study. Questionnaires were distributed and collected at community pharmacies. Data was analyzed by combining descriptive analysis and Chi-test. 280 valid questionnaires were collected, giving a response rate of 78%. Respondents generally showed positive attitude towards OTC TCM pharmaceutical services. However, they were uncertain about whether such pharmaceutical services should be considered as their primary responsibility. Respondents indicated that they acted proactively to find out all the medicines taken by their patients and to remind consumers of possible OTC TCM adverse reactions. However, they were less keen on recommending or re-directing consumers to suitable OTC TCM. The three main barriers hindering the provision of OTC TCM pharmaceutical service identified in this study were "insufficient professional knowledge" (54.6%), "ambiguity of the professional role of pharmacists" (54.6%) and "lack of scientific evidence of OTC TCM" (45.4%). The three main actions considered most relevant to improving pharmaceutical service of OTC TCM were "formulating or refining legislation to clarify the legal and professional role of pharmacists with respect to TCM" (60.7%), "strengthening training of pharmacists with respect to TCM" (57.9%), and "promoting public awareness of the pharmacist's role" (53.6%). According to the results of Chi-test, respondents' perceptions about the attitude, practice, perceived barriers, and improvement suggestions were significantly different depending on the education levels, certificate types and workloads of western medicine. The community pharmacists in Harbin, China were positive about the provision of OTC TCM pharmaceutical services. However, they were less certain about taking this duty as their primary responsibility. Insufficient knowledge and lack of role definition in the area of OTC TCM were found to be the major factors discouraging the provision of pharmaceutical service on OTC TCM by community pharmacists.

Cough-induced rib fractures.

PubMed

Hanak, Viktor; Hartman, Thomas E; Ryu, Jay H

2005-07-01

To define the demographic, clinical, and radiological features of patients with cough-induced rib fractures and to assess potential risk factors. For this retrospective, single-center study, we identified all cases of cough-induced rib fractures diagnosed at the Mayo Clinic in Rochester, Minn, over a 9-year period between January 1, 1996, and January 31, 2005. Bone densitometry data from patients' medical records were analyzed, and T scores were used to classify patients into bone density categories. The mean +/- SD age of the 54 study patients at presentation was 55+/-17 years, and 42 patients (78%) were female. Patients presented with chest wall pain after onset of cough. Rib fracture was associated with chronic cough (> or =3 weeks' duration) in 85% of patients. Rib fractures were documented by chest radiography, rib radiography, computed tomography, or bone scan. Chest radiography had been performed in 52 patients and revealed rib fracture in 30 (58%). There were 112 fractured ribs in 54 patients. One half of patients had more than one fractured rib. Right-sided rib fractures alone were present in 17 patients (26 fractured ribs), left-sided in 23 patients (35 fractured ribs), and bilateral in 14 patients (51 fractured ribs). The most commonly fractured rib on both sides was rib 6. The fractures were most common at the lateral aspect of the rib cage. Bone densitometry was done in 26 patients and revealed osteopenia or osteoporosis in 17 (65%). Cough-induced rib fractures occur primarily in women with chronic cough. Middle ribs along the lateral aspect of the rib cage are affected most commonly. Although reduced bone density is likely a risk factor, cough-induced rib fractures can occur in the presence of normal bone density.

Effects of Asian dust on daily cough occurrence in patients with chronic cough: A panel study

NASA Astrophysics Data System (ADS)

Higashi, Tomomi; Kambayashi, Yasuhiro; Ohkura, Noriyuki; Fujimura, Masaki; Nakai, Satoshi; Honda, Yasushi; Saijoh, Kiyofumi; Hayakawa, Kazuichi; Kobayashi, Fumihisa; Michigami, Yoshimasa; Olando, Anyenda Enoch; Hitomi, Yoshiaki; Nakamura, Hiroyuki

2014-08-01

Asian dust, known as kosa in Japanese, is a major public health concern. In this panel study, we evaluated the effects of exposure to kosa on daily cough occurrence. The study subjects were 86 patients being treated for asthma, cough variant asthma, or atopic cough in Kanazawa University Hospital from January 2011 to June 2011. Daily mean concentrations of kosa and spherical particles were obtained from light detection and ranging (LIDAR) measurements, and were categorized from Grade 1 (0 μg/m3) to 5 (over 100 μg/m3). The association between kosa and cough was analyzed by logistic regression with a generalized estimating equation. Kosa effects on cough were seen for all Grades with potential time lag effect. Particularly at Lag 0 (the day of exposure), a dose-response relationship was observed: the odds ratios for Grades 2, 3, 4, and 5 above the referent (Grade 1) were 1.111 (95% confidence interval (CI): 0.995-1.239), 1.171 (95% CI: 1.006-1.363), 1.357 (95% CI: 1.029-1.788), and 1.414 (95% CI: 0.983-2.036), respectively. Among the patients without asthma, the association was higher: the odds ratios for Grades 2, 3, 4 and 5 were 1.223 (95% CI: 0.999-1.497), 1.309 (95% CI: 0.987-1.737), 1.738 (95% CI: 1.029-2.935) and 2.403 (95% CI: 1.158-4.985), respectively. These associations remained after adjusting for the concentration of spherical particles or particulate matter with an aerodynamic diameter of less than 2.5 μm (PM2.5). Our findings demonstrate that kosa is an environmental factor which induces cough in a dose-response relationship.

Reprint of: Effects of Asian dust on daily cough occurrence in patients with chronic cough: A panel study

NASA Astrophysics Data System (ADS)

Higashi, Tomomi; Kambayashi, Yasuhiro; Ohkura, Noriyuki; Fujimura, Masaki; Nakai, Satoshi; Honda, Yasushi; Saijoh, Kiyofumi; Hayakawa, Kazuichi; Kobayashi, Fumihisa; Michigami, Yoshimasa; Olando, Anyenda Enoch; Hitomi, Yoshiaki; Nakamura, Hiroyuki

2014-11-01

Asian dust, known as kosa in Japanese, is a major public health concern. In this panel study, we evaluated the effects of exposure to kosa on daily cough occurrence. The study subjects were 86 patients being treated for asthma, cough variant asthma, or atopic cough in Kanazawa University Hospital from January 2011 to June 2011. Daily mean concentrations of kosa and spherical particles were obtained from light detection and ranging (LIDAR) measurements, and were categorized from Grade 1 (0 μg/m3) to 5 (over 100 μg/m3). The association between kosa and cough was analyzed by logistic regression with a generalized estimating equation. Kosa effects on cough were seen for all Grades with potential time lag effect. Particularly at Lag 0 (the day of exposure), a dose-response relationship was observed: the odds ratios for Grades 2, 3, 4, and 5 above the referent (Grade 1) were 1.111 (95% confidence interval (CI): 0.995-1.239), 1.171 (95% CI: 1.006-1.363), 1.357 (95% CI: 1.029-1.788), and 1.414 (95% CI: 0.983-2.036), respectively. Among the patients without asthma, the association was higher: the odds ratios for Grades 2, 3, 4 and 5 were 1.223 (95% CI: 0.999-1.497), 1.309 (95% CI: 0.987-1.737), 1.738 (95% CI: 1.029-2.935) and 2.403 (95% CI: 1.158-4.985), respectively. These associations remained after adjusting for the concentration of spherical particles or particulate matter with an aerodynamic diameter of less than 2.5 μm (PM2.5). Our findings demonstrate that kosa is an environmental factor which induces cough in a dose-response relationship.

Evaluation of knowledge, attitude, and practice of community pharmacists toward administration of over-the-counter drugs for the treatment of diarrhea in children: A pretest-posttest survey.

PubMed

Foroughinia, Farzaneh; Zarei, Pedram

2016-01-01

In this study, we aimed to assess knowledge, attitude, and practice of community pharmacists toward administration of over-the-counter (OTC) antidiarrheal drugs in our city pharmacies, Shiraz, Iran. In this descriptive cross-sectional study, 90 pharmacies among 128 pharmacies in our city were randomly chosen. The study was designed into two phases: A standard questionnaire to determine the level of knowledge and attitude of pharmacists and a simulated client method to evaluate practice among them. An educational pamphlet was then given to the pharmacists. One month later, knowledge, attitude, and performance of studied pharmacists were evaluated again using the same method. Our results showed that an average consultation time by female pharmacists was considerably more than male pharmacists (P < 0.001). Before intervention, only 37.8% of pharmacists performed appropriately by prescribing the proper medicine while this increased to 58.44% after intervention. The average score of pharmacists' knowledge was statistically increased (P < 0.001) and the pharmacists' performance was significantly improved (P < 0.001) after the educational intervention. In related to the attitude, pharmacists' tendency toward prescribing oral rehydration salt solutions (ORS) (P < 0.001) and their belief about the great effect of ORS on the treatment of diarrhea increased significantly after the intervention. It is concluded that training programs such as educational pamphlets and continuing educational seminars may play important roles in increasing pharmacists' knowledge and therefore improving their performance in prescribing OTC medicines.

Evaluation of knowledge, attitude, and practice of community pharmacists toward administration of over-the-counter drugs for the treatment of diarrhea in children: A pretest–posttest survey

PubMed Central

Foroughinia, Farzaneh; Zarei, Pedram

2016-01-01

Objective: In this study, we aimed to assess knowledge, attitude, and practice of community pharmacists toward administration of over-the-counter (OTC) antidiarrheal drugs in our city pharmacies, Shiraz, Iran. Methods: In this descriptive cross-sectional study, 90 pharmacies among 128 pharmacies in our city were randomly chosen. The study was designed into two phases: A standard questionnaire to determine the level of knowledge and attitude of pharmacists and a simulated client method to evaluate practice among them. An educational pamphlet was then given to the pharmacists. One month later, knowledge, attitude, and performance of studied pharmacists were evaluated again using the same method. Findings: Our results showed that an average consultation time by female pharmacists was considerably more than male pharmacists (P < 0.001). Before intervention, only 37.8% of pharmacists performed appropriately by prescribing the proper medicine while this increased to 58.44% after intervention. The average score of pharmacists’ knowledge was statistically increased (P < 0.001) and the pharmacists’ performance was significantly improved (P < 0.001) after the educational intervention. In related to the attitude, pharmacists’ tendency toward prescribing oral rehydration salt solutions (ORS) (P < 0.001) and their belief about the great effect of ORS on the treatment of diarrhea increased significantly after the intervention. Conclusion: It is concluded that training programs such as educational pamphlets and continuing educational seminars may play important roles in increasing pharmacists’ knowledge and therefore improving their performance in prescribing OTC medicines. PMID:27512712

78 FR 57623 - TRICARE Over-the-Counter Drug Demonstration Project

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-19

... DEPARTMENT OF DEFENSE Office of the Secretary TRICARE Over-the-Counter Drug Demonstration Project AGENCY: Office of the Secretary, DoD. ACTION: Notice of modification to the TRICARE Over-the-Counter Drug...) drugs to be included on the TRICARE uniform formulary. The Department has been engaged in a...

Assessing the relationship between pharmacists' job satisfaction and over-the-counter counselling at community pharmacies.

PubMed

Urbonas, Gvidas; Kubilienė, Loreta

2016-04-01

Community pharmacies have an increasing role in self-medication and community health is dependent on the quality of counselling services provided to patients. Some studies show that pharmacists' job satisfaction affects their work quality; other studies found that higher involvement in clinical services increases pharmacists' job satisfaction. To test the relationship between job satisfaction and over-the-counter counselling practice at community pharmacies. Community pharmacies in Lithuania. A convenience sample (n = 305) of community pharmacists participated in the cross-sectional survey where they expressed satisfaction with job and reported on their over-the-counter counselling behaviour on self-report scales. The Partial Least Squares Structural Equation Modelling approach was employed for data analysis. The strength of the relationship between job satisfaction and over-the-counter counselling service. A bidirectional relationship between job satisfaction and over-the-counter counselling service was found. In addition, job satisfaction and over-the-counter counselling quality depended on pharmacists' age. Organizations were recommended to create a counselling friendly environment that would increase pharmacists' job satisfaction and, in return, counselling quality. Also, additional motivation of the retired pharmacists, as well as development of counselling skills of the younger pharmacy workforce, were seen as a means to improve both organizational climate and counselling quality over the counter.

Prescribing Practices of Physicians at Different Health Care Institutions

PubMed Central

Mollahaliloglu, Salih; Alkan, Ali; Donertas, Basak; Ozgulcu, Senay; Akici, Ahmet

2013-01-01

Objective: Irrational pharmacotherapy is a widespread health care problem, and knowing the prescription practices of physicians at an institutional level can present solutions. This study aimed to investigate whether physicians’ prescribing patterns showed differences at the level of the health care institution. Materials and Methods: Photocopies of 3201 prescriptions written at primary health care centers (PHCs), public hospitals, private hospitals, and university hospitals (UHs) were collected from 10 provinces in Turkey. The prescriptions were evaluated according to prescribing indicators, and the details of drug utilization were compared for different health care institutions. Results: The average number of medicines per prescription was 2.83, and the highest average was noted in PHCs (2.96). The average cost per prescription was US $51.57, and the highest average cost was found in UHs (US $166.10). The most frequently prescribed drug group was different among health care institutions. With the exception of UHs, the “cold-cough medicines” were the most frequently prescribed medicines at all of the institutions. Thirty-nine percent of the prescriptions included antibiotics. Conclusion: Despite the similarities between the distributions of diagnoses on prescriptions by health care institutions, the contents of the prescriptions showed differences. The high levels of prescriptions for “cold-cough medicines,” whose use is widely debated, and the widespread tendency of physicians to prescribe antibiotics suggest that there is a growing need for disseminating the principles of rational pharmacotherapy. Furthermore, institutional differences must be considered when conducting rational pharmacotherapy programs. PMID:25610260

Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults.

PubMed

Chang, Anne B; Lasserson, Toby J; Gaffney, Justin; Connor, Frances L; Garske, Luke A

2011-01-19

Gastroesophageal reflux disease (GORD) is said to be the causative factor in up to 41% of adults with chronic cough. Treatment for GORD includes conservative measures (diet manipulation), pharmaceutical therapy (motility or prokinetic agents, H(2)-antagonist and proton pump inhibitors (PPI)) and fundoplication. To evaluate the efficacy of GORD treatment on chronic cough in children and adults with GORD and prolonged cough that is not related to an underlying respiratory disease, i.e. non-specific chronic cough. We searched the Cochrane Airways Group Specialised Register, the Cochrane Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, review articles and reference lists of relevant articles. The date of last search was 8 April 2010. All randomised controlled trials (RCTs) on GORD treatment for cough in children and adults without primary lung disease. Two review authors independently assessed trial quality and extracted data. We contacted study authors for further information. We included 19 studies (six paediatric, 13 adults). None of the paediatric studies could be combined for meta-analysis. A single RCT in infants found that PPI (compared to placebo) was not efficacious for cough outcomes (favouring placebo OR 1.61; 95% CI 0.57 to 4.55) but those on PPI had significantly increased adverse events (OR 5.56; 95% CI 1.18 to 26.25) (number needed to treat for harm in four weeks was 11 (95% CI 3 to 232)). In adults, analysis of H(2) antagonist, motility agents and conservative treatment for GORD was not possible (lack of data) and there were no controlled studies of fundoplication. We analysed nine adult studies comparing PPI (two to three months) to placebo for various outcomes in the meta-analysis. Using intention-to-treat, pooled data from studies resulted in no significant difference between treatment and placebo in total resolution of cough (OR 0.46; 95% CI 0.19 to 1.15). Pooled data revealed no overall significant improvement in cough outcomes (end of trial or change in cough scores). We only found significant differences in sensitivity analyses. We found a significant improvement in change of cough scores at end of intervention (two to three months) in those receiving PPI (standardised mean difference -0.41; 95% CI -0.75 to -0.07) using generic inverse variance analysis on cross-over trials. Two studies reported improvement in cough after five days to two weeks of treatment. PPI is not efficacious for cough associated with GORD symptoms in very young children (including infants) and should not be used for cough outcomes. There is insufficient data in older children to draw any valid conclusions. In adults, there is insufficient evidence to conclude definitely that GORD treatment with PPI is universally beneficial for cough associated with GORD. Clinicians should be cognisant of the period (natural resolution with time) and placebo effect in studies that utilise cough as an outcome measure. Future paediatric and adult studies should be double-blind, randomised controlled and parallel-design, using treatments for at least two months, with validated subjective and objective cough outcomes and include ascertainment of time to respond as well as assessment of acid and/or non-acid reflux.

Primary care for women. Management of common respiratory problems.

PubMed

Mays, M; Leiner, S

1996-01-01

This article reviews the clinical management of common respiratory illness that primary care providers encounter in an outpatient setting. The latest recommendations from the American Thoracic Society, the National Heart, Lung, and Blood Institute, and the Centers for Disease Control and Prevention are summarized. The article discusses the causative organisms and antibiotics of choice for community-acquired pneumonia, and how to determine which patients require hospitalization. The appropriate use of asthma medications is described in detail, along with strategies for reducing aeroallergen exposure and for educating patients. An extensive section covers the interpretation of tuberculin skin tests and use of prophylactic isoniazid for prevention therapy of latent tuberculous infection, as well as the treatment of active tuberculosis. Controversies regarding antibiotics for both acute and chronic bronchitis are discussed along with other treatment options including over-the-counter medications, bronchodilators, and non-pharmacologic interventions. Finally, a strategy for dealing with the complaint of chronic cough is outlined. Although many of these conditions require active comanagement by collaborating physicians, the nurse-midwife will be better able to communicate with an advocate for her clients if she possesses expanded and current knowledge of treatment strategies.

Kitchen chemistry: A scoping review of the diversionary use of pharmaceuticals for non-medicinal use and home production of drug solutions.

PubMed

Van Hout, Marie Claire

2014-01-01

Misuse of pharmaceuticals is of increasing drug policy and public health concern. A scoping review was conducted on the diversionary use of pharmaceuticals for non-medicinal use and home production of drug solutions. The research question was broad: What is known from the existing literature about the diversion of pharmaceuticals for non-medicinal use and for home production of drug solutions? The scoping process centred on the systematic selection, collection, and summarization of extant knowledge within this broad thematic remit. One hundred and thirty-four records were grouped into discrete thematic categories namely: non medicinal use and tampering with pharmaceuticals, oral misuse of codeine cough syrups, homemade drug solutions, and home-produced drug-related harms in the narrative review design. Forms of abuse of codeine cough syrup include mixtures with alcohol or soft drinks ('Purple Drank'), with kratom leaves ('Kratom cocktails'), or chemically altered to extract dextromorphan ('Lemon Drop'). Production of homemade opiates ('Cheornaya', 'Kolyosa', Himiya', 'Braun', 'Krokodil'), methamphetamine ('Vint', 'Pervitin'), methcathinone ('Jeff'), and cathinone ('Boltushka') are described. Displacement patterns between the non-medical use of pharmaceuticals, commercial, and homemade drugs appear dependent on availability of opiates, prescribing practices, supervision of substitution drug dosing, availability of cheap ingredients, policing, and awareness of harms. Adverse health and social consequences relate to the use of unknown and contaminated (end) substances, injecting practices, redosing, medical complications, and death. The review highlights a public health imperative requiring a multidisciplinary approach to quantify potential impact and required integrated policy responses incorporating international regulation, enforcement, health surveillance and service delivery. Copyright © 2014 John Wiley & Sons, Ltd.

Quantifying the influence of respiration and cardiac pulsations on cerebrospinal fluid dynamics using real-time phase-contrast MRI.

PubMed

Yildiz, Selda; Thyagaraj, Suraj; Jin, Ning; Zhong, Xiaodong; Heidari Pahlavian, Soroush; Martin, Bryn A; Loth, Francis; Oshinski, John; Sabra, Karim G

2017-08-01

To validate a real-time phase contrast magnetic resonance imaging (RT-PCMRI) sequence in a controlled phantom model, and to quantify the relative contributions of respiration and cardiac pulsations on cerebrospinal fluid (CSF) velocity at the level of the foramen magnum (FM). To validate the 3T MRI techniques, in vitro studies used a realistic model of the spinal subarachnoid space driven by pulsatile flow waveforms mimicking the respiratory and cardiac components of CSF flow. Subsequently, CSF flow was measured continuously during 1-minute RT-PCMRI acquisitions at the FM while healthy subjects (N = 20) performed natural breathing, deep breathing, breath-holding, and coughing. Conventional cardiac-gated PCMRI was obtained for comparison. A frequency domain power ratio analysis determined the relative contribution of respiration versus cardiac ([r/c]) components of CSF velocity. In vitro studies demonstrating the accuracy of RT-PCMRI within 5% of input values showed that conventional PCMRI measures only the cardiac component of CSF velocity (0.42 ± 0.02 cm/s), averages out respiratory effects, and underestimates the magnitude of CSF velocity (0.96 ± 0.07 cm/s). In vivo RT-PCMRI measurements indicated the ratio of respiratory to cardiac velocity pulsations averaged over all subjects as [r/c = 0.14 ± 0.27] and [r/c = 0.40 ± 0.47] for natural and deep breathing, respectively. During coughing, the peak CSF velocity increased by a factor of 2.27 ± 1.40. RT-PCMRI can noninvasively measure instantaneous CSF velocity driven by cardiac pulsations, respiration, and coughing in real time. A comparable contribution of respiration and cardiac pulsations on CSF velocity was found during deep breathing but not during natural breathing. 1 Technical Efficacy: Stage 1 J. MAGN. RESON. IMAGING 2017;46:431-439. © 2017 International Society for Magnetic Resonance in Medicine.

Update on well-baby and well-child care from 0 to 5 years

PubMed Central

Rourke, Leslie; Leduc, Denis; Constantin, Evelyn; Carsley, Sarah; Rourke, James

2010-01-01

Abstract OBJECTIVE To provide an overview of the 2009 edition of the Rourke Baby Record (RBR), which incorporates recent research in the literature relating to preventive health care for children aged 0 to 5 years. QUALITY OF EVIDENCE Recommendations are identified as supported by good, fair, or consensus evidence, according to the classification of the Canadian Task Force on Preventive Health Care. MAIN MESSAGE New information and recommendations are given for growth monitoring, nutrition, developmental surveillance, physical examination maneuvers, immunization schedules, and advice for parents. Anticipatory guidance updates relate to injury prevention, infant swaddling, literacy facilitation, nonparental child care, parenting skills programs, serum lead levels, over-the-counter cough and cold medications, pacifiers, antipyretics, insect repellents, and dental care and oral health. The 2009 RBR is available in English and French in both National and Ontario versions and is endorsed by the College of Family Physicians of Canada and the Canadian Paediatric Society. CONCLUSION The RBR website (www.rourkebabyrecord.ca) provides a practical tool for well-baby and well-child care, including background information, current evidence and literature review appraisal, an interactive walk-through of the guides with links to further information and evidence, and additional practical resources. PMID:21156890

Swift onset of central nervous system depression and asystole followingan overdose of Guaifenesin.

PubMed

Okic, Merisa; Johnson, Tom; Crifasi, Joseph A; Long, Christopher; Mitchell, Erik K

2013-06-01

Guaifenesin is an over-the-counter expectorant used for chest congestion and is available both in single-ingredient formulations and in combination with antihistamines, cough suppressants and decongestants. The documented side-effects of guaifenesin are generally mild. We present the case of a 23-year-old female who committed suicide by ingestion of guaifenesin along with small amounts of cetirizine, ethanol and sertraline. Approximately 2 h after ingestion, the patient experienced central nervous system depression followed by asystole. No anatomic cause of death could be determined at autopsy. The initial toxicology detected only ethanol, which was found at a concentration insufficient to cause death. Upon further analysis, guaifenesin was detected in femoral blood at 25.0 μg/mL, urine at >50.0 μg/mL, vitreous fluid at 9.2 μg/mL, brain at 17.0 μg/g and liver at 25.0 μg/g. This is the first reported human case that can be considered a death to which guaifenesin was the significant pharmacologic contributor. Guaifenesin is not detected by the primary screening methods employed by some labs and may be missed in toxicological analyses of overdoses unless specifically suspected.

Safety and Quality Concerns Regarding Over-the-Counter Sexual Enhancement Products Sold in the USA Market Pose a Major Health Risk.

PubMed

Ahmed, Mohammed; Kumari, Suneeta; Manali, Partam; Sonje, Snezana; Malik, Mansoor

2016-10-01

Safety and quality concerns regarding over the counter sexual enhancement products sold in the USA market pose a major health risk to the general public. Nevertheless, the use of herbal medicines continues to expand rapidly across world and many people perceive usage of herbal medication as a safe and reliable way to improve health outcome. The safety of herbal supplements has become a globally major concern in national and international health authorities due to increasing adverse events and adulterations associated with usage of herbal medications. These non FDA approved products with unknown ingredients are widely accessible for purchase ranging from local food, drug stores and to the internet. These Erectile Dysfunction (ED) pills may contain Sildenafil, the active ingredient of Viagra in much higher quantity then legally prescribed by a licensed physician or they may contain unknown quantities of Thiosildenafil, the active ingredient in Cialis. The types of chemicals found in these medications are making it harder for regulatory authorities to track them down. These products keep the consumer in the dark in terms of the quantity, ingredients, effectiveness and possible side effects. These sexual enhancement products are being sold as safe and natural with false hopes to resolve erectile dysfunction. Patients who are prone to impulsive hypersexual behavior such as patients with bipolar disorder, substance use, borderline personality disorder and those who may feel adamant to discuss erectile dysfunction with their physicians are more likely to become the victims of using illicit medications/ drugs with serious health risks consequences. We present a case report of an individual with bipolar disorder and hypersexual behavior who became victim to over the counter sexual enhancement products/supplements which caused serious health and life threatening consequences.

Preparative high-speed counter-current chromatography for purification of shikonin from the Chinese medicinal plant Lithospermum erythrorhizon.

PubMed

Lu, Hai-Tao; Jiang, Yue; Chen, Feng

2004-01-09

The bioactive compound shikonin was successfully isolated and purified from the crude extract of the traditional Chinese medicinal plant Lithospermum erythrorhizon Sieb. et Zucc. by preparative high-speed counter-current chromatography (HSCCC). The preparative HSCCC was performed using a two-phase solvent system composed of n-hexane-ethylacetate-ethanol-water (16:14:14:5 (v/v)). A total amount of 19.6 mg of shikonin at 98.9% purity was obtained from 52 mg of the crude extract (containing 38.9% shikonin) with 96.9% recovery. The preparative isolation and purification of shikonin by HSCCC was completed in 200 min in a one-step separation.

Patients' intention to consume prescribed and non-prescribed medicines: A study based on the theory of planned behaviour in selected European countries.

PubMed

Kamekis, A; Bertsias, A; Moschandreas, J; Petelos, E; Papadakaki, M; Tsiantou, V; Saridaki, A; Symvoulakis, E K; Souliotis, K; Papadakis, N; Faresjö, T; Faresjö, A; Martinez, L; Agius, D; Uncu, Y; Sengezer, T; Samoutis, G; Vlcek, J; Abasaeed, A; Merkouris, B; Lionis, C

2018-02-01

Polypharmacy has a significant impact on patients' health with overall expenditure on over-the-counter (OTC) medicines representing a substantial burden in terms of cost of treatment. The aim of this study, which was conducted within the framework of a European Project funded by the European Union under the Seventh Framework Programme and was entitled OTC-SOCIOMED, was to report on possible determinants of patient behaviour regarding the consumption of medicines, and particularly OTCs, in the context of primary care. A multicentre, cross-sectional study was designed and implemented in well-defined primary healthcare settings in Cyprus, the Czech Republic, France, Greece, Malta and Turkey. Patients completed a questionnaire constructed on the basis of the theory of planned behaviour (TPB), which was administered via face-to-face interviews. The percentage of patients who had consumed prescribed medicines over a 6-month period was consistently high, ranging from 79% in the Czech Republic and 82% in Turkey to 97% in Malta and 100% in Cyprus. Reported non-prescribed medicine consumption ranged from 33% in Turkey to 92% in the Czech Republic and 97% in Cyprus. TPB behavioural antecedents explained 43% of the variability of patients' intention to consume medicines in Malta and 24% in Greece, but only 3% in Turkey. Subjective norm was a significant predictor of the intention to consume medicines in all three countries (Greece, Malta and Turkey), whereas attitude towards consumption was a significant predictor of the expectation to consume medicines, if needed. This study shows that parameters such as patients' beliefs and influence from family and friends could be determining factors in explaining the high rates of medicine consumption. Factors that affect patients' behavioural intention towards medicine consumption may assist in the formulation of evidence-based policy proposals and inform initiatives and interventions aimed at increasing the appropriate use of medicines. © 2017 John Wiley & Sons Ltd.

Dietary supplements: What's in a name? What's in the bottle?

PubMed

Marcus, Donald M

2016-01-01

The Dietary Supplement Health and Education Act of 1994 (DSHEA), which arbitrarily classified herbals and other medicinal products as dietary supplements, obscured fundamental differences between two classes of products. Authentic supplements to the diet, such as multivitamins or calcium, have nutritional value and are safe. Herbals are used worldwide as medicines, they do not supplement the diet, they may cause severe adverse events, and they should be regulated as medicines. DSHEA also prevented the Food and Drug Administration (FDA) from effectively regulating herbal supplements as medicines. One consequence of weak FDA regulatory oversight is the poor quality of herbals. FDA inspections of manufacturing facilities have revealed violations of good manufacturing practices in over half of facilities inspected, including unsanitary conditions and lack of product specifications. Moreover, many "all natural" herbals marketed for weight loss, enhancement of sexual health and improving sports performance are adulterated with prescription and over-the-counter medications that have caused adverse cardiovascular events. New procedures to authenticate the identity of plants used in herbals will neither detect adulteration by medications nor provide assurance of appropriate pharmacological activity or safety. Nonvitamin, nonmineral "supplements" should be regulated as medicines, but revision or repeal of DSHEA faces strong opposition in Congress. The marketing of botanical supplements is based on unfounded claims that they are safe and effective. Health professionals need to inform patients and the public that there is no reason to take herbal medicines whose composition and benefits are unknown, and whose risks are evident. Copyright © 2015 John Wiley & Sons, Ltd.

49 CFR 219.103 - Prescribed and over-the-counter drugs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 4 2014-10-01 2014-10-01 false Prescribed and over-the-counter drugs. 219.103... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Prohibitions § 219.103 Prescribed and over-the-counter drugs. (a) This subpart does not prohibit the use of a controlled substance (on...

49 CFR 219.103 - Prescribed and over-the-counter drugs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 4 2012-10-01 2012-10-01 false Prescribed and over-the-counter drugs. 219.103... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Prohibitions § 219.103 Prescribed and over-the-counter drugs. (a) This subpart does not prohibit the use of a controlled substance (on...

49 CFR 219.103 - Prescribed and over-the-counter drugs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 4 2013-10-01 2013-10-01 false Prescribed and over-the-counter drugs. 219.103... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Prohibitions § 219.103 Prescribed and over-the-counter drugs. (a) This subpart does not prohibit the use of a controlled substance (on...

49 CFR 219.103 - Prescribed and over-the-counter drugs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 4 2011-10-01 2011-10-01 false Prescribed and over-the-counter drugs. 219.103... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Prohibitions § 219.103 Prescribed and over-the-counter drugs. (a) This subpart does not prohibit the use of a controlled substance (on...

49 CFR 219.103 - Prescribed and over-the-counter drugs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Prescribed and over-the-counter drugs. 219.103... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CONTROL OF ALCOHOL AND DRUG USE Prohibitions § 219.103 Prescribed and over-the-counter drugs. (a) This subpart does not prohibit the use of a controlled substance (on...

Chest radiography in supporting the diagnosis of asthma in children with persistent cough.

PubMed

Halaby, Claudia; Feuerman, Martin; Barlev, Dan; Pirzada, Melodi

2014-03-01

To establish whether chest radiographic findings suggestive of lower airway obstruction (LAO) disease support the diagnosis of asthma in pediatric patients with persistent cough in an outpatient setting. 180 patient charts were reviewed. The patients were children aged 1 to 18 years referred over a 3-year period to a pediatric pulmonary subspecialty clinic for evaluation of cough lasting ≥ 4 weeks. Chest radiographic images obtained after the initial evaluation of 90 patients diagnosed with cough-variant asthma and 90 patients diagnosed with persistent cough from nonasthma origins were compared with radiologic findings of a control group consisting of patients with a positive tuberculin skin test and no respiratory symptoms. Increased peribronchial markings/peribronchial cuffing and hyperinflation were considered radiographically suggestive findings of LAO disease. Children diagnosed with cough-variant asthma at the initial evaluation had higher rates of chest radiographic findings suggestive of LAO disease (30.00%) than children with persistent cough from other causes (17.80%) or those with a positive tuberculin skin test and no respiratory symptoms (8.16%) (overall P value = 0.0063). They also had higher rates of spirometry abnormalities suggestive of an LAO defect. Children with chest radiographic findings suggestive of LAO disease were found to be younger than those with normal chest radiographic findings (5.0 ± 2.7 years vs 8.6 ± 4.7 years; P < 0.0001). This study suggests that chest radiographic findings indicative of an LAO in correlation with the clinical presentation can support the diagnostic suspicion of asthma, especially in younger children unable to perform spirometry.

Cough sound analysis - a new tool for diagnosing pneumonia.

PubMed

Abeyratne, U R; Swarnkar, V; Triasih, Rina; Setyati, Amalia

2013-01-01

Pneumonia kills over 1,800,000 children annually throughout the world. Prompt diagnosis and proper treatment are essential to prevent these unnecessary deaths. Reliable diagnosis of childhood pneumonia in remote regions is fraught with difficulties arising from the lack of field-deployable imaging and laboratory facilities as well as the scarcity of trained community healthcare workers. In this paper, we present a pioneering class of enabling technology addressing both of these problems. Our approach is centered on automated analysis of cough and respiratory sounds, collected via microphones that do not require physical contact with subjects. We collected cough sounds from 91 patients suspected of acute respiratory illness such as pneumonia, bronchiolitis and asthma. We extracted mathematical features from cough sounds and used them to train a Logistic Regression classifier. We used the clinical diagnosis provided by the paediatric respiratory clinician as the gold standard to train and validate our classifier against. The methods proposed in this paper could separate pneumonia from other diseases at a sensitivity and specificity of 94% and 75% respectively, based on parameters extracted from cough sounds alone. Our method has the potential to revolutionize the management of childhood pneumonia in remote regions of the world.

[Physical and chemical emergencies in dermatology].

PubMed

Malisiewicz, B; Meissner, M; Kaufmann, R; Valesky, E

2018-05-01

Physical and chemical emergencies are often caused by household or work accidents. Regardless of the medical field and outside specialized clinics, the physician may be confronted with the situation for first or secondary care. The identification of the causing agent and a rapid assessment of the extent and severity of the tissue damage are essential to initiate early transfer to a specialized burn clinic. Grade 2b tissue damage is usually surgically treated. Smaller and superficial injuries can often be conservatively treated. Even supposedly safe and over-the-counter medicines can also lead to serious tissue damage.

Signs & Symptoms of Dextromethorphan Exposure from YouTube

PubMed Central

Chary, Michael; Park, Emily H.; McKenzie, Andrew; Sun, Julia; Manini, Alex F.; Genes, Nicholas

2014-01-01

Detailed data on the recreational use of drugs are difficult to obtain through traditional means, especially for substances like Dextromethorphan (DXM) which are available over-the-counter for medicinal purposes. In this study, we show that information provided by commenters on YouTube is useful for uncovering the toxicologic effects of DXM. Using methods of computational linguistics, we were able to recreate many of the clinically described signs and symptoms of DXM ingestion at various doses, using information extracted from YouTube comments. Our study shows how social networks can enhance our understanding of recreational drug effects. PMID:24533044

Malaria case detection using rapid diagnostic test at the community level in Ghana: consumer perception and practitioners' experiences.

PubMed

Danquah, Daniel A; Buabeng, Kwame O; Asante, Kwaku P; Mahama, Emmanuel; Bart-Plange, Constance; Owusu-Dabo, Ellis

2016-01-22

Ghana has scaled-up malaria control strategies over the past decade. Much as malaria morbidity and mortality seem to have declined with these efforts, there appears to be increased consumption of artemisinin-based combination therapy (ACT). This study explored the perception and experiences of community members and medicines outlet practitioners on malaria case detection using rapid diagnostic test (RDTs) to guide malaria therapy. This was a cross-sectional study using both quantitative and qualitative approaches for data. In-depth interviews with structured questionnaires were conducted among 197 practitioners randomly selected from community pharmacies and over-the-counter medicine sellers shops within two metropolis (Kumasi and Obuasi) in the Ashanti Region of Ghana. Two focus group discussions were also held in the two communities among female adult caregivers. Medicine outlet practitioners and community members often used raised body temperature of individuals as an index for malaria case detection. The raised body temperature was presumptively determined by touching the forehead with hands. Seventy percent of the practitioners' perceived malaria RDTs are used in hospitals and clinics but not in retail medicines outlets. Many of the practitioners and community members agreed to the need for using RDT for malaria case detection at medicine outlets. However, about 30% of the practitioners (n = 59) and some community members (n = 6) held the view that RDT negative results does not mean no malaria illness and would use ACT. Though malaria RDT use in medicines outlets was largely uncommon, both community members and medicine outlet practitioners welcomed its use. Public education is however needed to improve malaria case detection using RDTs at the community level, to inform appropriate use of ACT.

The genus Desmodium (Fabaceae)-traditional uses in Chinese medicine, phytochemistry and pharmacology.

PubMed

Ma, Xueqin; Zheng, Chengjian; Hu, Changling; Rahman, Khalid; Qin, Luping

2011-11-18

Plants of the genus Desmodium (Fabaceae), such as Desmodium styracifolium (Osbeck) Merr. and Desmodium gyrans (L. f.) DC., have a long history of medical use in Traditional Chinese Medicine to treat various ailments including rheumatism, pyrexia, dysentery, wounds, cough, malaria, hepatitis, hemoptysis, etc. In the theory of Traditional Chinese Medicine, most species have the effect of relieving internal heat or fever, neutralizing toxins, inhibiting pain, invigorating blood circulation, suppressing cough and alleviating dyspnea. A bibliographic investigation was accomplished by analyzing secondary sources including Chinese Herbal Classics, and worldwide accepted scientific databases (Pubmed, Scopus and Web of Science, SciFinder) were scrutinized for the available information on the ethnopharmacological uses in Chinese medicine, phytochemistry, pharmacology and toxicology of Desmodium species. The genus Desmodium is a large member of the Papilionaceae (Fabaceae) family. It contains about 350 plant species used for both feeding stuffs and herbal medicines, of which only about 30 species have been phytochemically or pharmacologically investigated. Desmodium plant extracts, as well as the active principles, have been experimentally studied for their anti-inflammatory, cytotoxic, antidiabetic, antinephrolithic, antibacterial, and nootropic activities in vitro or in vivo. And so far, a total of 212 compounds have been isolated from 15 Desmodium species and characterized mainly as flavonoids and alkaloids, followed by terpenoids, steroids, phenols, phenylpropanoids, glycosides and a number of volatile oils. The remaining unrevealed species are recorded chiefly in Asia and Africa being used in empirical treatment for various diseases. Desmodium species have long been used in TCM to treat various ailments. Available scientific references revealed that the traditional medical uses of some important Desmodium species in TCM have been evaluated by modern pharmacological studies. As literature demonstrated, flavonoids and alkaloids are perhaps responsible for most of the activities shown by the plants of this genus. Further studies are still required to reveal the structure-activity relationship of these active constituents. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Cough: impact, beliefs, and expectations from a national survey.

PubMed

Dal Negro, Roberto W; Mazzolini, Massimiliano; Turco, Paola; Zanasi, Alessandro

2016-01-01

Cough is one of the most common discomforts affecting general population, which can disrupt subjects' quality of life due to its physical, social, and psychological effects. Aim of the study was to investigate the impact of cough and related beliefs of general population. A cross-sectional telephone survey was carried out by means of a specific, validated questionnaire on a representative sample of Italian general population. All the interviews were carried out according to the Computer Assisted Telephone Interview (CATI) methodology by expert, professional interviewers. Distributions of all answers were calculated in the overall sample. A total of 1,251 subjects (mean age: 49 years; females 44.2 %) completed the interviews. The overall number of telephone calls was 5362, and the corresponding redemption rate was 1/4.3 (23.%). The sample was representative of national population in terms of geographical distribution, age, gender, and smoking habit. The majority of respondents was convinced that cough is merely a symptom of several different diseases, but 46.4 % of respondents affirmed that cough should be regarded as "a disease" per se. Only 29.1 % of subjects say that they usually do not complain of any cough over the year, while 18.4 % reported ≥ 3 episodes of cough/year. These episodes have a duration ranging 10-30 days in 19.9 % of subjects, and > 30 days in 6.9 % of subjects. The majority of respondents is worried about their cough only after 1 week, but 76.9 % of subjects is much more worried if cough affects a child. After a few days of cough, 23.1 % of subjects use domestic remedies; 20.9 % ask their pharmacist, and 33.4 % their doctor, being GPs (69.6 %) and lung physicians (16.2 %) the most asked professionals. The occurrence of bronchitis, pneumonia, upper airway infections, and allergic troubles are the most feared events. The majority of respondents are convinced that antibiotics and steroids should not be regarded as the gold standard for treating persistent cough (61.2 and 58.2 %, respectively), while anti-tussive drugs and aerosols in general are regarded as the most effective strategies (69.1 and 74.1 %, respectively). Moreover, 33.8 % of the sample is in favour of homeopathic drugs, while 23.2 % had already used an homeopathic anti-tussive syrup, and 27.6 % of subjects are really interested in using the homeopathic approach. The willingness to pay for an effective anti-tussive remedy was: 46.3 % up to 10 €; 27.8 % up to 20 €, and 13.3 % more than 20 €. Cough confirms its high impact in Italy, and a substantial proportion of individuals regards cough as "a disease". Only one out of three Italians refers to their doctor, but when cough is already persistent. Cough in children is much more feared than in adults. The majority of Italians have a proper and conservative position versus both antibiotic and the systemic steroid uses against cough. The Italian attitude to aerosol therapy confirms very high. Differently from the cough guidelines, anti-tussive drugs are highly valued among Italian people. The attitude and the interest to homeopathic anti-tussive remedies proves high. Finally, the willingness to pay for an effective anti-tussive remedy is quite high in Italy.

Disposal practices of unused and expired pharmaceuticals among general public in Kabul.

PubMed

Bashaar, Mohammad; Thawani, Vijay; Hassali, Mohamed Azmi; Saleem, Fahad

2017-01-07

Most of the medicine users remain unaware about the disposal of unused or expired medicines. The aim of this study was to know the disposal practices of unused and expired medicines among the general public in Kabul. This was a descriptive, cross-sectional survey, conducted through face-to-face interviews using prevalidated structured questionnaire. Returned questionnaires were double-checked for accuracy. Statistical Package for Social Science (SPSS) version 23 was used for statistical analysis. Total of 301 valid questionnaires were returned with a response rate of 100% in which 73.4% men and 26.6% women participated. More than half of the respondents were university graduates. Interestingly, 83.4% of the interviewees purchased medicines on the prescription of which 47.2% were university graduates, while 14.6% purchased medicine over the counter. Among the respondents, 46.5/100 purchased antibiotics and the remaining purchased NSAIDs, anti-hypertensive and anti-diabetic medicines. Significantly, 97/100 checked the expiry date of medicine before buying. Majority (95.3%) of the respondents' stored medicines at home. 77.7% of the respondents discarded the expired medicines in household trash. Majority of respondents held government responsible for creation of awareness for proper medicine disposal. Almost entire sample (98%) felt that improper disposal of unused and expired medicines can affect the environment and health. Gaps exist in practices, therefore robust, safe and cost-effective pharmaceutical waste management program supported with media campaign is needed. Healthcare practitioners and community pharmacists should offer training to educate customers on standard medicine disposal practices.

21 CFR 310.527 - Drug products containing active ingredients offered over-the-counter (OTC) for external use as...

Code of Federal Regulations, 2012 CFR

2012-04-01

... offered over-the-counter (OTC) for external use as hair growers or for hair loss prevention. 310.527... products containing active ingredients offered over-the-counter (OTC) for external use as hair growers or for hair loss prevention. (a) Amino acids, aminobenzoic acid, ascorbic acid, benzoic acid, biotin and...

21 CFR 310.527 - Drug products containing active ingredients offered over-the-counter (OTC) for external use as...

Code of Federal Regulations, 2014 CFR

2014-04-01

... offered over-the-counter (OTC) for external use as hair growers or for hair loss prevention. 310.527... products containing active ingredients offered over-the-counter (OTC) for external use as hair growers or for hair loss prevention. (a) Amino acids, aminobenzoic acid, ascorbic acid, benzoic acid, biotin and...

21 CFR 310.527 - Drug products containing active ingredients offered over-the-counter (OTC) for external use as...

Code of Federal Regulations, 2013 CFR

2013-04-01

... offered over-the-counter (OTC) for external use as hair growers or for hair loss prevention. 310.527... products containing active ingredients offered over-the-counter (OTC) for external use as hair growers or for hair loss prevention. (a) Amino acids, aminobenzoic acid, ascorbic acid, benzoic acid, biotin and...

Informational and symbolic content of over-the-counter drug advertising on television.

PubMed

Tsao, J C

1997-01-01

The informational and symbolic content of 150 over-the-counter drug commercials on television are empirically analyzed in this study. Results on the informational content suggest that over-the-counter drug ads tend to focus on the concern of what the drug will do for the consumer, rather than on the reasons why the drug should be ingested. Accordingly, advertising strategy is centered on consumer awareness of the product as the primary goal. Educational commitment, however, did not seem to be blended into the promotional efforts for over-the-counter drugs. Findings on the symbolic content of over-the-counter drug ads reveal that drug images have been distorted. Performance of most drugs has been portrayed to be simple resolutions to relieve the symptom. Moreover, a casual attitude toward drug usage is encouraged in the commercials, while time lapse of drug effects is overlooked.

Metabolomic profiling of the flower bud and rachis of Tussilago farfara with antitussive and expectorant effects on mice.

PubMed

Li, Zhen-Yu; Zhi, Hai-Juan; Xue, Shui-Yu; Sun, Hai-Feng; Zhang, Fu-Sheng; Jia, Jin-Ping; Xing, Jie; Zhang, Li-Zeng; Qin, Xue-Mei

2012-03-06

Flower bud of Tussilago farfara L. is widely used for the treatment of cough, bronchitis and asthmatic disorders in the Traditional Chinese Medicine. However, due to the increasing demands, adulteration with rachis is frequently encountered in the marketplace. No report demonstrated the chemical and pharmacological differences between flower bud and rachis before. The water extracts were orally administrated to mice. Ammonia induced mice coughing model was used to evaluate the antitussive activity. The expectorant activity was evaluated by volume of phenol red in mice's tracheas. Metabolites were identified directly from the crude extracts through 1D- and 2D-NMR spectra. A metabolic profiling carried out by (1)H NMR spectroscopy and multivariate data analysis was applied to crude extracts from flower bud and rachis. Flower bud significantly lengthened the latent period of cough, decreased cough frequency caused by ammonia and enhanced tracheal phenol red output in expectorant evaluation. Principal component analysis (PCA) yielded good separation between flower bud and rachis, and corresponding loading plot showed that the phenolic compounds, organic acid, sugar, amino acid, terpene and sterol contributed to the discrimination. These findings provide pharmacological and chemical evidence that only flower bud can be used as the antitussive and expectorant herbal drug. The high concentration of chlorogenic acid, 3,5-dicaffeoylquinic acid, rutin in flower buds may be related with the antitussive and expectorant effects of Flos Farfara. To guarantee the clinical effect, rachis should be picked out before use. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

What is legal medicine--are legal and forensic medicine the same?

PubMed

Beran, Roy G

2010-04-01

Some consider the terms "forensic" and "legal" medicine to be synonymous but this is counter to the title of the Faculty of Forensic and Legal Medicine or the dual strands for progression to fellowship of the Australian College of Legal Medicine. The paper examines a very brief historical background to legal medicine and develops a definition of the strands thereof, namely legal and forensic medicine. It demonstrates that the two are different components of the application of medical knowledge upon the legal system. Legal medicine has greater relevance to civil and tort law, impacting upon patient care, whereas forensic medicine relates to criminal law and damage to, or by, patients.

Medicinal Chemistry and Applications of Incretins and DPP-4 Inhibitors in the Treatment of Type 2 Diabetes Mellitus

PubMed Central

Lotfy, Mohamed; Singh, Jaipaul; Kalász, Huba; Tekes, Kornelia; Adeghate, Ernest

2011-01-01

Diabetes mellitus (DM) is a major metabolic disorder currently affecting over 200 million people worldwide. Approximately 90% of all diabetic patients suffer from Type 2 diabetes mellitus (T2DM). The world's economy coughs out billions of dollars annually to diagnose, treat and manage patients with diabetes. It has been shown that the naturally occurring gut hormones incretins, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) can preserve the morphology and function of pancreatic beta cell. In addition, GIP and GLP-1 act on insulin receptors to facilitate insulin-receptor binding, resulting in optimal glucose metabolism. This review examines the medicinal chemistry and roles of incretins, specifically, GLP-1 and drugs which can mimic its actions and prevent its enzymatic degradation. The review discussed GLP-1 agonists such as exenatide, liraglutide, taspoglutide and albiglutide. The paper also identified and reviewed a number of inhibitors, which can block dipeptidyl peptidase 4 (DPP-4), the enzyme responsible for the rapid degradation of GLP-1. These DPP-4 inhibitors include sitagliptin, saxagliptin, vildagliptin and many others which are still in the experimental phase. PMID:21966329

Severe Pleuropulmonary Paragonimiasis Caused by Paragonimus mexicanus Treated as Tuberculosis in Ecuador.

PubMed

Calvopina, Manuel; Romero-Alvarez, Daniel; Macias, Rubén; Sugiyama, Hiromu

2017-01-11

A 30-year-old male, from a subtropical region of Ecuador, was hospitalized with a 5-year history of persistent cough with rusty brown sputum, chest pain, and progressive dyspnea. The patient underwent thoracic surgery 3 years ago for pleural effusion and subsequently received a 9-month regimen treatment of tuberculosis. However, there was no clinical resolution and symptoms became progressively worse. A chest radiograph and computerized tomography scan showed several small nodules in both lungs. Eggs of Paragonimus spp. were observed in sputum smears, but the smears were negative for acid-fast bacilli. Molecular characterization of eggs by the internal transcribed spacer-2 regions identified them as Paragonimus mexicanus The patient was treated with praziquantel and tested negative parasitologically for 12 months. There was clinical resolution of the cough and expectoration, but dyspnea and chest pain persisted. © The American Society of Tropical Medicine and Hygiene.

Perception, Price and Preference: Consumption and Protection of Wild Animals Used in Traditional Medicine.

PubMed

Liu, Zhao; Jiang, Zhigang; Fang, Hongxia; Li, Chunwang; Mi, Aizi; Chen, Jing; Zhang, Xiaowei; Cui, Shaopeng; Chen, Daiqiang; Ping, Xiaoge; Li, Feng; Li, Chunlin; Tang, Songhua; Luo, Zhenhua; Zeng, Yan; Meng, Zhibin

2016-01-01

A wide array of wildlife species, including many animals, are used in traditional medicines across many medicinal systems, including in Traditional Chinese Medicine (TCM). Due to over-exploitation and habitat loss, the populations of many animals commonly used in TCM have declined and are unable to meet market demand. A number of measures have been taken to try to reduce the impact that this large and growing market for TCM may have on wild animal species. Consumer preferences and behavior are known to play an important role in the consumption and protection of wild animals used in traditional medicine, and thus are likely to be an important factor in the success of many of these mechanisms--particularly given the significant percentage of TCMs that are over-the-counter products (access to which is not mediated by practitioners). In this study we conducted questionnaires and designed stated preference experiments embodying different simulation scenarios using a random sample of the population in Beijing to elicit individuals' knowledge, perceptions and preferences toward wild or farmed animal materials and their substitutes used in traditional Chinese medicine. We found that respondents had a stated preference for wild materials over farm-raised and other alternatives because they believe that the effectiveness of wild-sourced materials is more credible than that of other sources. However, we also found that, although respondents used TCM products, they had a poor understanding of the function or composition of either traditional Chinese medicines or proprietary Chinese medicines (PCM), and paid little attention to the composition of products when making purchasing decisions. Furthermore, awareness of the need for species protection, or "conservation consciousness" was found to play an important role in willingness to accept substitutions for wild animal materials, while traditional animal medicinal materials (TAMs) derived from well-known endangered species, such as bear bile and tiger bone, show relatively higher substitutability. These results suggest that there is still hope for conservation measures which seek to promote a transition to farmed animal, plant and synthetic ingredients and provide clear directions for future social marketing, education and engagement efforts.

Perception, Price and Preference: Consumption and Protection of Wild Animals Used in Traditional Medicine

PubMed Central

Liu, Zhao; Jiang, Zhigang; Fang, Hongxia; Li, Chunwang; Mi, Aizi; Chen, Jing; Zhang, Xiaowei; Cui, Shaopeng; Chen, Daiqiang; Ping, Xiaoge; Li, Feng; Li, Chunlin; Tang, Songhua; Luo, Zhenhua; Zeng, Yan; Meng, Zhibin

2016-01-01

A wide array of wildlife species, including many animals, are used in traditional medicines across many medicinal systems, including in Traditional Chinese Medicine (TCM). Due to over-exploitation and habitat loss, the populations of many animals commonly used in TCM have declined and are unable to meet market demand. A number of measures have been taken to try to reduce the impact that this large and growing market for TCM may have on wild animal species. Consumer preferences and behavior are known to play an important role in the consumption and protection of wild animals used in traditional medicine, and thus are likely to be an important factor in the success of many of these mechanisms—particularly given the significant percentage of TCMs that are over-the-counter products (access to which is not mediated by practitioners). In this study we conducted questionnaires and designed stated preference experiments embodying different simulation scenarios using a random sample of the population in Beijing to elicit individuals’ knowledge, perceptions and preferences toward wild or farmed animal materials and their substitutes used in traditional Chinese medicine. We found that respondents had a stated preference for wild materials over farm-raised and other alternatives because they believe that the effectiveness of wild-sourced materials is more credible than that of other sources. However, we also found that, although respondents used TCM products, they had a poor understanding of the function or composition of either traditional Chinese medicines or proprietary Chinese medicines (PCM), and paid little attention to the composition of products when making purchasing decisions. Furthermore, awareness of the need for species protection, or “conservation consciousness” was found to play an important role in willingness to accept substitutions for wild animal materials, while traditional animal medicinal materials (TAMs) derived from well-known endangered species, such as bear bile and tiger bone, show relatively higher substitutability. These results suggest that there is still hope for conservation measures which seek to promote a transition to farmed animal, plant and synthetic ingredients and provide clear directions for future social marketing, education and engagement efforts. PMID:26930487

78 FR 38574 - Technical Amendments to Counter-Terrorism Sanctions Regulations Implemented by OFAC

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-27

... relieve human suffering, such as food, clothing, or medicine, may be made by, to, or for the benefit of...; explosives; false documentation or identification; communications equipment; computers; electronic or other... medicine, may be made by, to, or for the benefit of, or received from, any specially designated terrorist...

21 CFR 310.534 - Drug products containing active ingredients offered over-the-counter (OTC) for human use as oral...

Code of Federal Regulations, 2014 CFR

2014-04-01

... offered over-the-counter (OTC) for human use as oral wound healing agents. 310.534 Section 310.534 Food... active ingredients offered over-the-counter (OTC) for human use as oral wound healing agents. (a... aqueous solution have been present in oral mucosal injury drug products for use as oral wound healing...

21 CFR 310.534 - Drug products containing active ingredients offered over-the-counter (OTC) for human use as oral...

Code of Federal Regulations, 2012 CFR

2012-04-01

... offered over-the-counter (OTC) for human use as oral wound healing agents. 310.534 Section 310.534 Food... active ingredients offered over-the-counter (OTC) for human use as oral wound healing agents. (a... aqueous solution have been present in oral mucosal injury drug products for use as oral wound healing...

21 CFR 310.534 - Drug products containing active ingredients offered over-the-counter (OTC) for human use as oral...

Code of Federal Regulations, 2013 CFR

2013-04-01

... offered over-the-counter (OTC) for human use as oral wound healing agents. 310.534 Section 310.534 Food... active ingredients offered over-the-counter (OTC) for human use as oral wound healing agents. (a... aqueous solution have been present in oral mucosal injury drug products for use as oral wound healing...

21 CFR 310.534 - Drug products containing active ingredients offered over-the-counter (OTC) for human use as oral...

Code of Federal Regulations, 2011 CFR

2011-04-01

... offered over-the-counter (OTC) for human use as oral wound healing agents. 310.534 Section 310.534 Food... active ingredients offered over-the-counter (OTC) for human use as oral wound healing agents. (a... aqueous solution have been present in oral mucosal injury drug products for use as oral wound healing...

21 CFR 310.534 - Drug products containing active ingredients offered over-the-counter (OTC) for human use as oral...

Code of Federal Regulations, 2010 CFR

2010-04-01

... offered over-the-counter (OTC) for human use as oral wound healing agents. 310.534 Section 310.534 Food... active ingredients offered over-the-counter (OTC) for human use as oral wound healing agents. (a... aqueous solution have been present in oral mucosal injury drug products for use as oral wound healing...

A portable automatic cough analyser in the ambulatory assessment of cough.

PubMed

Krajnik, Malgorzata; Damps-Konstanska, Iwona; Gorska, Lucyna; Jassem, Ewa

2010-03-14

Cough is one of the main symptoms of advanced lung disease. However, the efficacy of currently available treatment remains unsatisfactory. Research into the new antitussives requires an objective assessment of cough. The aim of the study was to test the feasibility of a new automatic portable cough analyser and assess the correlation between subjective and objective evaluations of cough in 13 patients with chronic cough. The patients' individual histories, a cough symptom score and a numeric cough scale (1-10) were used as a subjective evaluation of cough and a computerized audio-timed recorder was used to measure the frequency of coughing. The pre-clinical validation has shown that an automated cough analyser is an accurate and reliable tool for the ambulatory assessment of chronic cough. In the clinical part of the experiment for the daytime, subjective cough scoring correlated with the number of all cough incidents recorded by the cough analyser (r = 0.63; p = 0.022) and the number of cough incidents per hour (r = 0.60; p = 0.03). However, there was no relation between cough score and the time spent coughing per hour (r = 0.48; p = 0.1). As assessed for the night-time period, no correlation was found between subjective cough scoring and the number of incidents per hour (r = 0.29; p = 0.34) or time spent coughing (r = 0.26; p = 0.4). An automated cough analyser seems to be a feasible tool for the ambulatory monitoring of cough. There is a moderate correlation between subjective and objective assessments of cough during the daytime, whereas the discrepancy in the evaluation of night-time coughing might suggest that subjective analysis is unreliable.

Validation of the ERS standard citric acid cough challenge in healthy adult volunteers

PubMed Central

2010-01-01

Protocols measuring cough sensitivity can vary in terms of nebuliser, tussive agent, single and dose response. A definitive method for measuring cough sensitivity needs to be established. The ERS guidelines recommend the KoKo DigiDoser (KD) delivery system. Study aim, was to compare the reproducibility of this citric acid (CA) cough challenge and previously established Mefar dosimeter (MD) protocol. 39 (female 26) volunteers mean age (40.4 yrs) were randomised to either KD or MD. Intra-day and inter-day reproducibility was compared. We calculated the concentration of citric acid evoking 2 coughs (C2). The geometric mean C2 (95%CI) was similar for both KD and MD, of 263 (200,339) mM and 209 (151,288) mM respectively. The mean KD C2 was not significantly different. (F = 0.807, p = 0.93) from baseline over 1, 2, and 4 hrs however, the MD demonstrated significant variability (F = 7.85, P < 0.001) Measuring mean log C2 at baseline and at 2 weeks, the KD demonstrated a stronger intraclass correlation of log C2 at baseline with 2 week log C2, ICC = 0.70 than was shown with the Mefar, ICC = 0.41 Administering CA from KD offers a reproducible cough challenge in healthy volunteers. The results correlate well with the MD challenge but offer greater intra-day and inter-day reproducibility. Trial Registration Current controlled trials ISRCTN98385033 PMID:20698995

Comparison of water and air charged transducer catheter pressures in the evaluation of cystometrogram and voiding pressure studies.

PubMed

McKinney, Timothy B; Babin, Elizabeth A; Ciolfi, Veronica; McKinney, Cynthia R; Shah, Nima

2018-04-01

Air-charged (AC) and water-perfused (WP) catheters have been evaluated for differences in measuring pressures for voiding dysfunction. Typically, a two-catheter system was used. We believe that simultaneous pressure measurements with AC and WP in a single catheter will provide analogous pressures for coughs, Valsalvas, and maximum pressures in voiding pressure studies (VPS). This IRB approved prospective study included 50 women over age 21. AC dual TDOC catheters were utilized. The water-filling channel served as the bladder filler and the water pressure readings. Patients were evaluated with empty bladders and at volumes of 50-100 mL, 200 mL, and maximum capacity with cough and Valsalva maneuvers. Comparative analysis was performed on maximum stress peak pressures. At maximum bladder capacity, VPS was done and maximum voiding pressure was recorded. Comparing coughs and Valsalva maneuvers pressures, there was significant increase in variability between AC and WP measurements with less than 50 mL volume (P < 0.001). Significant correlations were observed between AC and WP measurements for coughs and Valsalvas with bladder volume over 50 mL. Visual impression showed virtually identical tracings. Cough measurements had an average difference of 0.25 cmH 2 O (±8.81) and Valsalva measurements had an average difference of 3.15 cmH 2 O (±4.72). Thirty-eight women had usable maximum voiding pressure measurements and had a strong correlation. Cystometrogram and maximum voiding pressure measurements done with either water or air charged catheters will yield similarly accurate results and are comparable. Results suggest more variability at low bladder volumes <50 mL. © 2018 Wiley Periodicals, Inc.

Evidence-Based Medicine as a Tool for Undergraduate Probability and Statistics Education

PubMed Central

Masel, J.; Humphrey, P. T.; Blackburn, B.; Levine, J. A.

2015-01-01

Most students have difficulty reasoning about chance events, and misconceptions regarding probability can persist or even strengthen following traditional instruction. Many biostatistics classes sidestep this problem by prioritizing exploratory data analysis over probability. However, probability itself, in addition to statistics, is essential both to the biology curriculum and to informed decision making in daily life. One area in which probability is particularly important is medicine. Given the preponderance of pre health students, in addition to more general interest in medicine, we capitalized on students’ intrinsic motivation in this area to teach both probability and statistics. We use the randomized controlled trial as the centerpiece of the course, because it exemplifies the most salient features of the scientific method, and the application of critical thinking to medicine. The other two pillars of the course are biomedical applications of Bayes’ theorem and science and society content. Backward design from these three overarching aims was used to select appropriate probability and statistics content, with a focus on eliciting and countering previously documented misconceptions in their medical context. Pretest/posttest assessments using the Quantitative Reasoning Quotient and Attitudes Toward Statistics instruments are positive, bucking several negative trends previously reported in statistics education. PMID:26582236

High prevalence of complementary and alternative medicine use in patients with genetically proven mitochondrial disorders.

PubMed

Franik, Sebastian; Huidekoper, Hidde H; Visser, Gepke; de Vries, Maaike; de Boer, Lonneke; Hermans-Peters, Marion; Rodenburg, Richard; Verhaak, Chris; Vlieger, Arine M; Smeitink, Jan A M; Janssen, Mirian C H; Wortmann, Saskia B

2015-05-01

Despite major advances in understanding the pathophysiology of mitochondrial diseases, clinical management of these conditions remains largely supportive, and no effective treatment is available. We therefore assumed that the burden of disease combined with the lack of adequate treatment leaves open a big market for complementary and alternative medicine use. The objective of this study was to evaluate the use and perceived effectiveness of complementary and alternative medicine in children and adults with genetically proven mitochondrial disease. The reported use was surprisingly high, with 88% of children and 91% of adults having used some kind of complementary and alternative medicine in the last 2 years. Also, the mean cost of these treatments was impressive, being 489/year for children and 359/year for adult patients. Over-the-counter remedies (e.g., food supplements, homeopathy) and self-help techniques (e.g., Reiki, yoga) were the most frequently used complementary and alternative therapies in our cohort: 54% of children and 60% of adults reported the various complementary and alternative medicine therapies to be effective. Given the fact that currently no effective treatment exists, further research toward the different therapies is needed, as our study clearly demonstrates that such therapies are highly sought after by affected patients.

Does deregulation in community pharmacy impact accessibility of medicines, quality of pharmacy services and costs? Evidence from nine European countries.

PubMed

Vogler, Sabine; Habimana, Katharina; Arts, Danielle

2014-09-01

To analyse the impact of deregulation in community pharmacy on accessibility of medicines, quality of pharmacy services and costs. We analysed and compared community pharmacy systems in five rather deregulated countries (England, Ireland, the Netherlands, Norway, Sweden) and four rather regulated countries (Austria, Denmark, Finland, Spain). Data were collected by literature review, a questionnaire survey and interviews. Following a deregulation, several new pharmacies and dispensaries of Over-the-Counter (OTC) medicines tended to be established, predominantly in urban areas. Unless prevented by regulation, specific stakeholders, e.g. wholesalers, were seen to gain market dominance which limited envisaged competition. There were indications for an increased workload for pharmacists in some deregulated countries. Economic pressure to increase the pharmacy turnover through the sale of OTC medicines and non-pharmaceuticals was observed in deregulated and regulated countries. Prices of OTC medicines were not found to decrease after a deregulation in pharmacy. Access to pharmacies usually increases after a deregulation but this is likely to favour urban populations with already good accessibility. Policy-makers are recommended to take action to ensure equitable accessibility and sustainable competition in a more deregulated environment. No association between pharmaceutical expenditure and the extent of regulation/deregulation appears to exist. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Purchasing Over-the-counter medicines from Australian pharmacy: What do the pharmacy customers value and expect?

PubMed

Chan, Vincent; Tran, Hung

2016-01-01

Over-the-counter medicines (OTC) are widely available and can be purchased without a prescription. Their availability means that a customer may choose to purchase them without the involvement of a pharmacy/pharmacist. It is important to understand customer OTC purchasing perceptions and behaviour from a pharmacy to better understand the needs and opportunities in this space. This study aimed to examine customers' key expectations and what they value when purchasing OTC and how the effect of health status/stress and perceived risks/benefits of purchasing OTCs from a pharmacy may influence their OTC shopping behaviour. Customers from two metropolitan pharmacies across two different suburbs in Brisbane, Queensland, Australia completed a self-administered questionnaire. Data collection was conducted over a six-week period. The questionnaire examined demographics, current level of health and stress, as well as a range of questions (seven-point Likert-scale) examining perceived benefits and risks, what they value, trust and expect when purchasing OTC. A total of 86 customers from a broad range of demographics were captured in this study. When asked about their current health state, 41% and 23% respectively indicated that they were stressed and tense when they arrived at the pharmacy but many were feeling well (38%). Most customers strongly agreed/agreed that trust in the advice from a pharmacy (96%), trust in the products (73%), and the altruistic approach of a pharmacy (95%) were critical to them. Further, 82% and 78% respectively disagreed that time pressures or costs were concerns, despite many feeling tense and stressed when they came in. When asked where they intend to buy their future OTC, 89% indicated pharmacy instead of a supermarket. High levels of trust, confidence and sense of altruism and care were key factors for customers buying OTC from a pharmacy, regardless of time pressures, costs or existing levels of stress and health.

Purchasing Over-the-counter medicines from Australian pharmacy: What do the pharmacy customers value and expect?

PubMed Central

2016-01-01

Background: Over-the-counter medicines (OTC) are widely available and can be purchased without a prescription. Their availability means that a customer may choose to purchase them without the involvement of a pharmacy/pharmacist. It is important to understand customer OTC purchasing perceptions and behaviour from a pharmacy to better understand the needs and opportunities in this space. Objective: This study aimed to examine customers’ key expectations and what they value when purchasing OTC and how the effect of health status/stress and perceived risks/benefits of purchasing OTCs from a pharmacy may influence their OTC shopping behaviour. Methods: Customers from two metropolitan pharmacies across two different suburbs in Brisbane, Queensland, Australia completed a self-administered questionnaire. Data collection was conducted over a six-week period. The questionnaire examined demographics, current level of health and stress, as well as a range of questions (seven-point Likert-scale) examining perceived benefits and risks, what they value, trust and expect when purchasing OTC. Results: A total of 86 customers from a broad range of demographics were captured in this study. When asked about their current health state, 41% and 23% respectively indicated that they were stressed and tense when they arrived at the pharmacy but many were feeling well (38%). Most customers strongly agreed/agreed that trust in the advice from a pharmacy (96%), trust in the products (73%), and the altruistic approach of a pharmacy (95%) were critical to them. Further, 82% and 78% respectively disagreed that time pressures or costs were concerns, despite many feeling tense and stressed when they came in. When asked where they intend to buy their future OTC, 89% indicated pharmacy instead of a supermarket. Conclusions: High levels of trust, confidence and sense of altruism and care were key factors for customers buying OTC from a pharmacy, regardless of time pressures, costs or existing levels of stress and health. PMID:27785164

Ethnomedicinal, Phytochemical and Ethnopharmacological Aspects of Four Medicinal Plants of Malvaceae Used in Indian Traditional Medicines: A Review

PubMed Central

Abat, Jasmeet Kaur; Kumar, Sanjay; Mohanty, Aparajita

2017-01-01

The ethnomedicinal values of plants form the basis of the herbal drug industry. India has contributed its knowledge of traditional system medicines (Ayurveda and Siddha) to develop herbal medicines with negligible side effects. The World Health Organization has also recognized the benefits of drugs developed from natural products. Abutilon indicum, Hibiscus sabdariffa, Sida acuta and Sida rhombifolia are ethnomedicinal plants of Malvaceae, commonly used in Indian traditional system of medicines. Traditionally these plants were used in the form of extracts/powder/paste by tribal populations of India for treating common ailments like cough and cold, fever, stomach, kidney and liver disorders, pains, inflammations, wounds, etc. The present review is an overview of phytochemistry and ethnopharmacological studies that support many of the traditional ethnomedicinal uses of these plants. Many phytoconstituents have been isolated from the four ethnomedicinal plants and some of them have shown pharmacological activities that have been demonstrated by in vivo and/or in vitro experiments. Ethnomedicinal uses, supported by scientific evidences is essential for ensuring safe and effective utilization of herbal medicines. PMID:29057840

Ethnomedicinal, Phytochemical and Ethnopharmacological Aspects of Four Medicinal Plants of Malvaceae Used in Indian Traditional Medicines: A Review.

PubMed

Abat, Jasmeet Kaur; Kumar, Sanjay; Mohanty, Aparajita

2017-10-18

The ethnomedicinal values of plants form the basis of the herbal drug industry. India has contributed its knowledge of traditional system medicines (Ayurveda and Siddha) to develop herbal medicines with negligible side effects. The World Health Organization has also recognized the benefits of drugs developed from natural products. Abutilon indicum, Hibiscus sabdariffa, Sida acuta and Sida rhombifolia are ethnomedicinal plants of Malvaceae, commonly used in Indian traditional system of medicines. Traditionally these plants were used in the form of extracts/powder/paste by tribal populations of India for treating common ailments like cough and cold, fever, stomach, kidney and liver disorders, pains, inflammations, wounds, etc. The present review is an overview of phytochemistry and ethnopharmacological studies that support many of the traditional ethnomedicinal uses of these plants. Many phytoconstituents have been isolated from the four ethnomedicinal plants and some of them have shown pharmacological activities that have been demonstrated by in vivo and/or in vitro experiments. Ethnomedicinal uses, supported by scientific evidences is essential for ensuring safe and effective utilization of herbal medicines.

Analysis of Clinicians' Perceptual Cough Evaluation.

PubMed

Laciuga, Helena; Brandimore, Alexandra E; Troche, Michelle S; Hegland, Karen W

2016-08-01

This study examined the relationships between subjective descriptors and objective airflow measures of cough. We hypothesized that coughs with specific airflow characteristics would share common subjective perceptual descriptions. Thirty clinicians (speech-language pathologists, otolaryngologists, and neurologists) perceptually evaluated ten cough audio samples with specific airflow characteristics determined by peak expiratory flow rate, cough expired volume, cough duration, and number of coughs in the cough epoch. Participants rated coughs by strength, duration, quality, quantity, and overall potential effectiveness for airway protection. Perception of cough strength and effectiveness was determined by the combination of presence of pre-expulsive compression phase, short peak expiratory airflow rate rise time, high peak expiratory flow rates, and high cough volume acceleration. Perception of cough abnormality was defined predominantly by descriptors of breathiness and strain. Breathiness was characteristic for coughs with either absent compression phases and relatively high expiratory airflow rates or coughs with significantly low expired volumes and reduced peak flow rates. In contrast, excessive strain was associated with prolonged compression phases and low expiratory airflow rates or the absence of compression phase with high peak expiratory rates. The study participants reached greatest agreement in distinguishing between single and multiple coughs. Their assessment of cough strength and effectiveness was less consistent. Finally, the least agreement was shown in determining the quality categories. Modifications of cough airflow can influence perceptual cough evaluation outcomes. However, the inconsistency of cough ratings among our participants suggests that a uniform cough rating system is required.

Hysteroscopy

MedlinePlus

... done through the scope. Ablation uses heat, cold, electricity, or radio waves to destroy the lining of ... counter pain medicine for the cramping. A watery discharge for up to several weeks. You can return ...

Over-the-counter sales of antibiotics from community pharmacies in Abu Dhabi.

PubMed

Dameh, Majd; Green, James; Norris, Pauline

2010-10-01

The aim of this study is to investigate over-the-counter sale of antibiotics from community pharmacies in Abu Dhabi city, focusing on the extent, demographic and socioeconomic determinants of this practice. The study was conducted in the capital of the United Arab Emirates, Abu Dhabi, and involved 17 randomly selected private pharmacies. A cross-sectional design using structured observations of 30 clients purchasing antibiotics from a pharmacy staff (either a pharmacist or pharmacy assistant) at each selected pharmacy. A total of 510 interactions were observed. Statistical analysis was performed using SPSS. The extent and types of antibiotics sold over-the-counter in Abu Dhabi city as observed in the selected sample of community pharmacies, and the demographic and socioeconomic factors that contributed to this practice. Sixty eight percent (68.4%) of the observed antibiotic sales were sold over-the-counter without prescriptions. Injection antibiotics constituted 2.2% of the antibiotics sold, 45.5% of which were sold over-the-counter. Combination of penicillins including β-lactamase inhibitors (34.0%), penicillins with extended spectrum (22.3%) and second generation cephalosporins (11.2%) were the mostly commonly sold antibiotic groups. Respiratory conditions (63.1%) were the most frequent reason for purchasing antibiotics. Over-the-counter sales of antibiotics were related to client ethnicity and age, gender of pharmacy staff and health complaint. Our study revealed high sales of over-the-counter antibiotics, despite this being illegal. The ineffectiveness of antibiotics in treating respiratory conditions of viral origin and effects of such practice on the emergence of bacterial resistance necessitates prompt action.

Women as home caregivers: gender portrayal in OTC drug commercials.

PubMed

Craig, R S

1992-01-01

Concern has long been expressed over possible adverse effects of television advertising of over-the-counter (OTC) medicines. This study investigated a sample of prime time network television ads to determine how gender portrayals differed in drug and non-drug commercials. Findings indicated that women were significantly more likely than men to appear as characters in drug ads than in ads for other products, and that they are frequently portrayed in these commercials as experts on home medical care, often as mothers caring for ill children. This supports the hypothesis that drug advertisers take advantage of stereotypical images of women as home medical caregivers. It also raises the question of whether female consumers are being encouraged by these ads to overuse OTC medications as a way of gaining the family's love and respect.

The natural history of community-acquired common colds symptoms assessed over 4-years.

PubMed

Witek, Theodore J; Ramsey, David L; Carr, Andrew N; Riker, Donald K

2015-03-01

The common cold is the most frequently experienced infection among humans, but limited data exist to characterize the onset, duration, severity and intersection of symptoms in community-acquired colds. A more complete understanding of the symptom frequency and burden in naturally occurring colds is needed. We characterized common cold symptoms from 226 cold episodes experienced by 104 male or female subjects. Subjects were enrolled in the work environment in an attempt to start symptom evaluation (frequency and severity) at the earliest sign of their cold. We also assessed the symptom that had the greatest impact on the subject by asking them to identify their single most bothersome symptom. Symptom reporting started within 24 hours of cold onset for most subjects. Sore throat was a harbinger of the illness but was accompanied by multiple symptoms, including nasal congestion, runny nose and headache. Cough was not usually the most frequent symptom, but was present throughout the cold, becoming most bothersome later in the cold. Nasal congestion, pain (eg, sore throat, headache, muscle pains) or feverishness and secretory symptoms (eg, runny nose, sneezing), and even cough, were simultaneously experienced with high incidence over the first 4 days of illness. The single most bothersome symptom was sore throat on day 1, followed by nasal congestion on days 2-5 and cough on days 6 and 7. There is substantial overlap in the appearance of common cold symptoms over the first several days of the common cold. Nasal congestion, secretory and pain symptoms frequently occur together, with cough being somewhat less prominent, but quite bothersome when present. These data establish the typical symptomatology of a common cold and provide a foundation for the rational treatment of cold symptoms typically experienced by cold sufferers.

The World Anti-Doping Code in sport: Update for 2015.

PubMed

Hughes, David

2015-10-01

Some athletes cheat by using drugs or medical methods such as transfusion to enhance their performance. However, this may put their health at risk. The World Anti-Doping Agency prohibits certain methods and drugs that may enhance performance, harm the athlete or violate the spirit of sport. Some may be banned only during competitions, but others are banned at all times. Prohibited substances include over-the-counter and prescription medicines. It is therefore important for athletes and health professionals to check what is permitted. There are many resources available through organisations such as the Australian Sports Anti-Doping Authority and the World Anti-Doping Agency.

Modeling the effect of exogenous melatonin on the sleep-wake switch.

PubMed

Johnson, Nicholas; Jain, Gauray; Sandberg, Lianne; Sheets, Kevin

2012-01-01

According to the Centers for Disease Control and Prevention and the Institute of Medicine of the National Academies, insufficient sleep has become a public health epidemic. Approximately 50-70 million adults (20 years or older) suffer from some disorder of sleep and wakefulness, hindering daily functioning and adversely affecting health and longevity. Melatonin, a naturally produced hormone which plays a role in sleep-wake regulation, is currently offered as an over-the-counter sleep aid. However, the effects of melatonin on the sleep-wake cycle are incompletely understood. The goal of this modeling study was to incorporate the effects of exogenous melatonin administration into a mathematical model of the human sleep-wake switch. The model developed herein adds a simple kinetic model of the MT1 melatonin receptor to an existing model which simulates the interactions of different neuronal groups thought to be involved in sleep-wake regulation. Preliminary results were obtained by simulating the effects of an exogenous melatonin dose typical of over-the-counter sleep aids. The model predicted an increase in homeostatic sleep drive and a resulting alteration in circadian rhythm consistent with experimental results. The time of melatonin administration was also observed to have a strong influence on the sleep-wake effects elicited, which is also consistent with prior experimental findings.

Comparison of voluntary and reflex cough effectiveness in Parkinson’s disease

PubMed Central

Hegland, Karen Wheeler; Troche, Michelle S.; Brandimore, Alexandra E.; Davenport, Paul W.; Okun, Michael S.

2016-01-01

Introduction Multiple airway protective mechanisms are impacted with Parkinson’s disease (PD), including swallowing and cough. Cough serves to eject material from the lower airways, and can be produced voluntarily (on command) and reflexively in response to aspirate material or other airway irritants. Voluntary cough effectiveness is reduced in PD however it is not known whether reflex cough is affected as well. The goal of this study was to compare the effectiveness between voluntary and reflex cough in patients with idiopathic PD. Methods Twenty patients with idiopathic PD participated. Cough airflow data were recorded via facemask in line with a pneumotachograph. A side delivery port connected the nebulizer for delivery of capsaicin, which was used to induce cough. Three voluntary coughs and three reflex coughs were analyzed from each participant. A two-way repeated measures analysis of variance was used to compare voluntary versus reflex cough airflow parameters. Results Significant differences were found for peak expiratory flow rate (PEFR) and cough expired volume (CEV) between voluntary and reflex cough. Specifically, both PEFR and CEV were reduced for reflex as compared to voluntary cough. Conclusion Cough PEFR and CEV are indicative of cough effectiveness in terms of the ability to remove material from the lower airways. Differences between these two cough types likely reflect differences in the coordination of the respiratory and laryngeal subsystems. Clinicians should be aware that evaluation of cough function using voluntary cough tasks overestimates the PEFR and CEV that would be achieved during reflex cough in patients with PD. PMID:25246315

What is chronic cough in children?

PubMed Central

Ioan, Iulia; Poussel, Mathias; Coutier, Laurianne; Plevkova, Jana; Poliacek, Ivan; Bolser, Donald C.; Davenport, Paul W.; Derelle, Jocelyne; Hanacek, Jan; Tatar, Milos; Marchal, François; Schweitzer, Cyril; Fontana, Giovanni; Varechova, Silvia

2014-01-01

The cough reflex is modulated throughout growth and development. Cough—but not expiration reflex—appears to be absent at birth, but increases with maturation. Thus, acute cough is the most frequent respiratory symptom during the first few years of life. Later on, the pubertal development seems to play a significant role in changing of the cough threshold during childhood and adolescence resulting in sex-related differences in cough reflex sensitivity in adulthood. Asthma is the major cause of chronic cough in children. Prolonged acute cough is usually related to the long-lasting effects of a previous viral airway infection or to the particular entity called protracted bacterial bronchitis. Cough pointers and type may orient toward specific etiologies, such as barking cough in croup or tracheomalacia, paroxystic whooping cough in Pertussis. Cough is productive in protracted bacterial bronchitis, sinusitis or bronchiectasis. Cough is usually associated with wheeze or dyspnea on exertion in asthma; however, it may be the sole symptom in cough variant asthma. Thus, pediatric cough has particularities differentiating it from adult cough, so the approach and management should be developmentally specific. PMID:25221517

Willingness-To-Accept Pharmaceutical Retail Inconvenience: Evidence from a Contingent Choice Experiment

PubMed Central

Finlay, Keith; Stoecker, Charles; Cunningham, Scott

2015-01-01

Objectives Restrictions on retail purchases of pseudoephedrine are one regulatory approach to reduce the social costs of methamphetamine production and use, but may impose costs on legitimate users of nasal decongestants. This is the first study to evaluate the costs of restricting access to medications on consumer welfare. Our objective was to measure the inconvenience cost consumers place on restrictions for cold medication purchases including identification requirements, purchase limits, over-the-counter availability, prescription requirements, and the active ingredient. Methods We conducted a contingent choice experiment with Amazon Mechanical Turk workers that presented participants with randomized, hypothetical product prices and combinations of restrictions that reflect the range of public policies. We used a conditional logit model to calculate willingness-to-accept each restriction. Results Respondents’ willingness-to-accept prescription requirements was $14.17 ($9.76–$18.58) and behind-the-counter restrictions was $9.68 ($7.03–$12.33) per box of pseudoephedrine product. Participants were willing to pay $4.09 ($1.66–$6.52) per box to purchase pseudoephedrine-based products over phenylephrine-based products. Conclusions Restricting access to medicines as a means of reducing the social costs of non-medical use can imply large inconvenience costs for legitimate consumers. These results are relevant to discussions of retail access restrictions on other medications. PMID:26024444

Willingness-to-accept pharmaceutical retail inconvenience: evidence from a contingent choice experiment.

PubMed

Finlay, Keith; Stoecker, Charles; Cunningham, Scott

2015-01-01

Restrictions on retail purchases of pseudoephedrine are one regulatory approach to reduce the social costs of methamphetamine production and use, but may impose costs on legitimate users of nasal decongestants. This is the first study to evaluate the costs of restricting access to medications on consumer welfare. Our objective was to measure the inconvenience cost consumers place on restrictions for cold medication purchases including identification requirements, purchase limits, over-the-counter availability, prescription requirements, and the active ingredient. We conducted a contingent choice experiment with Amazon Mechanical Turk workers that presented participants with randomized, hypothetical product prices and combinations of restrictions that reflect the range of public policies. We used a conditional logit model to calculate willingness-to-accept each restriction. Respondents' willingness-to-accept prescription requirements was $14.17 ($9.76-$18.58) and behind-the-counter restrictions was $9.68 ($7.03-$12.33) per box of pseudoephedrine product. Participants were willing to pay $4.09 ($1.66-$6.52) per box to purchase pseudoephedrine-based products over phenylephrine-based products. Restricting access to medicines as a means of reducing the social costs of non-medical use can imply large inconvenience costs for legitimate consumers. These results are relevant to discussions of retail access restrictions on other medications.

Epidemiology of cough in relation to China

PubMed Central

2013-01-01

Cough is one of the most common complaints for which patients seek medical attention. Misdiagnosis and mistreatment of cough exist commonly in China. The prevalence of acute cough caused by upper airway infection fluctuates between 9% and 64% in the community, for chronic cough, the prevalence >10% in most surveys, ranging from 7.2%-33%. The common causes of chronic cough are upper airway cough syndrome (previously called as post nasal drip syndrome [PNDS]), cough variant asthma (CVA), gastroesophageal reflux related cough (GERD) and eosinophilic bronchitis (EB). There is a regional discrepancy regarding the prevalence of common causes of cough and distribution of gender among China, UK, USA, the most common cause of chronic cough in China are CVA, followed by UACS, EB and atopic cough (AC), the male is almost equal to female in numbers in China. The risk factors for cough includes cold air, smoking, environmental pollutants, noxious substances and allergens, and unreasonable diet habits. PMID:23835047

Outbreak of acute renal failure in Panama in 2006: a case-control study.

PubMed

Rentz, E Danielle; Lewis, Lauren; Mujica, Oscar J; Barr, Dana B; Schier, Joshua G; Weerasekera, Gayanga; Kuklenyik, Peter; McGeehin, Michael; Osterloh, John; Wamsley, Jacob; Lum, Washington; Alleyne, Camilo; Sosa, Nestor; Motta, Jorge; Rubin, Carol

2008-10-01

In September 2006, a Panamanian physician reported an unusual number of patients with unexplained acute renal failure frequently accompanied by severe neurological dysfunction. Twelve (57%) of 21 patients had died of the illness. This paper describes the investigation into the cause of the illness and the source of the outbreak. Case-control and laboratory investigations were implemented. Case patients (with acute renal failure of unknown etiology and serum creatinine > 2 mg/dl) were individually matched to hospitalized controls for age (+/- 5 years), sex and admission date (< 2 days before the case patient). Questionnaire and biological data were collected. The main outcome measure was the odds of ingesting prescription cough syrup in cases and controls. Forty-two case patients and 140 control patients participated. The median age of cases was 68 years (range: 25-91 years); 64% were male. After controlling for pre-existing hypertension and renal disease and the use of angiotensin-converting enzyme inhibitors, a significant association was found between ingestion of prescription cough syrup and illness onset (adjusted odds ratio: 31.0, 95% confidence interval: 6.93-138). Laboratory analyses confirmed the presence of diethylene glycol (DEG) in biological samples from case patients, 8% DEG contamination in cough syrup samples and 22% contamination in the glycerin used to prepare the cough syrup. The source of the outbreak was DEG-contaminated cough syrup. This investigation led to the recall of approximately 60 000 bottles of contaminated cough syrup, widespread screening of potentially exposed consumers and treatment of over 100 affected patients.

Factors associated with polypharmacy and excessive polypharmacy in older people with intellectual disability differ from the general population: a cross-sectional observational nationwide study

PubMed Central

O'Dwyer, Máire; Peklar, Jure; McCallion, Philip; McCarron, Mary; Henman, Martin C

2016-01-01

Objectives (1) To evaluate the prevalence of polypharmacy (5–9 medicines) and excessive polypharmacy (10+ medicines) and (2) to determine associated demographic and clinical characteristics in an ageing population with intellectual disabilities (IDs). Design Observational cross-sectional study. Setting Wave One (2009/2010) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). Participants A nationally representative sample of 753 persons with ID, aged between 41 and 90 years. Participants/proxy reported medicines (prescription and over the counter) taken on a regular basis; medication data was available for 736 participants (98%). Main outcome measures/interventions Participants were divided into those with no polypharmacy (0–4 medicines), polypharmacy (5–9 medicines) and excessive polypharmacy (10+ medicines). Medication use patterns were analysed according to demographic variables and reported chronic conditions. A multinomial logistic regression model identified factors associated with polypharmacy (5–9 medicines) and excessive polypharmacy (≥10 medicines). Results Overall, 90% of participants reported use of medicines. Polypharmacy was observed in 31.5% of participants and excessive polypharmacy in 20.1%. Living in a residential institution, and reporting a mental health or neurological condition were strongly associated with polypharmacy and excessive polypharmacy after adjusting for confounders, but age or gender had no significant effect. Conclusions Polypharmacy was commonplace for older adults with ID and may be partly explained by the high prevalence of multimorbidity reported. Review of appropriateness of medication use is essential, as polypharmacy places ageing people with ID at risk of adverse effects. PMID:27044582

Airway Hypersensitivity, Reflux, and Phonation Contribute to Chronic Cough

PubMed Central

Francis, David O.; Slaughter, James C.; Ates, Fehmi; Higginbotham, Tina; Stevens, Kristin L.; Garrett, C. Gaelyn; Vaezi, Michael F.

2015-01-01

Background & Aims Although chronic cough is a common, its etiology is often elusive, making patient management a challenge. Gastroesophageal reflux and airway hypersensitivity can cause chronic cough. We explored the relationship between reflux, phonation, and cough in patients with idiopathic chronic cough. Methods We performed a blinded, cross-sectional study of non-smoking patients with chronic cough (duration > 8 weeks) refractory to reflux treatment referred to the Digestive Disease Center at Vanderbilt University. All underwent 24-hour acoustic recording concurrently and temporally synchronized with ambulatory pH-impedance monitoring. Cough, phonation, and pH-impedance events were recorded. We evaluated the temporal relationship between cough and phonation or reflux events using Poisson and logistic regression. Results Seventeen patients met the inclusion criteria (88% female; 100% Caucasian; median age, 63 years and interquartile age range, 52–66 years; mean body mass index, 30.6 and interquartile range 27.9–34.0); there were 2048 analyzable coughing events. The probability of subsequent coughing increased with higher burdens of preceding cough, reflux, or phonation. Within the first 15 min after a cough event, the cough event itself was the main trigger of subsequent cough events. After this period, de novo coughing occurred with increases of 1.46-fold in association with reflux alone (95% confidence interval, 1.17–1.82; P<.001) and 1.71-fold in association with the combination of phonation and reflux events. Conclusion Antecedent phonation and reflux increased the rate of cough events in patients with idiopathic chronic cough. Reflux events were more strongly associated with increased rate of coughing. Our findings support the concept that airway hypersensitivity is a cause of chronic cough, and that the vocal folds may be an effector in chronic cough. ClinicalTrials.gov number, NCT01263626. PMID:26492842

The role of the Therapeutic Goods Administration and the Medicine and Medical Devices Safety Authority in evaluating complementary and alternative medicines in Australia and New Zealand.

PubMed

Ghosh, Dilip; Skinner, Margot; Ferguson, Lynnette R

2006-04-03

Currently, the regulation of complementary and alternative medicines and related health claims in Australia and New Zealand is managed in a number of ways. Complementary medicines, including herbal, minerals, nutritional/dietary supplements, aromatherapy oils and homeopathic medicines are regulated under therapeutic goods/products legislation. The Therapeutic Goods Administration (TGA), a division of the Commonwealth Department of Health and Ageing is responsible for administering the provisions of the legislation in Australia. The New Zealand Medicines and Medical Devices Safety Authority (Medsafe) administers the provision of legislation in New Zealand. In December 2003 the Australian and New Zealand governments signed a Treaty to establish a single, bi-national agency to regulate therapeutic products, including medical devices prescription, over-the-counter and complementary medicines. A single agency will replace the Australian TGA and the New Zealand Medsafe. The role of the new agency will be to safeguard public health through regulation of the quality, safety and efficacy or performance of therapeutic products in both Australia and New Zealand. The major activities of the new joint Australia New Zealand therapeutic products agency are in product licensing, specifying labelling standards and setting the advertising scheme, together with determining the risk classes of medicines and creating an expanded list of ingredients permitted in Class I medicines. A new, expanded definition of complementary medicines is proposed and this definition is currently under consultation. Related Australian and New Zealand legislation is being developed to implement the joint scheme. Once this legislation is passed, the Treaty will come into force and the new joint regulatory scheme will begin. The agency is expected to commence operation no later than 1 July 2006 and will result in a single agency to regulate complementary and alternative medicines.

Medicines discarded in household garbage: analysis of a pharmaceutical waste sample in Vienna

PubMed Central

2014-01-01

Objectives To analyze a sample of pharmaceutical waste drawn from household garbage in Vienna, with the aim to learn whether and which medicines end up unused in normal household waste. Methods We obtained a pharmaceutical waste sample from the Vienna Municipal Waste Department. This was drawn by their staff in a representative search in October and November 2009. We did a manual investigation of the sample which contained packs and loose blisters, excluded medical devices and traced loose blisters back to medicines packs. We reported information on the prescription status, origin, therapeutic group, dose form, contents and expiry date. We performed descriptive statistics for the total data set and for sub-groups (e.g. items still containing some of original content). Results In total, 152 packs were identified, of which the majority was prescription-only medicines (74%). Cardiovascular medicines accounted for the highest share (24%). 87% of the packs were in oral form. 95% of the packs had not expired. 14.5% of the total data set contained contents but the range of content left in the packs varied. Results on the packs with contents differed from the total: the shares of Over-the Counter medicines (36%), of medicines of the respiratory system (18%) and of the musculo-skeletal system (18%), for dermal use (23%) and of expired medicines (19%) were higher compared to the full data set. Conclusions The study showed that some medicines end up unused or partially used in normal household garbage in Vienna. Our results did not confirm speculations about a high percentage of unused medicines improperly discarded. There is room for improved patient information and counseling to enhance medication adherence and a proper discharge of medicines. PMID:25848546

Medicines discarded in household garbage: analysis of a pharmaceutical waste sample in Vienna.

PubMed

Vogler, Sabine; Leopold, Christine; Zuidberg, Christel; Habl, Claudia

2014-01-01

To analyze a sample of pharmaceutical waste drawn from household garbage in Vienna, with the aim to learn whether and which medicines end up unused in normal household waste. We obtained a pharmaceutical waste sample from the Vienna Municipal Waste Department. This was drawn by their staff in a representative search in October and November 2009. We did a manual investigation of the sample which contained packs and loose blisters, excluded medical devices and traced loose blisters back to medicines packs. We reported information on the prescription status, origin, therapeutic group, dose form, contents and expiry date. We performed descriptive statistics for the total data set and for sub-groups (e.g. items still containing some of original content). In total, 152 packs were identified, of which the majority was prescription-only medicines (74%). Cardiovascular medicines accounted for the highest share (24%). 87% of the packs were in oral form. 95% of the packs had not expired. 14.5% of the total data set contained contents but the range of content left in the packs varied. Results on the packs with contents differed from the total: the shares of Over-the Counter medicines (36%), of medicines of the respiratory system (18%) and of the musculo-skeletal system (18%), for dermal use (23%) and of expired medicines (19%) were higher compared to the full data set. The study showed that some medicines end up unused or partially used in normal household garbage in Vienna. Our results did not confirm speculations about a high percentage of unused medicines improperly discarded. There is room for improved patient information and counseling to enhance medication adherence and a proper discharge of medicines.

Dynamics of male pelvic floor muscle contraction observed with transperineal ultrasound imaging differ between voluntary and evoked coughs.

PubMed

Stafford, Ryan E; Mazzone, Stuart; Ashton-Miller, James A; Constantinou, Christos; Hodges, Paul W

2014-04-15

Coughing provokes stress urinary incontinence, and voluntary coughs are employed clinically to assess pelvic floor dysfunction. Understanding urethral dynamics during coughing in men is limited, and it is unclear whether voluntary coughs are an appropriate surrogate for spontaneous coughs. We aimed to investigate the dynamics of urethral motion in continent men during voluntary and evoked coughs. Thirteen men (28-42 years) with no history of urological disorders volunteered to participate. Transperineal ultrasound (US) images were recorded and synchronized with measures of intraabdominal pressure (IAP), airflow, and abdominal/chest wall electromyography during voluntary coughs and coughs evoked by inhalation of nebulized capsaicin. Temporal and spatial aspects of urethral movement induced by contraction of the striated urethral sphincter (SUS), levator ani (LA), and bulbocavernosus (BC) muscles and mechanical aspects of cough generation were investigated. Results showed coughing involved complex urethral dynamics. Urethral motion implied SUS and BC shortening and LA lengthening during preparatory and expulsion phases. Evoked coughs resulted in greater IAP, greater bladder base descent (LA lengthening), and greater midurethral displacement (SUS shortening). The preparatory inspiration cough phase was shorter during evoked coughs, as was the latency between onset of midurethral displacement and expulsion. Maximum midurethral displacement coincided with maximal bladder base descent during voluntary cough, but followed it during evoked cough. The data revealed complex interaction between muscles involved in continence in men. Spatial and temporal differences in urethral dynamics and cough mechanics between cough types suggest that voluntary coughing may not adequately assess capacity of the continence mechanism.

26 CFR 1.1092(c)-3 - Qualifying over-the-counter options.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 11 2010-04-01 2010-04-01 true Qualifying over-the-counter options. 1.1092(c)-3...-counter options. (a) In general. Under section 1092(c)(4)(B)(i), an equity option is not a qualified covered call option unless it is traded on a national securities exchange that is registered with the...

Bronchoconstriction-triggered cough in atopic cough: A retrospective study.

PubMed

Ohkura, Noriyuki; Hara, Johsuke; Sakai, Tamami; Okazaki, Akihito; Abo, Miki; Kasahara, Kazuo; Fujimura, Masaki

2016-06-01

Atopic cough (AC) and cough variant asthma (CVA) were identified as major causes of chronic non-productive cough in a Japanese study. A characteristic feature of CVA is the presence of a heightened cough response to bronchoconstriction. On the other hand, the cough response to bronchoconstriction in AC remains unclear. Methacholine (Mch)-induced cough in AC was measured and compared with that in CVA. Diagnoses of AC and CVA were made based on patient history, physical examination, response to bronchodilator therapy, cough reflex sensitivity to capsaicin, spirometry, and airway responsiveness to methacholine. Thirteen AC patients and 12 CVA patients in whom the criteria were met were recruited to the study. After inhalation of Mch at PC35-PEF40 that means milder bronchoconstriction than PC20-FEV1, cough was triggered a few times in AC. [cough number: 1/ 32 min (0-40)]. Conversely, significantly greater number of coughs was provoked in CVA, compared with AC [cough number: 35.5/ 32 min (25-125), p < 0.05]. The cough response to bronchoconstriction is reduced in AC compared to CVA. This feature may be useful in the diagnosis of chronic cough.

Point prevalence and epidemiological characteristics of chronic cough in the general adult population

PubMed Central

Kang, Min-Gyu; Song, Woo-Jung; Kim, Hyun-Jung; Won, Ha-Kyeong; Sohn, Kyoung-Hee; Kang, Sung-Yoon; Jo, Eun-Jung; Kim, Min-Hye; Kim, Sae-Hoon; Kim, Sang-Heon; Park, Heung-Woo; Chang, Yoon-Seok; Lee, Byung-Jae; Morice, Alyn H.; Cho, Sang-Heon

2017-01-01

Abstract Cough is frequently self-limiting, but may persist longer in certain individuals. Most of previous studies on the epidemiology of chronic cough have only measured period prevalence, and thus have afforded limited information on the burden and natural course. We aimed to investigate the epidemiology of chronic cough by using a point prevalence measure in a large-scale general population. We analyzed cross-sectional data collected from 18,071 adults who participated in the Korean National Health and Nutrition Examination Survey 2010–2012. Presence and duration of current cough was ascertained by structured questionnaires, and cough was classified into acute (<3 weeks), subacute (3–8 weeks), or chronic cough (≥8 weeks). Demographic and clinical parameters were examined in relation to chronic cough. The point prevalences of acute, subacute, and chronic cough were 2.5 ± 0.2%, 0.8 ± 0.1% and 2.6 ± 0.2%, respectively. The proportion of current cough showed a steep decrease after 1 week of duration. However, 2 peaks in the prevalence of current cough were revealed; cough durations of less than 1 week and longer than 1 year were most common (31.1% and 27.7% of current cough, respectively). Subacute and chronic cough were more prevalent in the elderly (≥65 years); the positive associations with older age were independent of other confounders, including current smoking and comorbidities. This is the first report on the epidemiology of cough using a point prevalence measure in a nationally representative population sample. Our findings indicate a high burden of chronic cough among adults with current cough in the community. The dual-peak of cough duration suggested that the pathophysiology of acute and chronic cough may differ. The preponderance of elderly people in the prevalence of chronic cough warrants further investigation. In addition, more sophistication and validation of tools to define chronic cough will help our understanding of the epidemiology. PMID:28353590

Mechanical Stimulation by Postnasal Drip Evokes Cough

PubMed Central

Iwata, Toshiyuki; Ito, Isao; Niimi, Akio; Ikegami, Koji; Marumo, Satoshi; Tanabe, Naoya; Nakaji, Hitoshi; Kanemitsu, Yoshihiro; Matsumoto, Hisako; Kamei, Junzo; Setou, Mitsutoshi; Mishima, Michiaki

2015-01-01

Cough affects all individuals at different times, and its economic burden is substantial. Despite these widespread adverse effects, cough research relies on animal models, which hampers our understanding of the fundamental cause of cough. Postnasal drip is speculated to be one of the most frequent causes of chronic cough; however, this is a matter of debate. Here we show that mechanical stimuli by postnasal drip cause chronic cough. We distinguished human cough from sneezes and expiration reflexes by airflow patterns. Cough and sneeze exhibited one-peak and two-peak patterns, respectively, in expiratory airflow, which were also confirmed by animal models of cough and sneeze. Transgenic mice with ciliary dyskinesia coughed substantially and showed postnasal drip in the pharynx; furthermore, their cough was completely inhibited by nasal airway blockade of postnasal drip. We successfully reproduced cough observed in these mice by injecting artificial postnasal drip in wild-type mice. These results demonstrated that mechanical stimulation by postnasal drip evoked cough. The findings of our study can therefore be used to develop new antitussive drugs that prevent the root cause of cough. PMID:26581078

Characterization of urge to cough and cough symptoms associated with the common cold: results of a US internet survey.

PubMed

Eccles, Ron; Dicpinigaitis, Peter; Turner, Ronald B; Druce, Howard M; Adeleke, Maryann; Mann, Ashley L

2016-06-01

Our knowledge of cough physiology is limited despite years of study. Even less is known about the sensation of urge to cough. Given that limited clinical data are available about urge to cough and cough attributes during a common cold, we sought to gain insights into experiences and perceptions related to these symptoms. An internet survey consisting of 51 questions was fielded in the United States. Eligible survey participants included men and women aged 18 years and older who had suffered from a cold with cough within the three months preceding the survey. Participants who confirmed suffering from recurrent cough, asthma, chronic bronchitis, chronic obstructive pulmonary disease, cystic fibrosis, or gastrointestinal reflux were excluded. Of 19,530 initial respondents, 8011 had a cold in the past three months. Of these, 6484 (81%) had experienced cough symptoms; 2708 respondents with cough due to cold and no exclusionary condition made up the analysis sample. Most respondents (62%) reported that cough developed one to two days after the onset of cold symptoms, and 45% felt that cough worsened their other cold symptoms. In 69% of respondents, cough outlasted other cold symptoms. Urge to cough was reported by 98% of respondents, and among these respondents, 64% described it as uncontrollable and 65% rated severity as moderate. More than half of respondents (57%) considered the sensation of urge to cough and the act of coughing as equally bothersome. Although urge to cough and inability to control cough were the most bothersome aspects of cough due to cold, few (<20%) respondents asked healthcare providers for treatment recommendations. Symptoms of urge to cough and cough are common and have a significant impact on cold sufferers. Understanding attributes of these symptoms may provide insights for effective management and the development of novel treatment strategies.

Pertussis may be the cause of prolonged cough in adolescents and adults in the interepidemic period.

PubMed

Pimentel, Analíria Moraes; Baptista, Paulo Neves; Ximenes, Ricardo Arraes de Alencar; Rodrigues, Laura Cunha; Magalhães, Vera; Silva, Andrea Rosane Sousa; Souza, Nadjla Ferreira; Matos, Deize Gomes Cavalcanti de; Pessoa, Ana Kelly Lins

2015-01-01

This study was aimed to evaluate the prevalence of pertussis in adolescents and adults with cough lasting more than 14 days and less than 30 days. This is a prospective observational study in interepidemic period of pertusis. Ten public health outpatient clinics in the city of Recife, Brazil, were randomly selected for the study. The study population consisted of individuals aged 10 years and over with cough that had lasted between 14 and 30 days. Nasopharyngeal swabs were collected for culture and PCR in order to identify Bordetella pertussis. We adopted the Centers for Disease Control and Prevention in the US (CDC) definition of cases of pertussis. A total of 192 individuals were identified as suspected cases. Their mean age was 40.7 years. Pertussis was confirmed in 10 of the 192 suspected cases, with an estimated prevalence of 5.21% (95% confidence interval 2.03-8.38). All cases met the clinical case definition for pertussis; one suspect had both culture and PCR positive. PCR confirmed 100% of the cases, 7/10 by PCR and 3/10 by epidemiological linkage with a case confirmed by PCR. During an interepidemic period, 1 in 20 cases of prolonged cough had pertussis, suggesting this is an important cause of prolonged cough in adolescents and adults. Copyright © 2014. Published by Elsevier Editora Ltda.

A Cough-Based Algorithm for Automatic Diagnosis of Pertussis.

PubMed

Pramono, Renard Xaviero Adhi; Imtiaz, Syed Anas; Rodriguez-Villegas, Esther

2016-01-01

Pertussis is a contagious respiratory disease which mainly affects young children and can be fatal if left untreated. The World Health Organization estimates 16 million pertussis cases annually worldwide resulting in over 200,000 deaths. It is prevalent mainly in developing countries where it is difficult to diagnose due to the lack of healthcare facilities and medical professionals. Hence, a low-cost, quick and easily accessible solution is needed to provide pertussis diagnosis in such areas to contain an outbreak. In this paper we present an algorithm for automated diagnosis of pertussis using audio signals by analyzing cough and whoop sounds. The algorithm consists of three main blocks to perform automatic cough detection, cough classification and whooping sound detection. Each of these extract relevant features from the audio signal and subsequently classify them using a logistic regression model. The output from these blocks is collated to provide a pertussis likelihood diagnosis. The performance of the proposed algorithm is evaluated using audio recordings from 38 patients. The algorithm is able to diagnose all pertussis successfully from all audio recordings without any false diagnosis. It can also automatically detect individual cough sounds with 92% accuracy and PPV of 97%. The low complexity of the proposed algorithm coupled with its high accuracy demonstrates that it can be readily deployed using smartphones and can be extremely useful for quick identification or early screening of pertussis and for infection outbreaks control.

A Cough-Based Algorithm for Automatic Diagnosis of Pertussis

PubMed Central

Pramono, Renard Xaviero Adhi; Imtiaz, Syed Anas; Rodriguez-Villegas, Esther

2016-01-01

Pertussis is a contagious respiratory disease which mainly affects young children and can be fatal if left untreated. The World Health Organization estimates 16 million pertussis cases annually worldwide resulting in over 200,000 deaths. It is prevalent mainly in developing countries where it is difficult to diagnose due to the lack of healthcare facilities and medical professionals. Hence, a low-cost, quick and easily accessible solution is needed to provide pertussis diagnosis in such areas to contain an outbreak. In this paper we present an algorithm for automated diagnosis of pertussis using audio signals by analyzing cough and whoop sounds. The algorithm consists of three main blocks to perform automatic cough detection, cough classification and whooping sound detection. Each of these extract relevant features from the audio signal and subsequently classify them using a logistic regression model. The output from these blocks is collated to provide a pertussis likelihood diagnosis. The performance of the proposed algorithm is evaluated using audio recordings from 38 patients. The algorithm is able to diagnose all pertussis successfully from all audio recordings without any false diagnosis. It can also automatically detect individual cough sounds with 92% accuracy and PPV of 97%. The low complexity of the proposed algorithm coupled with its high accuracy demonstrates that it can be readily deployed using smartphones and can be extremely useful for quick identification or early screening of pertussis and for infection outbreaks control. PMID:27583523

[Pregnancy and vaccinoprevention].

PubMed

Galev, A; Nacheva, A

2014-01-01

Vaccinations protect woman and her fetus against different infectious diseases, but their application on pregnant should be extremely responsible. In this review I present information about some infectious diseases and vaccines during pregnancy. Women, planning to get pregnant should be advised to do serological tests in order to find out their immune status against some infections, leading to fetal congenital malformations (rubella, chicken pox, hepatitis B) and if necessary to get vaccinated at least a month before pregnancy. Despite the lack of vaccines against Cytomegalovirus (CMV), parvovirus 19 and Toxoplasma gondii it is good to know woman's immune status against these infections in order to clarify the clinical approach in case of future contact with sick or carriers. Parvovirus 19 could cause fetal death, while CMV could be transmitted to the child. Immune women wouldn't get sick and wouldn't transmit Toxoplasmagondii to the fetus during pregnancy. Recommended vaccines before pregnancy include vaccines against flu, human papilloma virus, MMR (morbilli, measles, rubella), Tdap (tetanus, diphtheria, whooping cough), chicken pox. CDC-Atlanta recommends during pregnancy two vaccines--against flu, in case it wasn't done before pregnancy, and Tdap during every pregnancy between 27-th and 36-th gestation week. Whooping cough is very dangerous for the baby during the first two months after birth, while it is not yet vaccinated. From this point of view it is of best interest of the mother to have strong immunity in order to transfer antibodies during breastfeeding, as well as for the father and the rest who will take care for the newborn child to be vaccinated against whooping cough. During pregnancy vaccinations against tuberculosis, morbilli, measles, rubella, meningococcal disease, typhoid fever and chicken pox are contraindicated. In case of contact vaccinations against rabies, anthrax, small pox, poliomyelitis and yellow fever should be taken into consideration. Immediately after birth, if the vaccination against whooping cough is missed young mother vaccination is recommended. The vaccination is one of the greatest achievements of the modern medicine, but it is still an object of vigorous attacks, concerning used products safety. One of the most spreading fears is about sterility after vaccination. Over a period of three years (2009-2012) 563 women were vaccinated by SACMEH against HPV. Forty two of them (13.40%) interrupt vaccination due to pregnancy (18 of them after the first shot and 24 after the second shot). Our observations show, that this vaccine is carried out good by the patients, tit is safe and does not cause sterility.

Antitussive effect of carcainium chloride in patients with chronic cough and idiopathic interstitial pneumonias: A pilot study.

PubMed

Lavorini, Federico; Spina, Domenico; Walker, Michael J; Franciosi, Lui; Page, Clive P; Fontana, Giovanni A

2016-10-01

Cough is a common presenting symptom in patients with idiopathic interstitial pneumonia (IIP); it is often disabling, and lacks effective treatment. Studies in animals suggest that carcainium chloride, a quaternary derivative of the local anesthetic lidocaine, is able to inhibit experimentally induced cough by a mechanism of action distinct from that of lidocaine. To determine the effectiveness of aerosolised carcainium chloride (VRP700) in controlling cough in patients with IIP. Eight female patients (mean age 71 years) with IIP were investigated in a double blind, randomised, placebo controlled crossover, adaptive contingency study design (EudraCT Number 2010-021350-19). The study consisted of a screening visit to assess the eligibility of patients, and two separated (48-72 h) study days. On the two study days, patients were randomised to receive either nebulized VRP700 (1.0 mg/kg) on the first study visit followed by nebulised placebo (sodium chloride 0.9%) on the second visit, or placebo on the first visit followed by VRP700 on the second visit. The primary endpoint was cough frequency over a 4-h assessment period; secondary endpoints were subjective cough-related level of discomfort as assessed by a visual analogue scale (VAS) and the subjective response to treatment as assessed by a quality of life question. Safety (ECG, spirometry, urine and blood tests) and adverse events occurring during the trial were also investigated. In all patients both VRP700 and placebo decreased cough frequency; however, mean decreases in cough frequency after treatment with VRP700 were significantly (P < 0.001) higher than with placebo. Similarly, mean reductions in VAS score were significantly (P < 0.001) higher after treatment with VRP 700 compared with placebo. All but one patient indicated that they felt better after receiving VRP700. No adverse events were reported during the study, nor were any changes in ECG variables, spirometry, urine and blood tests noted. The results of this exploratory study indicate that nebulised VRP700 improved cough and quality of life in hospitalised IIP patients with no significant side effects. A larger trial is warranted to assess these promising results. Copyright © 2016 Elsevier Ltd. All rights reserved.

Community intervention to improve knowledge and practices on commonly used drugs.

PubMed

Kafle, K K; Karkee, S B; Shrestha, N; Prasad, R R; Bhuju, G B; Das, P L; Chataut, B D

2010-01-01

World Health Organisation (WHO) estimates that about half of all medicines are inappropriately prescribed, dispensed and sold and about half of all patients fail to take their medicines properly. The overall objective of the study was improving use of medicines in the community by creating awareness among different target groups. It was a pre-post comparison of intervention implemented at the community level in purposively selected Bhaktapur District of Kathmandu Valley, Nepal. The study was conducted in the private schools of the study district. Twelve schools were randomly selected. Thereafter, students from 6-9 grades were listed from the selected schools. Then 15% of the total students in each grade were randomly selected to get six students from each grade of the each school, totaling 288 students. The households of the selected students served as the sample households for the study. Thus, there were 288 households sampled for the study. The intervention and the targeted intermediary groups consisted of a. training of schools teachers b. training of journalists c. interactive discussions of trained school teachers with school children using key messages and c. communication of key messages through the local F.M. radio, newspaper/magazine. There was a significant increase in correct knowledge on action of antibiotics and excellent knowledge on the methods of administration of antibiotics of households after the intervention. Similarly, there was a significant increase in knowledge on cough as a disease and a significant decrease in the use of cough medicines after intervention. There was also a significant increase in excellent knowledge on the sources of vitamins and a significant decrease in the use of vitamin/tonics after the intervention. The participation of intermediary groups eg. school teachers, journalists and school children in the implementation of intervention were successful. The groups have fulfilled the commitments in implementing the plan of action. The key messages have effectively reached the households, and the knowledge and practices of the community members in drug use have improved.

Hybrid MRI-Ultrasound acquisitions, and scannerless real-time imaging.

PubMed

Preiswerk, Frank; Toews, Matthew; Cheng, Cheng-Chieh; Chiou, Jr-Yuan George; Mei, Chang-Sheng; Schaefer, Lena F; Hoge, W Scott; Schwartz, Benjamin M; Panych, Lawrence P; Madore, Bruno

2017-09-01

To combine MRI, ultrasound, and computer science methodologies toward generating MRI contrast at the high frame rates of ultrasound, inside and even outside the MRI bore. A small transducer, held onto the abdomen with an adhesive bandage, collected ultrasound signals during MRI. Based on these ultrasound signals and their correlations with MRI, a machine-learning algorithm created synthetic MR images at frame rates up to 100 per second. In one particular implementation, volunteers were taken out of the MRI bore with the ultrasound sensor still in place, and MR images were generated on the basis of ultrasound signal and learned correlations alone in a "scannerless" manner. Hybrid ultrasound-MRI data were acquired in eight separate imaging sessions. Locations of liver features, in synthetic images, were compared with those from acquired images: The mean error was 1.0 pixel (2.1 mm), with best case 0.4 and worst case 4.1 pixels (in the presence of heavy coughing). For results from outside the bore, qualitative validation involved optically tracked ultrasound imaging with/without coughing. The proposed setup can generate an accurate stream of high-speed MR images, up to 100 frames per second, inside or even outside the MR bore. Magn Reson Med 78:897-908, 2017. © 2016 International Society for Magnetic Resonance in Medicine. © 2016 International Society for Magnetic Resonance in Medicine.

Face Masks and Cough Etiquette Reduce the Cough Aerosol Concentration of Pseudomonas aeruginosa in People with Cystic Fibrosis.

PubMed

Wood, Michelle E; Stockwell, Rebecca E; Johnson, Graham R; Ramsay, Kay A; Sherrard, Laura J; Jabbour, Nassib; Ballard, Emma; O'Rourke, Peter; Kidd, Timothy J; Wainwright, Claire E; Knibbs, Luke D; Sly, Peter D; Morawska, Lidia; Bell, Scott C

2018-02-01

People with cystic fibrosis (CF) generate Pseudomonas aeruginosa in droplet nuclei during coughing. The use of surgical masks has been recommended in healthcare settings to minimize pathogen transmission between patients with CF. To determine if face masks and cough etiquette reduce viable P. aeruginosa aerosolized during coughing. Twenty-five adults with CF and chronic P. aeruginosa infection were recruited. Participants performed six talking and coughing maneuvers, with or without face masks (surgical and N95) and hand covering the mouth when coughing (cough etiquette) in an aerosol-sampling device. An Andersen Cascade Impactor was used to sample the aerosol at 2 meters from each participant. Quantitative sputum and aerosol bacterial cultures were performed, and participants rated the mask comfort levels during the cough maneuvers. During uncovered coughing (reference maneuver), 19 of 25 (76%) participants produced aerosols containing P. aeruginosa, with a positive correlation found between sputum P. aeruginosa concentration (measured as cfu/ml) and aerosol P. aeruginosa colony-forming units. There was a reduction in aerosol P. aeruginosa load during coughing with a surgical mask, coughing with an N95 mask, and cough etiquette compared with uncovered coughing (P < 0.001). A similar reduction in total colony-forming units was observed for both masks during coughing; yet, participants rated the surgical masks as more comfortable (P = 0.013). Cough etiquette provided approximately half the reduction of viable aerosols of the mask interventions during voluntary coughing. Talking was a low viable aerosol-producing activity. Face masks reduce cough-generated P. aeruginosa aerosols, with the surgical mask providing enhanced comfort. Cough etiquette was less effective at reducing viable aerosols.

Respiratory kinematic and airflow differences between reflex and voluntary cough in healthy young adults

PubMed Central

Brandimore, Alexandra E.; Troche, Michelle S.; Huber, Jessica E.; Hegland, Karen W.

2015-01-01

Background: Cough is a defensive behavior that can be initiated in response to a stimulus in the airway (reflexively), or on command (voluntarily). There is evidence to suggest that physiological differences exist between reflex and voluntary cough; however, the output (mechanistic and airflow) differences between the cough types are not fully understood. Therefore, the aims of this study were to determine the lung volume, respiratory kinematic, and airflow differences between reflex and voluntary cough in healthy young adults. Methods: Twenty-five participants (14 female; 18–29 years) were recruited for this study. Participants were evaluated using respiratory inductance plethysmography calibrated with spirometry. Experimental procedures included: (1) respiratory calibration, (2) three voluntary sequential cough trials, and (3) three reflex cough trials induced with 200 μM capsaicin. Results: Lung volume initiation (LVI; p = 0.003) and lung volume excursion (LVE; p < 0.001) were significantly greater for voluntary cough compared to reflex cough. The rib cage and abdomen significantly influenced LVI for voluntary cough (p < 0.001); however, only the rib cage significantly impacted LVI for reflex cough (p < 0.001). LVI significantly influenced peak expiratory flow rate (PEFR) for voluntary cough (p = 0.029), but not reflex cough (p = 0.610). Discussion: Production of a reflex cough results in significant mechanistic and airflow differences compared to voluntary cough. These findings suggest that detection of a tussigenic stimulus modifies motor aspects of the reflex cough behavior. Further understanding of the differences between reflex and voluntary cough in older adults and in persons with dystussia (cough dysfunction) will be essential to facilitate the development of successful cough treatment paradigms. PMID:26500560

Cough Headaches

MedlinePlus

... secondary cough headaches may require surgery. Symptoms Primary cough headaches Begin suddenly with and just after coughing ... by a dull, aching pain for hours Secondary cough headaches Secondary cough headaches often have symptoms similar ...

21 CFR 310.547 - Drug products containing quinine offered over-the-counter (OTC) for the treatment and/or...

Code of Federal Regulations, 2014 CFR

2014-04-01

...-counter (OTC) for the treatment and/or prevention of malaria. 310.547 Section 310.547 Food and Drugs FOOD... over-the-counter (OTC) for the treatment and/or prevention of malaria. (a) Quinine and quinine salts have been used OTC for the treatment and/or prevention of malaria, a serious and potentially life...

21 CFR 310.547 - Drug products containing quinine offered over-the-counter (OTC) for the treatment and/or...

Code of Federal Regulations, 2013 CFR

2013-04-01

...-counter (OTC) for the treatment and/or prevention of malaria. 310.547 Section 310.547 Food and Drugs FOOD... over-the-counter (OTC) for the treatment and/or prevention of malaria. (a) Quinine and quinine salts have been used OTC for the treatment and/or prevention of malaria, a serious and potentially life...

21 CFR 310.547 - Drug products containing quinine offered over-the-counter (OTC) for the treatment and/or...

Code of Federal Regulations, 2012 CFR

2012-04-01

...-counter (OTC) for the treatment and/or prevention of malaria. 310.547 Section 310.547 Food and Drugs FOOD... over-the-counter (OTC) for the treatment and/or prevention of malaria. (a) Quinine and quinine salts have been used OTC for the treatment and/or prevention of malaria, a serious and potentially life...

21 CFR 310.547 - Drug products containing quinine offered over-the-counter (OTC) for the treatment and/or...

Code of Federal Regulations, 2011 CFR

2011-04-01

...-counter (OTC) for the treatment and/or prevention of malaria. 310.547 Section 310.547 Food and Drugs FOOD... over-the-counter (OTC) for the treatment and/or prevention of malaria. (a) Quinine and quinine salts have been used OTC for the treatment and/or prevention of malaria, a serious and potentially life...

21 CFR 310.547 - Drug products containing quinine offered over-the-counter (OTC) for the treatment and/or...

Code of Federal Regulations, 2010 CFR

2010-04-01

...-counter (OTC) for the treatment and/or prevention of malaria. 310.547 Section 310.547 Food and Drugs FOOD... over-the-counter (OTC) for the treatment and/or prevention of malaria. (a) Quinine and quinine salts have been used OTC for the treatment and/or prevention of malaria, a serious and potentially life...

The Objective Assessment of Cough Frequency in Bronchiectasis.

PubMed

Spinou, Arietta; Lee, Kai K; Sinha, Aish; Elston, Caroline; Loebinger, Michael R; Wilson, Robert; Chung, Kian Fan; Yousaf, Nadia; Pavord, Ian D; Matos, Sergio; Garrod, Rachel; Birring, Surinder S

2017-10-01

Cough in bronchiectasis is associated with significant impairment in health status. This study aimed to quantify cough frequency objectively with a cough monitor and investigate its relationship with health status. A secondary aim was to identify clinical predictors of cough frequency. Fifty-four patients with bronchiectasis were compared with thirty-five healthy controls. Objective 24-h cough, health status (cough-specific: Leicester Cough Questionnaire LCQ and bronchiectasis specific: Bronchiectasis Health Questionnaire BHQ), cough severity and lung function were measured. The clinical predictors of cough frequency in bronchiectasis were determined in a multivariate analysis. Objective cough frequency was significantly raised in patients with bronchiectasis compared to healthy controls [geometric mean (standard deviation)] 184.5 (4.0) vs. 20.6 (3.2) coughs/24-h; mean fold-difference (95% confidence interval) 8.9 (5.2, 15.2); p < 0.001 and they had impaired health status. There was a significant correlation between objective cough frequency and subjective measures; LCQ r = -0.52 and BHQ r = -0.62, both p < 0.001. Sputum production, exacerbations (between past 2 weeks to 12 months) and age were significantly associated with objective cough frequency in multivariate analysis, explaining 52% of the variance (p < 0.001). There was no statistically significant association between cough frequency and lung function. Cough is a common and significant symptom in patients with bronchiectasis. Sputum production, exacerbations and age, but not lung function, were independent predictors of cough frequency. Ambulatory objective cough monitoring provides novel insights and should be further investigated as an outcome measure in bronchiectasis.

An integrated global chemomics and system biology approach to analyze the mechanisms of the traditional Chinese medicinal preparation Eriobotrya japonica - Fritillaria usuriensis dropping pills for pulmonary diseases.

PubMed

Tao, Jin; Hou, Yuanyuan; Ma, Xiaoyao; Liu, Dan; Tong, Yongling; Zhou, Hong; Gao, Jie; Bai, Gang

2016-01-08

Traditional Chinese medicine (TCM) herbal formulae provide valuable therapeutic strategies. However, the active ingredients and mechanisms of action remain unclear for most of these formulae. Therefore, the identification of complex mechanisms is a major challenge in TCM research. This study used a network pharmacology approach to clarify the anti-inflammatory and cough suppressing mechanisms of the Chinese medicinal preparation Eriobotrya japonica - Fritillaria usuriensis dropping pills (ChuanbeiPipa dropping pills, CBPP). The chemical constituents of CBPP were identified by high-quality ultra-performance liquid chromatography/quadrupole time-of-flight mass spectrometry (UPLC/Q-TOF-MS), and anti-inflammatory ingredients were selected and analyzed using the PharmMapper and Kyoto Encyclopedia of Genes and Genomes (KEGG) bioinformatics websites to predict the target proteins and related pathways, respectively. Then, an RNA-sequencing (RNA-Seq) analysis was carried out to investigate the different expression of genes in the lung tissue of rats with chronic bronchitis. Six main constituents affected 19 predicted pathways, including ursolic acid and oleanolic acid from Eriobotrya japonica (Thunb.) Lindl. (Eri), peiminine from Fritillaria usuriensis Maxim. (Fri), platycodigenin and polygalacic acid from Platycodon grandiflorum (Jacq.) A. DC. (Pla) and guanosine from Pinellia ternata (Thunb.) Makino. (Pin). Expression of 34 genes was significantly decreased after CBPP treatment, affecting four therapeutic functions: immunoregulation, anti-inflammation, collagen formation and muscle contraction. The active components acted on the mitogen activated protein kinase (MAPK) pathway, transforming growth factor (TGF)-beta pathway, focal adhesion, tight junctions and the action cytoskeleton to exert anti-inflammatory effects, resolve phlegm, and relieve cough. This novel approach of global chemomics-integrated systems biology represents an effective and accurate strategy for the study of TCM with multiple components and multiple target mechanisms.

Flow Field of a Human Cough

NASA Astrophysics Data System (ADS)

Hertzberg, Jean

2005-11-01

Cough generated infectious aerosols are of interest while developing strategies for the mitigation of disease risks ranging from the common cold to SARS. In this work, the velocity field of human cough was measured using particle image velocimetry (PIV). The project subjects (total 29) coughed into an enclosure seeded with stage fog for most measurements. Cough flow speed profiles, average widths of the cough jet, waveform, and maximum cough speeds were measured. Maximum cough speeds ranged from 1.5 m/s to 28.8 m/s. No correlation was found for maximum cough flow speeds to height or gender. The slow growth of the width of the cough flow suggests that a cough may penetrate farther into a room than a steady jet of similar volume. The velocity profile was found to scale with the square root of downstream distance.

Stress and medicine use for headache: does sense of coherence modify the association?

PubMed

Koushede, Vibeke; Holstein, Bjørn E; Andersen, Anette; Hansen, Ebba Holme

2011-10-01

Medicine use as a strategy for coping with daily stressors is an under-studied issue. Studies show that stress is associated with use of over-the-counter medicine, but the underlying mechanisms are not well understood. The aim of this study was to examine whether sense of coherence (SOC) modifies the association between perceived stress and medicine use for headache. National cross-sectional study in Denmark. men and women aged 25-44 years, n = 990. The survey was conducted by web-based questionnaires and telephone interviews. The outcome measure was medicine use for headache. The independent variable was perceived stress. SOC and gender were investigated as moderators. Social class, headache prevalence and severity, and response method were included as co-variates. Our study showed that SOC modified the association between stress and medicine use for headache (only statistically significant among women). The odds for medicine use among women who felt stressed were 2.30 (1.39-3.79) compared to women who did not feel stressed; among men who felt stressed the equivalent odds were 1.46 (0.80-2.66). In analysis stratified by SOC, the odds for medicine use when stressed were 2.09 (0.71-6.21) among women with high SOC, 2.21 (1.10-4.41) among women with medium SOC and 3.69 (1.09-12.47) among women with low SOC. The equivalent odds for men were 1.29 (0.33-5.04), 1.33 (0.59-3.04) and 2.47 (0.57-10.64), respectively. SOC modifies the association between stress and medicine use especially among women. Individuals with fewer coping resources may be more likely to use medicine beyond indication to treat stress.

Medicine, morality, and the market.

PubMed

Owen, D

1984-07-07

In extracts from a lecture given at McGill University, the author describes the rise of a marketing or corporate ethos in medicine, stemming from economic constraints and the demographic pressures of aging populations in the U.S., Canada, and the United Kingdom. To counter the trend to corporate rather than public policy making in medicine, he advocates a holistic approach to health care, a revival of interest in preventive health, and encouragement of the self-help movement. Owen calls for a reorientation of medical attitudes so that traditional moral values of medicine present a "counterweight to the mechanistic, technological, cost-effectiveness of the market place."

Airway remodeling associated with cough hypersensitivity as a consequence of persistent cough: An experimental study.

PubMed

Nakaji, Hitoshi; Niimi, Akio; Matsuoka, Hirofumi; Iwata, Toshiyuki; Cui, Shilei; Matsumoto, Hisako; Ito, Isao; Oguma, Tsuyoshi; Otsuka, Kojiro; Takeda, Tomoshi; Inoue, Hideki; Tajiri, Tomoko; Nagasaki, Tadao; Kanemitsu, Yoshihiro; Chin, Kazuo; Mishima, Michiaki

2016-11-01

Chronic cough involves airway remodeling associated with cough reflex hypersensitivity. Whether cough itself induces these features remains unknown. Guinea pigs were assigned to receive treatment with citric acid (CA), saline (SA), or CA+dextromethorphan (DEX). All animals were exposed to 0.5M CA on days 1 and 22. On days 4-20, the CA and CA+DEX groups were exposed to CA, and the SA group to saline thrice weekly, during which the CA+DEX group was administered DEX pretreatment to inhibit cough. The number of coughs was counted during each 10-min CA or SA exposure. Terbutaline premedication was started to prevent bronchoconstriction. Bronchoalveolar lavage and pathology were examined on day 25. Average cough number for 10 CA exposures was examined as "cough index" in the CA group, which was divided into frequent (cough index>5) and infrequent (<5) cough subgroups for lavage and pathology analysis. The number of coughs significantly increased in the CA group from day 13 onwards. In the CA+DEX and SA groups, the number of coughs did not differ between days 1 and 22, while average number of coughs during days 4-20 was significantly lower than at days 1 and 22. Bronchoalveolar cell profiles were similar among the four groups. The smooth muscle area of small airways was significantly greater in the frequent-cough subgroup than in the other groups (in which it was similar), and highly correlated with cough index in CA group. Repeated cough induces airway smooth muscle remodeling associated with cough reflex hypersensitivity. Copyright © 2016 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

Inhibitory effect of cervical trachea and chest wall vibrations on cough reflex sensitivity and perception of urge-to-cough in healthy male never-smokers

PubMed Central

2013-01-01

Background Non-pharmacological options for symptomatic management of cough are desired. Although chest wall mechanical vibration is known to ameliorate cough reflex sensitivity, the effect of mechanical vibrations on perceptions of urge-to-cough has not been studied. Therefore, we investigated the effect of mechanical vibration of cervical trachea, chest wall and femoral muscle on cough reflex sensitivity, perceptions of urge-to-cough as well as dyspnea. Methods Twenty-four healthy male never-smokers were investigated for cough reflex sensitivity, perceptions of the urge-to-cough and dyspnea with or without mechanical vibration. Cough reflex sensitivity and urge-to-cough were evaluated by the inhalation of citric acid. The perception of dyspnea was evaluated by Borg scores during applications of external inspiratory resistive loads. Mechanical vibration was applied by placing a vibrating tuning fork on the skin surface of cervical trachea, chest wall and femoral muscle. Results Cervical trachea vibration significantly increased cough reflex threshold, as expressed by the lowest concentration of citric acid that elicited five or more coughs (C5), and urge-to-cough threshold, as expressed by the lowest concentration of citric acid that elicited urge-to-cough (Cu), but did not significantly affect dypnea sensation during inspiratory resistive loading. On the other hand, the chest wall vibration not only significantly increased C5 and Cu but also significantly ameliorated the load-response curve of dyspnea sensation. Conclusions Both cervical and trachea vibrations significantly inhibited cough reflex sensitivity and perception of urge-to-cough. These vibration techniques might be options for symptomatic cough management. PMID:24088411

Women's questions about medicines in pregnancy - An analysis of calls to an Australian national medicines call centre.

PubMed

Pijpers, Eva L; Kreijkamp-Kaspers, Sanne; McGuire, Treasure M; Deckx, Laura; Brodribb, Wendy; van Driel, Mieke L

2017-06-01

For many medicines, safe use during pregnancy is not established and adherence is often poor due to safety concerns. Therefore, it is important to identify consumers' medicines information needs during pregnancy. A retrospective, mixed methods analysis was conducted on eight years of pregnancy-related calls to an Australian national medicines call centre. The call profile of pregnancy and non-pregnancy-related questions were compared. Medicines involved in pregnancy calls were categorised by class (Anatomical Therapeutic Chemical (ATC)3 level), and Therapeutic Goods Administration pregnancy category. Questions in these calls were also themed by pregnancy stage. We identified 4573 pregnancy-related and 118 547 non-pregnancy-related calls. The caller profile for pregnancy-related calls was female (93.7%), asking for herself (83.0%), and while 70.1% of questions involved one medicine, 9.6% involved three or more medicines. Pregnancy enquiries were prompted more often by conflicting information, inadequate information or desire for a second opinion. For 1166 calls, where the stage of pregnancy was available, most questions concerned safety. Medication classified as 'safe' during pregnancy accounted for 34% of these questions. After antidepressants, most calls were made about over-the-counter (OTC) medicines (paracetamol, dexchlorpheniramine, codeine). Safe treatment for everyday conditions was of increasing concern as the pregnancy progressed. Pregnant women are concerned about the safety of medication use in pregnancy and a significant proportion overestimate risk. Psychotropic medication and fertility are strong drivers to seek information during preconception. Everyday illnesses and self-medication with OTC medication are a common concern throughout pregnancy, even though many medicines are safe to use. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

The difficult coughing child: prolonged acute cough in children

PubMed Central

2013-01-01

Cough is one of the most common symptoms that patients bring to the attention of primary care clinicians. Cough can be designated as acute (<3 weeks in duration), prolonged acute cough (3 to 8 weeks in duration) or chronic (> 8 weeks in duration). The use of the term ‘prolonged acute cough’ in a cough guideline allows a period of natural resolution to occur before further investigations are warranted. The common causes are in children with post viral or pertussis like illnesses causing the cough. Persistent bacterial bronchitis typically occurs when an initial dry acute cough due to a viral infection becomes a prolonged wet cough remaining long after the febrile illness has resolved. This cough responds to a completed course of appropriate antibiotics. PMID:23574624

Aging deteriorated perception of urge-to-cough without changing cough reflex threshold to citric acid in female never-smokers.

PubMed

Ebihara, Satoru; Ebihara, Takae; Kanezaki, Masashi; Gui, Peijun; Yamasaki, Miyako; Arai, Hiroyuki; Kohzuki, Masahiro

2011-06-28

The effect of aging on the cognitive aspect of cough has not been studied yet. The purpose of this study is to investigate the aging effect on the perception of urge-to-cough in healthy individuals. Fourteen young, female, healthy never-smokers were recruited via public postings. Twelve elderly female healthy never-smokers were recruited from a nursing home residence. The cough reflex threshold and the urge-to-cough were evaluated by inhalation of citric acid. The cough reflex sensitivities were defined as the lowest concentration of citric acid that elicited two or more coughs (C2) and five or more coughs (C5). The urge-to-cough was evaluated using a modified the Borg scale. There was no significant difference in the cough reflex threshold to citric acid between young and elderly subjects. The urge-to-cough scores at the concentration of C2 and C5 were significantly smaller in the elderly than young subjects. The urge-to-cough log-log slope in elderly subjects (0.73 ± 0.71 point · L/g) was significantly gentler than those of young subjects (1.35 ± 0.53 point · L/g, p < 0.01). There were no significant differences in the urge-to-cough threshold estimated between young and elderly subjects. The cough reflex threshold did not differ between young and elderly subjects whereas cognition of urge-to-cough was significantly decreased in elderly subjects in female never-smokers. Objective monitoring of cough might be important in the elderly people.

Vaginal sponge and spermicides

MedlinePlus

Birth control - over the counter; Contraceptives - over the counter; Family planning - vaginal sponge; Contraception - vaginal sponge ... preventing pregnancy as some other forms of birth control. However, using a spermicide or sponge is much ...

Prevalence of cough throughout childhood: A cohort study.

PubMed

Jurca, Maja; Ramette, Alban; Dogaru, Cristian M; Goutaki, Myrofora; Spycher, Ben D; Latzin, Philipp; Gaillard, Erol A; Kuehni, Claudia E

2017-01-01

Cough in children is a common reason for medical consultations and affects quality of life. There are little population-based data on the epidemiology of recurrent cough in children and how this varies by age and sex, or between children with and without wheeze. We determined the prevalence of cough throughout childhood, comparing several standardised cough questions. We did this for the entire population and separately for girls and boys, and for children with and without wheeze. In a population-based prospective cohort from Leicestershire, UK, we assessed prevalence of cough with repeated questionnaires from early childhood to adolescence. We asked whether the child usually coughed more than other children, with or without colds, had night-time cough or cough triggered by various factors (triggers, related to increased breathing effort, allergic or food triggers). We calculated prevalence from age 1 to 18 years using generalised estimating equations for all children, and for children with and without wheeze. Of 7670 children, 10% (95% CI 10-11%) coughed more than other children, 69% (69-70%) coughed usually with a cold, 34% to 55% age-dependently coughed without colds, and 25% (25-26%) had night-time cough. Prevalence of coughing more than peers, with colds, at night, and triggered by laughter varied little throughout childhood, while cough without colds and cough triggered by exercise, house dust or pollen became more frequent with age. Cough was more common in boys than in girls in the first decade of life, differences got smaller in early teens and reversed after the age of 14 years. All symptoms were more frequent in children with wheeze. Prevalence of cough in children varies with age, sex and with the questions used to assess it, suggesting that comparisons between studies are only valid for similar questions and age groups.

Point prevalence and epidemiological characteristics of chronic cough in the general adult population: The Korean National Health and Nutrition Examination Survey 2010-2012.

PubMed

Kang, Min-Gyu; Song, Woo-Jung; Kim, Hyun-Jung; Won, Ha-Kyeong; Sohn, Kyoung-Hee; Kang, Sung-Yoon; Jo, Eun-Jung; Kim, Min-Hye; Kim, Sae-Hoon; Kim, Sang-Heon; Park, Heung-Woo; Chang, Yoon-Seok; Lee, Byung-Jae; Morice, Alyn H; Cho, Sang-Heon

2017-03-01

Cough is frequently self-limiting, but may persist longer in certain individuals. Most of previous studies on the epidemiology of chronic cough have only measured period prevalence, and thus have afforded limited information on the burden and natural course. We aimed to investigate the epidemiology of chronic cough by using a point prevalence measure in a large-scale general population.We analyzed cross-sectional data collected from 18,071 adults who participated in the Korean National Health and Nutrition Examination Survey 2010-2012. Presence and duration of current cough was ascertained by structured questionnaires, and cough was classified into acute (<3 weeks), subacute (3-8 weeks), or chronic cough (≥8 weeks). Demographic and clinical parameters were examined in relation to chronic cough.The point prevalences of acute, subacute, and chronic cough were 2.5 ± 0.2%, 0.8 ± 0.1% and 2.6 ± 0.2%, respectively. The proportion of current cough showed a steep decrease after 1 week of duration. However, 2 peaks in the prevalence of current cough were revealed; cough durations of less than 1 week and longer than 1 year were most common (31.1% and 27.7% of current cough, respectively). Subacute and chronic cough were more prevalent in the elderly (≥65 years); the positive associations with older age were independent of other confounders, including current smoking and comorbidities.This is the first report on the epidemiology of cough using a point prevalence measure in a nationally representative population sample. Our findings indicate a high burden of chronic cough among adults with current cough in the community. The dual-peak of cough duration suggested that the pathophysiology of acute and chronic cough may differ. The preponderance of elderly people in the prevalence of chronic cough warrants further investigation. In addition, more sophistication and validation of tools to define chronic cough will help our understanding of the epidemiology.

Efficacy, safety, quality control, marketing and regulatory guidelines for herbal medicines (phytotherapeutic agents).

PubMed

Calixto, J B

2000-02-01

This review highlights the current advances in knowledge about the safety, efficacy, quality control, marketing and regulatory aspects of botanical medicines. Phytotherapeutic agents are standardized herbal preparations consisting of complex mixtures of one or more plants which contain as active ingredients plant parts or plant material in the crude or processed state. A marked growth in the worldwide phytotherapeutic market has occurred over the last 15 years. For the European and USA markets alone, this will reach about $7 billion and $5 billion per annum, respectively, in 1999, and has thus attracted the interest of most large pharmaceutical companies. Insufficient data exist for most plants to guarantee their quality, efficacy and safety. The idea that herbal drugs are safe and free from side effects is false. Plants contain hundreds of constituents and some of them are very toxic, such as the most cytotoxic anti-cancer plant-derived drugs, digitalis and the pyrrolizidine alkaloids, etc. However, the adverse effects of phytotherapeutic agents are less frequent compared with synthetic drugs, but well-controlled clinical trials have now confirmed that such effects really exist. Several regulatory models for herbal medicines are currently available including prescription drugs, over-the-counter substances, traditional medicines and dietary supplements. Harmonization and improvement in the processes of regulation is needed, and the general tendency is to perpetuate the German Commission E experience, which combines scientific studies and traditional knowledge (monographs). Finally, the trend in the domestication, production and biotechnological studies and genetic improvement of medicinal plants, instead of the use of plants harvested in the wild, will offer great advantages, since it will be possible to obtain uniform and high quality raw materials which are fundamental to the efficacy and safety of herbal drugs.

Risks and Cough-Aggravating Factors in Prolonged Cough. Epidemiological Observations from the Nagahama Cohort Study.

PubMed

Matsumoto, Hisako; Izuhara, Yumi; Niimi, Akio; Tabara, Yasuharu; Nagasaki, Tadao; Kanemitsu, Yoshihiro; Murase, Kimihiko; Oguma, Tsuyoshi; Ito, Isao; Muro, Shigeo; Sekine, Akihiro; Matsuda, Fumihiko; Kosugi, Shinji; Nakayama, Takeo; Chin, Kazuo; Mishima, Michiaki

2017-05-01

Chronic cough hypersensitivity, a potentially important concept of chronic or prolonged cough, is featured by heightened cough response to low-intensity stimuli, which may be generated in the absence of airflow limitations or allergic conditions. However, there is little epidemiological evidence to support this. In this large-scale community survey, we aimed to determine risks and cough-aggravating factors of prolonged cough while focusing on serum IgE levels. Prevalence of prolonged cough, defined as cough lasting 3 weeks or longer, was determined in 9,804 residents from a baseline measurement of the Nagahama Cohort Study, conducted from 2008 to 2010. Risk assessment of prolonged cough was confined to subjects without asthma (n = 9,402). A follow-up measurement of the Nagahama Study was successively conducted from 2013 to 2015, recruiting the same residents living in Nagahama City, Japan (n = 8,292). Validation analysis was performed in the follow-up measurement. In a baseline measurement, prolonged cough was reported by 9.5% of subjects without asthma and 32.3% of subjects with asthma. In subjects without asthma, various cough-aggravating factors were associated with prolonged cough. On the multivariate analysis, several cough-aggravating factors, including nighttime or early morning, weather, pollen season, and common cold, were associated with prolonged cough, independent of female sex, younger age, chronic obstructive pulmonary disease, postnasal drip, daytime sputum, and lower serum total IgE. Serum-specific IgE levels against Japanese cedar pollen were significantly higher in subjects who responded "yes" to "cough in the pollen season" than in those who did not respond, whereas, among subjects who responded "yes" to "cough in the pollen season," prolonged coughers showed lower serum IgE levels against Japanese cedar pollen than temporal coughers. Validation analysis in a follow-up measurement confirmed the associations between prolonged cough and cough-aggravating factors observed in the baseline measurement. The presence of several cough-aggravating factors in the absence of severe allergic conditions may support the presence of cough hypersensitivity.

Indoor risk factors for cough and their relation to wheeze and sensitization in Chilean young adults.

PubMed

Potts, James F; Rona, Roberto J; Oyarzun, Manuel J; Amigo, Hugo; Bustos, Patricia

2008-04-01

We assessed the effects of indoor risk factors, including smoking, on different types of cough and on cough and wheeze in combination. Our sample was composed of 1232 men and women residing in a semirural area of Chile. We used a standardized questionnaire, sensitization to 8 allergens, and bronchial hyperresponsiveness to methacholine to assess cough and wheeze characteristics. Information was gathered on dampness, mold, ventilation, heating, housing quality, smoking, and environmental tobacco smoke exposure. Most exposures were associated with cough alone or cough in combination with wheeze. Smoking, past smoking, and environmental tobacco smoke exposure were strongly associated with dry cough and wheeze. The use of coal for heating was associated with dry cough. Leaks, mold, and lack of kitchen ventilation were associated with cough and wheeze. Nocturnal cough and productive cough were associated with specific types of sensitization, but dry cough was not. Productive cough was associated with hyperresponsiveness to methacholine. Several different types of indoor exposures, including environmental tobacco smoke exposure, are important contributors to morbidity associated with cough and wheeze. A vigorous preventive strategy designed to lower exposures to indoor risk factors would lower rates of respiratory morbidity.

Indoor risk factors for cough and their relation to wheeze and sensitization in Chilean young adults

DOE Office of Scientific and Technical Information (OSTI.GOV)

Potts, J.F.; Rona, R.J.; Oyarzun, M.J.

2008-04-15

We assessed the effects of indoor risk factors, including smoking, on different types of cough and on cough and wheeze in combination. Our sample was composed of 1232 men and women residing in a semi-rural area of Chile. We used a standardized questionnaire, sensitization to 8 allergens, and bronchial hyperresponsiveness to methacholine to assess cough and wheeze characteristics. Information was gathered on dampness, mold, ventilation, heating, housing quality, smoking, and environmental tobacco smoke exposure. Most exposures were associated with cough alone or cough in combination with wheeze. Smoking, past smoking, and environmental tobacco smoke exposure were strongly associated with drymore » cough and wheeze. The use of coal for heating was associated with dry cough. Leaks, mold, and lack of kitchen ventilation were associated with cough and wheeze. Nocturnal cough and productive cough were associated with specific types of sensitization, but dry cough was not. Productive cough was associated with hyperresponsiveness to methacholine. Several different types of indoor exposures, including environmental tobacco smoke exposure, are important contributors to morbidity associated with cough and wheeze. A vigorous preventive strategy designed to lower exposures to indoor risk factors would lower rates of respiratory morbidity.« less

Position statement from the European Board and College of Obstetrics & Gynaecology (EBCOG): The use of medicines during pregnancy - call for action.

PubMed

Van Calsteren, Kristel; Gersak, Ksenija; Sundseth, Hildrun; Klingmann, Ingrid; Dewulf, Lode; Van Assche, André; Mahmood, Tahir

2016-06-01

Less than 10% of medicines approved by the FDA since 1980 have provided enough information as regards risks for birth defects associated with their use (Adam et al. (2011) [1]). Nevertheless, it is estimated that over 90% of pregnant women take over-the-counter (OTC) or prescription medication (Ke et al., 2014 [2]). Considering the fact that the use of medication in the period before conception and during lactation can also influence the development of the child, information on the impact of their usage during reproductive life is important for everyone. The lack of clear information on this topic results in situations where life-saving medication is discontinued, withheld or used in a reduced dosage by pregnant women, while on the other hand medicines with (potential) toxic effects are taken. This is unacceptable and it is a major public concern that must be addressed. Currently, Europe lacks a robust and comprehensive information system about medication use in reproductive life (from preconception, during pregnancy and during lactation). In order to improve maternal health, and subsequently the health of our next generation, reliable and up to date information should be made available. It should be readily accessible for both health care providers and women who are considering getting pregnant or who are already pregnant. In order to tackle this gap in public health, this paper describes current knowledge of the use of medicines before and during pregnancy. It calls upon all stakeholders involved in medical care, research and medicine regulation, such as policy makers, regulators and governmental agencies, to take action to protect patients and improve public health. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Position Statement from the European Board and College of Obstetrics & Gynaecology (EBCOG) : The use of medicines during pregnancy: call for action.

PubMed

Van Calsteren, Kristel; Gersak, Ksenija; Sundseth, Hildrun; Klingmann, Ingrid; Dewulf, Lode; Van Assche, André; Mahmood, Tahir

2016-06-01

Less than 10% of medicines approved by the FDA since 1980 have provided enough information as regard risks for birth defects associated with their use [1]. Nevertheless, it is estimated that over 90% of pregnant women take over-the-counter (OTC) or prescription medication [2]. Considering the fact that the use of medication in the period before conception and during lactation can also influence the development of the child, information on the impact of their usage during reproductive life is important for everyone. The lack of clear information on this topic results in situations where life-saving medication is discontinued, withheld or used in a reduced dosage by pregnant women, while on the other hand medicines with (potential) toxic effects are taken. This is unacceptable and it is a major public concern that must be addressed. Currently, Europe lacks a robust and comprehensive information system about medication use in reproductive life (preconception, pregnancy and lactation). In order to improve maternal health, and subsequently the health of our next generation, reliable and up to date information should be made available. It should be readily accessible for both health care providers and women who are considering getting pregnant or who are already pregnant. In order to tackle this gap in public health, this paper describes current knowledge of the use of medicines before and during pregnancy. It calls upon all stakeholders involved in medical care, research and medicine regulation, such as policy makers, regulators and governmental agencies, to take action to protect patients and improve public health. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Medication administered to children from 0 to 7.5 years in the Avon Longitudinal Study of Parents and Children (ALSPAC)

PubMed Central

Northstone, K.

2007-01-01

Objective To present data on the parentally-reported use of all types of medicinal products in children from 0 to 7.5 years, in a large cohort in south-west England. Methods Participants in the population-based Avon Longitudinal Study of Parents and Children (ALSPAC) have been sent self-completion postal questionnaires since they were enrolled during pregnancy. The use of medicinal products has been obtained from questionnaires sent out when the study children were 4 weeks, 54, 78 and 91 months old. Results The data included prescription, over-the-counter and complementary and alternative medicines. Around three-quarters of study children were exposed to some form of medicinal product before 8 weeks of age. Dermatological preparations were the most commonly used products in young babies. Activated dimeticone, for treatment of colic and flatulence, was given to 16% of babies and gripe water was used by 13%. Other commonly reported products included oral and topical antifungals and ophthalmic antibiotics. Several OTC products, not licensed for use in this age group, were reported. At each of the older ages surveyed, over 95% of children had used some form of medicinal product within the previous 12–18 months. Use of several product categories was higher at 54 months than at 78 or 91 months, such as topical steroids, analgesics (mostly paracetamol) and systemic antibiotics (mainly amoxicillin). Conversely, use of other categories, such as asthma medication, throat preparations (sprays and lozenges) and anti-inflammatory products, increased with increasing age. Conclusion Parentally-reported use of medicinal products in the ALSPAC study children appears to be consistent with data from other sources. The use of medicinal products by young children is high and does not always conform to the product labelling. PMID:17200835

Behavioural aspects surrounding medicine purchases from pharmacies in Australia

PubMed Central

Emmerton, Lynne

2008-01-01

Objective This study aimed to produce current data regarding behavioural aspects of non-prescription (over-the-counter) medicine purchases, in light of changes in the pharmaceutical market and increasing provision of professional services in pharmacies. Methods Data were collected in 15 community pharmacies in South-East Queensland, Australia, over 540 hours in five days in August, 2006. The method, previously validated, involved documentation of both observational and interview data. Fifteen trained researchers were stationed in a selected pharmacy each to unobtrusively observe all eligible sales of non-prescription medicines, and, where possible, interview the purchasers post-sale. Non-response was supplemented by observational data and recall by the salesperson. The data included details of the purchase and purchasing behaviour, while new questions addressed issues of topical importance, including customers’ privacy concerns. A selection of the analyses is reported here. Results In total, 3470 purchases were documented (135-479 per pharmacy), with customers of 67.5% of purchases (74.7% excluding an outlier pharmacy) participating in the survey. Customers averaged 1.2 non-prescription medicines per transaction. Two-thirds (67.2%) of customers were female, and 38.8% of the customers were aged 31-45 years. Analgesics and respiratory medicines accounted for two-thirds of the sales data (33.4% and 32.4%, respectively). Intended-brand purchases comprised 71% of purchases (2004/2824); in-store substitution then occurred in 8.8% of these cases, mainly following recommendations by pharmacy staff. Medicines intended for self-use comprised 62.9% of purchases (1752/2785). First-time purchases (30.8%, 799/2594) were more commonly influenced by pharmacy staff than by advertising. Conclusions This study used validated methods adapted to a changing marketplace, thus providing data that both confirm and add to knowledge surrounding medicine purchases. Despite the dynamics of the non-prescription market, it revealed consistencies with previous research. PMID:25177407

Etiology and treatment of cough in idiopathic pulmonary fibrosis.

PubMed

Vigeland, Christine L; Hughes, Andrew H; Horton, Maureen R

2017-02-01

Idiopathic pulmonary fibrosis (IPF) is a progressive disease of dysregulated wound healing leading to unremitting scarring and loss of lung function. The predominant symptoms are dyspnea on exertion and a persistent dry cough. For patients with IPF, cough is more than just bothersome; it has a significant negative impact on quality of life and is a marker of disease severity and progression. The etiology of cough in IPF is unclear but may be due to architectural distortion of the lungs, increased sensitivity of the cough reflex, airway inflammation, or changes in mucus production and clearance. There also may be an overlap between IPF cough and cough due to other common etiologies such as asthma, gastroesophageal reflux disease, upper airway cough syndrome, and medications. There are no approved therapies to specifically treat IPF cough, and recently approved medications for IPF have not been evaluated in cough. Few clinical trials have focused on treatments for IPF cough. To date, there is only one randomized, placebo control therapeutic study for IPF cough with thalidomide, which significantly reduced IPF cough and improved quality of life. Two additional cohort studies report that interferon-α and prednisolone also decrease IPF cough. However, no medication is approved to treat IPF cough. Currently, the mainstay of therapy for IPF cough is standard cough suppressants, which have limited efficacy and often intolerable side effects. Future studies are needed to determine an effective therapy to alleviate this particularly debilitating symptom and improve overall quality of life for patients suffering with IPF. Copyright © 2016 Elsevier Ltd. All rights reserved.

Plasma substance P levels in patients with persistent cough.

PubMed

Otsuka, Kojiro; Niimi, Akio; Matsumoto, Hisako; Ito, Isao; Yamaguchi, Masafumi; Matsuoka, Hirofumi; Jinnai, Makiko; Oguma, Tsuyoshi; Takeda, Tomoshi; Nakaji, Hitoshi; Chin, Kazuo; Sasaki, Kazuhiko; Aoyama, Norihito; Mishima, Michiaki

2011-01-01

Substance P (SP) is involved in the pathogenesis of cough in animal models. However, few studies in humans have been reported and the roles of SP in clinical cough remain obscure. To clarify the relevance of plasma levels of SP in patients with persistent cough. We studied 82 patients with cough persisting for at least 3 weeks and 15 healthy controls. Patients were classified as having asthmatic cough (cough-variant asthma and cough-predominant asthma; n = 61) or nonasthmatic cough (n = 21; postinfectious cough, n = 6; gastroesophageal reflux disease, n = 5; idiopathic cough, n = 5, and others, n = 5). Correlations were evaluated between plasma SP levels as measured with ELISA and methacholine airway hyperresponsiveness (airway sensitivity and airway reactivity), capsaicin cough sensitivity, sputum eosinophil and neutrophil counts, and pulmonary function. Plasma SP levels were significantly elevated in patients with both asthmatic and nonasthmatic cough compared with controls [31.1 pg/ml (range 18.0-52.2) and 30.0 pg/ml (range 15.1-50.3) vs. 15.4 pg/ml (range 11.3-23.7); p = 0.003 and p = 0.038, respectively] but did not differ between the two patient groups (p = 0.90). Plasma SP levels correlated with airway sensitivity (threshold dose of methacholine) in the patients with asthmatic cough (r = -0.37, p = 0.005) but not with airway reactivity, cough sensitivity, FEV1 values, or sputum eosinophil and neutrophil counts in either group. Increased levels of SP in plasma are associated with persistent cough in humans and might be related to airway sensitivity in asthmatic cough. Copyright © 2011 S. Karger AG, Basel.

Cough and expiration reflexes elicited by inhaled irritant gases are intensified in ovalbumin-sensitized mice.

PubMed

Zhang, Cheng; Lin, Ruei-Lung; Hong, Jeff; Khosravi, Mehdi; Lee, Lu-Yuan

2017-05-01

This study was designed to determine the effect of active sensitization with ovalbumin (Ova) on cough responses to inhaled irritant gases in mice. Conscious mice moved freely in a recording chamber, while the pressure change in the chamber and audio and video signals of the mouse movements were recorded simultaneously to measure the frequencies of cough reflex (CR) and expiration reflex (ER). To further verify the accuracy of cough analysis, the intrapleural pressure was also recorded by a telemetry sensor surgically implanted in the intrapleural space in a subgroup of mice. During the irritant gas inhalation challenge, sulfur dioxide (SO 2 ; 200 and 400 ppm) or ammonia (NH 3 ; 0.1% and 0.2%) was drawn into the chamber at a constant flow rate for 8 min. Ova sensitization and sham sensitization with vehicle (Veh) were performed over a 25-day period in separate groups of mice. Our results showed that 1 ) both SO 2 and NH 3 inhalation challenges increased CR and ER frequencies in a concentration-dependent manner before Ova sensitization; 2 ) the baseline CR frequency was significantly elevated after Ova sensitization, accompanied by pronounced airway inflammation; and 3 ) Ova sensitization also markedly augmented the responses of CR and ER to both SO 2 and NH 3 inhalation challenges; in sharp contrast, the cough responses did not change after sham sensitization in the Veh group. In conclusion, Ova sensitization caused distinct and lingering increases in baseline cough frequency, and also intensified both CR and ER responses to inhaled irritant gases, which probably resulted from an allergic inflammation-induced hypersensitivity of airway sensory nerves. Copyright © 2017 the American Physiological Society.

Ayurvedic medicine in Mauritius: Profile of Ayurvedic outlet, use, sale, distribution, regulation and importation.

PubMed

Elaheebocus, Naailah; Mahomoodally, M Fawzi

2017-02-02

Ayurvedic medicine (AM) is a legalised alternative traditional medical system in the multicultural tropical island of Mauritius. A panoply of Ayurvedic specialised shops/centres involved in the provision of Ayurvedic services hereafter termed as 'outlets' operates in different regions of the island and is extensively exploited by a significant number of Mauritians. Nonetheless, there is currently no study geared towards studying the status of AM and profile of Ayurvedic outlets in Mauritius and there is undoubtedly a dearth of standardized regulatory framework governing the practice of AM in Mauritius. The present study attempts to study the profile of Ayurvedic outlets, sale, distribution, regulation and importation of AM in Mauritius. To evaluate the characteristics profile of Ayurvedic shops/clinics/pharmacies/centres, to document common Ayurvedic products used in the treatment and management of diseases, and to analyse existing regulatory control of AM in Mauritius. Ayurvedic outlets were identified using a random approach. Once permission granted, outlets were visited where face-to-face interviews with Ayurvedic practitioners/directors/dispensers were undertaken using a semi-structured questionnaire. The characteristics of the outlets with respect to the type of business registration, procurement and dispensing of products, registration and qualification of personnels employed amongst others were studied. The International Classification of Diseases (ICD) 10 was used to classify common AM dispensed to patients. Additionally, information was sought from local authorities pertaining to existing legislation governing the importation and regulation of AM in Mauritius. A total of 16 Ayurvedic outlets ('pharmacies' (n=3), clinics (n=2), shops (n=5) and centres (n=6)) was surveyed. Six outlets dispensed AM strictly on prescription only after consultation with an onsite full-time employed registered Ayurvedic practitioner. Seven outlets offered AM both on prescription and over-the-counter where consultation was not mandatory. The remaining three outlets, where no Ayurvedic practitioner was employed, did not offer consultation at any time and dispensed the medicines over-the-counter most of the time. There is currently no such legal framework that acknowledges the existence of an Ayurvedic pharmacy in Mauritius and no trained Ayurvedic pharmacist was recruited in any of the outlets. It was also found that no specific requirements were in place to establish an Ayurvedic outlet in Mauritius. A wide variety of Ayurvedic formulated and single herb products were recorded to be in use against common diseases. Ayurvedic products were imported from India (n=10), purchased from local suppliers (n=6) or locally manufactured (n=1). The Traditional Medicine Board under the aegis of the pharmacy board is a regulatory body which requires Ayurvedic practitioners to be registered so as to practice AM in Mauritius. Additionally, the government has an Ayurvedic committee, under the aegis of the Pharmacy board in the Ministry of Health and Quality of Life to monitor the importation of AM. However, no legal framework has been enacted to regulate the sale of AM under prescription or under the supervision of an Ayurvedic practitioner. The current regulatory framework is such that the sale/use/distribution of AM is not strictly controlled unlike its importation. This has led to a certain form of unregulated practice in the private sector whereby the dispensing and sale of AM are being done over-the-counter without professional recommendations. It is recommended that authorities need to regulate the Ayurvedic medical system in Mauritius by amending stringent laws to ensure safety of patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Cough in the Elderly Population: Relationships with Multiple Comorbidity

PubMed Central

Song, Woo-Jung; Morice, Alyn H.; Kim, Min-Hye; Lee, Seung-Eun; Jo, Eun-Jung; Lee, Sang-Min; Han, Ji-Won; Kim, Tae Hui; Kim, Sae-Hoon; Jang, Hak-Chul; Kim, Ki Woong; Cho, Sang-Heon; Min, Kyung-Up; Chang, Yoon-Seok

2013-01-01

Background The epidemiology of cough in the elderly population has not been studied comprehensively. The present study aimed to investigate the epidemiology of cough in a community elderly population, particularly in relation with their comorbidity. Methods A cross-sectional analysis was performed using a baseline dataset from the Korean Longitudinal Study on Health and Aging, a community-based elderly population cohort study. Three types of cough (frequent cough, chronic persistent cough, and nocturnal cough) were defined using questionnaires. Comorbidity was examined using a structured questionnaire. Health-related quality of life was assessed using the Short Form 36 questionnaire. Results The prevalence was 9.3% for frequent cough, 4.6% for chronic persistent cough, and 7.3% for nocturnal cough. In multivariate logistic regression analyses, smoking, asthma and allergic rhinitis were found to be risk factors for cough in the elderly. Interestingly, among comorbidities, constipation and uncontrolled diabetes mellitus (HbA1c ≥ 8%) were also found to have positive associations with elderly cough. In the Short Form 36 scores, chronic persistent cough was independently related to impairment of quality of life, predominantly in the mental component. Conclusions Cough has a high prevalence and is detrimental to quality of life in the elderly. Associations with smoking, asthma and rhinitis confirmed previous findings in younger populations. Previously unrecognised relationships with constipation and uncontrolled diabetes mellitus suggested the multi-faceted nature of cough in the elderly. PMID:24205100

21 CFR 350.1 - Scope.

Code of Federal Regulations, 2011 CFR

2011-04-01

... ANTIPERSPIRANT DRUG PRODUCTS FOR OVER-THE-COUNTER HUMAN USE General Provisions § 350.1 Scope. (a) An over-the-counter antiperspirant drug product in a form suitable for topical administration is generally recognized...

21 CFR 350.1 - Scope.

Code of Federal Regulations, 2014 CFR

2014-04-01

... ANTIPERSPIRANT DRUG PRODUCTS FOR OVER-THE-COUNTER HUMAN USE General Provisions § 350.1 Scope. (a) An over-the-counter antiperspirant drug product in a form suitable for topical administration is generally recognized...

21 CFR 350.1 - Scope.

Code of Federal Regulations, 2013 CFR

2013-04-01

... ANTIPERSPIRANT DRUG PRODUCTS FOR OVER-THE-COUNTER HUMAN USE General Provisions § 350.1 Scope. (a) An over-the-counter antiperspirant drug product in a form suitable for topical administration is generally recognized...

21 CFR 350.1 - Scope.

Code of Federal Regulations, 2012 CFR

2012-04-01

... ANTIPERSPIRANT DRUG PRODUCTS FOR OVER-THE-COUNTER HUMAN USE General Provisions § 350.1 Scope. (a) An over-the-counter antiperspirant drug product in a form suitable for topical administration is generally recognized...

21 CFR 350.1 - Scope.

Code of Federal Regulations, 2010 CFR

2010-04-01

... ANTIPERSPIRANT DRUG PRODUCTS FOR OVER-THE-COUNTER HUMAN USE General Provisions § 350.1 Scope. (a) An over-the-counter antiperspirant drug product in a form suitable for topical administration is generally recognized...

Assessing patients' attitudes towards dietary supplements.

PubMed

Wierzejska, Regina; Jarosz, Mirosław; Siuba, Magdalena; Rambuszek, Michał

2014-01-01

There is currently many over the counter products on the market that exert nutritional or physiological effects on the human body. The differences between dietary supplements and non-prescription drugs are however poorly understood by the average consumer and may thus affect their expectations as to the desired effect produced on the body. To evaluate patients' knowledge and attitudes towards dietary supplements as compared to non-prescription drugs. Subjects were 335 patients of the Mazowiecki Voivodeship Hospital in Warsaw, Poland. The data were collected from a face-to-face interview using a single and multiple choice questionnaire with 10 questions on dietary supplements. Statistical analysis used the Chi-square (χ2) test. The majority of respondents were found to be familiar with the term 'dietary supplements', but had difficulties in classifying these products into appropriate categories. Over 55% do not consider dietary supplements to be foodstuffs and more than 40% considered such products to be drugs. Most respondents thought that the main purpose of taking dietary supplements is to improve nutrition, but over one third expected them to also treat disease. Over 70% declared taking notice to which category the non-prescription products they bought belongs to ie. whether non-prescription drugs (medicinal products) or dietary supplements. Many patients mistakenly believe that dietary supplements are drugs and can be used to treat disease and health disorders. dietary supplements, opinion on dietary supplements, nutrition, dietary supplement vs. medicinal product.

Diagnosis and treatment of chronic cough in China: an insight into the status quo

PubMed Central

2012-01-01

Chronic cough is a very common complaint in clinics throughout China. Clinical and basic science research on chronic cough started late, but in recent years the effort has yielded promising findings regarding the etiological diagnosis, treatment and pathogenesis. We found that inflammation in nonasthmatic eosinophilic bronchitis has some similarities to cough variant asthma but also a number of distinct differences. Recent evidence has also suggested a mechanistic link between airway neurogenic inflammation and and gastroesophageal reflux cough (GERC). Cough-related animal models have been developed, including models for esophageal reflux, nonasthmatic eosinophilic bronchitis and allergic rhinitis. Normal reference values for differential cell counts in induced sputum, cough sensitivity and esophageal 24-h pH monitoring in Chinese healthy subjects have been established. By using a modified algorithm for the etiological diagnosis of chronic cough, the causes of chronic cough have been investigated across a number of cities in China. The most common causes of chronic cough are cough variant asthma, eosinophilic bronchitis, upper airway cough symptoms, atopic cough and GERC, however, there are some regional variations. The Chinese National Guidelines on Diagnosis and Management of Chronic Cough were drafted in 2005, updated in 2009, and have been widely publicized and disseminated through many channels since their publication. PMID:22839528

"This body does not want free medicines": South African consumer perceptions of drug quality.

PubMed

Patel, Aarti; Gauld, Robin; Norris, Pauline; Rades, Thomas

2010-01-01

OBJECTIVES Like many other developing countries, South Africa provides free medicines through its public health care facilities. Recent policies encourage generic substitution in the private sector. This study explored South African consumer perceptions of drug quality and whether these perceptions influenced how people procured and used their medicines. METHODS The study was undertaken in Durban, Cape Town and Johannesburg in South Africa between December 2005 and January 2006. A combination of purposive and snowball sampling was used to recruit participants from low and middle socio-economic groups as well as the elderly and teenagers. Data were collected through 12 focus group discussions involving a total of 73 participants. Interviews were tape-recorded. Thematic analysis was performed on the transcripts. RESULTS Irrespective of socio-economic status, respondents described medicine quality in terms of the effect the medicine produced on felt symptoms. Generic medicines, as well as medicines supplied without charge by the state, were considered to be poor quality and treated with suspicion. Respondents obtained medicines from three sources: public sector hospitals and/or clinics, dispensing doctors and community pharmacies. Cost, avoidance of feeling 'second-class', receiving individualized care and choice in drug selection were the main determinants influencing their procurement behaviour. Selection of over-the-counter medicines was influenced by prior knowledge of products, through advertising and previous use. Participants perceived that they had limited influence on selection of prescription medicines. Generic substitution would be supported if the doctor, rather than the pharmacist, recommended it. CONCLUSIONS Our findings emphasize the importance of meaningful consumer involvement in the development of national medicines policies, and strategic campaigns targeting consumers and prescribers regarding the quality of generic and essential medicines. Where consumers perceive free or generic medicines as inferior, this could significantly undermine attempts to implement national medicines policies aimed to improve access to medicines.

21 CFR 333.101 - Scope.

Code of Federal Regulations, 2010 CFR

2010-04-01

... TOPICAL ANTIMICROBIAL DRUG PRODUCTS FOR OVER-THE-COUNTER HUMAN USE First Aid Antibiotic Drug Products § 333.101 Scope. (a) An over-the-counter first aid antibiotic drug product in a form suitable for...

Treatment of Neurogenic Cough with Tramadol: A Pilot Study.

PubMed

Dion, Gregory R; Teng, Stephanie E; Achlatis, Efstratios; Fang, Yixin; Amin, Milan R

2017-07-01

This study employs validated cough assessment tools to prospectively determine the impact of tramadol on cough severity and quality of life in subjects with neurogenic cough. The study was a prospective case series with planned data collection at a tertiary care academic medical center laryngology practice. Sixteen consecutive collected subjects with neurogenic cough prospectively completed pre- and posttreatment validated cough assessment tools, the cough severity index (CSI) and Leicester Cough Questionnaire (LCQ). All subjects in the study reported at least some improvement in their cough symptoms. In a Wilcoxon signed rank test that compared paired results, CSI scores improved from 23 to 14 and LCQ scores improved from 74 to 103 ( P = .003 and P = .005, respectively). This small preliminary assessment suggests that tramadol warrants additional evaluation as a treatment for neurogenic cough.

Chronic Cough and OSA: A New Association?

PubMed Central

Sundar, Krishna M.; Daly, Sarah E.

2011-01-01

Chronic cough is defined as cough lasting more than 2 months. Common causes for chronic cough in nonsmokers with normal chest radiographs and pulmonary functions include gastroesophageal reflux disease (GERD), cough-variant asthma (CVA), and upper airway cough syndrome (UACS). Current guidelines recommend diagnosing the etiology of chronic cough based upon the results of therapy for suspected GERD, CVA, and UACS. Despite following current recommendations for diagnosis and treatment, the cause for a significant proportion of chronic cough remains unexplained. Recent reports indicate the resolution of chronic cough following treatment of concomitantly diagnosed obstructive sleep apnea (OSA). Whether this represents a co-occurrence of two commonly prevalent disorders or a pathophysiologic relationship between OSA and cough remains unknown. This review offers insights into a pathophysiologic link between OSA and the commonly purported etiologies for cough, namely, GERD, UACS, and CVA. In addition, evidence for a relationship between airway inflammation that can trigger or perpetuate cough and OSA is discussed. This review explores mechanisms by which nocturnal continuous positive airway therapy resolves cough by improving underlying airway inflammation secondary to OSA and impacts upon GERD, CVA, and UACS. Citation: Sundar KM; Daly SE. Chronic cough and OSA: a new association? J Clin Sleep Med 2011;7(6):669-677. PMID:22171209

Biological activity of common mullein, a medicinal plant.

PubMed

Turker, Arzu Ucar; Camper, N D

2002-10-01

Common Mullein (Verbascum thapsus L., Scrophulariaceae) is a medicinal plant that has been used for the treatment of inflammatory diseases, asthma, spasmodic coughs, diarrhea and other pulmonary problems. The objective of this study was to assess the biological activity of Common Mullein extracts and commercial Mullein products using selected bench top bioassays, including antibacterial, antitumor, and two toxicity assays--brine shrimp and radish seed. Extracts were prepared in water, ethanol and methanol. Antibacterial activity (especially the water extract) was observed with Klebsiella pneumonia, Staphylococcus aureus, Staphylococcus epidermidis and Escherichia coli. Agrobacterium tumefaciens-induced tumors in potato disc tissue were inhibited by all extracts. Toxicity to Brine Shrimp and to radish seed germination and growth was observed at higher concentrations of the extracts.

[Summary of Hui prescriptions for treating cough].

PubMed

Zhang, Wen-jin; Liu, Yue; Zhang, Xin-hui

2015-02-01

In this study, by using the method of literature research, 35 prescriptions related to asthma therapy has been screened out from Hui medicine through collecting the ancient and modern literature. A comparison of fragrant medicine between the name in Arab and Chinese herbal medicine is done. The countif function in Microsoft Excel 2007 is used to get the prescriptions of the drug on the frequency statistics, summarizing the common drugs of Hui medicine for asthma are Pinellia, almond, white sugar, walnut. According to the commonly used drugs, the pathogeny and treatment principle about Hui medicine for asthma is preliminarily inferred combining literature research and the related Hui medical theory. In this study, those prescriptions have been classified into 21 cases which are effective and can be used in medical therapy according to the relevant literatures with the development of the Hui people in their long process of formation of the unique diet culture, 14 useful and convenient Halal diet therapies are made up according to the indications, therapies, party name and composition. Halal diet and "medicine and food" herbs are preliminarily analyzed and summarized, which can be convenient for the people to reduce pains through the diet and improve health awareness.

Assembling cyavanaprāsh, Ayurveda's best-selling medicine.

PubMed

Bode, Maarten

2015-04-01

The paper discusses the many forms and representations of cyavanaprāsh, Ayurveda's best-selling medicine, already mentioned in Caraka's Compendium (c. 200 CE). The medicine's compositions, applications, and meanings, change over time and from locality to locality. Cyavanaprāsh is, for example, a patriotic formula, a booster of the immune system, a modern geriatric drug, and one of the elements in canonical Ayurvedic treatments. In the beginning of the 19th century cyavanaprāsh was a patriotic formula for fortifying Indian bodies and the nascent Indian nation. Nowadays the medicine is a Fast Moving Consumer Good (FMCG) and a money maker for Dabur India Ltd., the world largest Ayurvedic manufacturer. Instead of vitalising the nation its consumption now promises to make urban middle class consumers effectively modern. Branding and modern science must make Dabur Chyawanprash attractive in the eyes of these consumers. Ayurveda and cyavanaprāsh are also part of a global counter culture marked by neo-Orientalism and Ayurvedic medicines as facilitators of spirituality. The marketing of cyavanaprāsh by India's largest Ayurvedic manufacturer is used as a case study for discussing the proliferation of Ayurvedic brands and its critics. The imaging of Ayurvedic brands such as Dabur Chyawanprash threatens to obscure the fact that Ayurveda represents a unique way of looking upon health, disease and the human body. The proliferation of brands also makes Ayurvedic medicines more expensive and puts pressure on the natural environment as the main supplier of Ayurvedic ingredients.

Establishing a gold standard for manual cough counting: video versus digital audio recordings

PubMed Central

Smith, Jaclyn A; Earis, John E; Woodcock, Ashley A

2006-01-01

Background Manual cough counting is time-consuming and laborious; however it is the standard to which automated cough monitoring devices must be compared. We have compared manual cough counting from video recordings with manual cough counting from digital audio recordings. Methods We studied 8 patients with chronic cough, overnight in laboratory conditions (diagnoses were 5 asthma, 1 rhinitis, 1 gastro-oesophageal reflux disease and 1 idiopathic cough). Coughs were recorded simultaneously using a video camera with infrared lighting and digital sound recording. The numbers of coughs in each 8 hour recording were counted manually, by a trained observer, in real time from the video recordings and using audio-editing software from the digital sound recordings. Results The median cough frequency was 17.8 (IQR 5.9–28.7) cough sounds per hour in the video recordings and 17.7 (6.0–29.4) coughs per hour in the digital sound recordings. There was excellent agreement between the video and digital audio cough rates; mean difference of -0.3 coughs per hour (SD ± 0.6), 95% limits of agreement -1.5 to +0.9 coughs per hour. Video recordings had poorer sound quality even in controlled conditions and can only be analysed in real time (8 hours per recording). Digital sound recordings required 2–4 hours of analysis per recording. Conclusion Manual counting of cough sounds from digital audio recordings has excellent agreement with simultaneous video recordings in laboratory conditions. We suggest that ambulatory digital audio recording is therefore ideal for validating future cough monitoring devices, as this as this can be performed in the patients own environment. PMID:16887019

Survey on attitudes of Italian pediatricians toward cough

PubMed Central

Zanasi, Alessandro; Morcaldi, Luigi; Cazzato, Salvatore; Mazzolini, Massimiliano; Lecchi, Marzia; Morselli-Labate, Antonio Maria; Mastroroberto, Marianna; Dal Negro, Roberto W

2017-01-01

Context Children’s cough is a daily concern for most pediatricians. The management of both acute and chronic cough requires a systematic and comprehensive approach. Despite the approved protocols for management, the pediatric assessment of cough and the corresponding prescribing attitude frequently do not fit these protocols, which can be affected by parental suggestions – sometimes substantially. Objective The objective of this study was to investigate both the perception and the behavior of a representative sample of Italian pediatricians toward cough in real life. Methods A specific questionnaire consisting of 18 questions was prepared. The questionnaire was completed by 300 pediatricians (all members of PAIDOSS: Italian National Observatory on Health of Childhood and Adolescence) who represented ~300,000 children. Results A vast majority of children have cough throughout the year (99.3% of respondents have cough during autumn/winter and 64.7% in spring/summer). Allergic disease is the most frequent suspected cause of chronic cough in children (53%), and this is supported by the high demand for consultations: 73% seek the opinion of allergologists, 62% of otorhinolaryngologists and only 33% of pulmonologists. The majority of pediatricians (92%) reported that they prescribe therapy in acute cough regardless of cough guidelines. Moreover, the survey pointed out the abuse of aerosol therapy (26% in acute cough and 38% in chronic cough) and of antibiotics prescription (22% in acute cough and 42% in chronic cough). Conclusion Our survey suggests that some Italian pediatricians’ therapeutic attitudes should be substantially improved in order to achieve better management of cough in children and to minimize the burden of cough. PMID:28352199

21 CFR 333.301 - Scope.

Code of Federal Regulations, 2014 CFR

2014-04-01

... TOPICAL ANTIMICROBIAL DRUG PRODUCTS FOR OVER-THE-COUNTER HUMAN USE Topical Acne Drug Products § 333.301 Scope. (a) An over-the-counter acne drug product in a form suitable for topical application is generally...

21 CFR 333.301 - Scope.

Code of Federal Regulations, 2013 CFR

2013-04-01

... TOPICAL ANTIMICROBIAL DRUG PRODUCTS FOR OVER-THE-COUNTER HUMAN USE Topical Acne Drug Products § 333.301 Scope. (a) An over-the-counter acne drug product in a form suitable for topical application is generally...

21 CFR 333.301 - Scope.

Code of Federal Regulations, 2012 CFR

2012-04-01

... TOPICAL ANTIMICROBIAL DRUG PRODUCTS FOR OVER-THE-COUNTER HUMAN USE Topical Acne Drug Products § 333.301 Scope. (a) An over-the-counter acne drug product in a form suitable for topical application is generally...

21 CFR 357.801 - Scope.

Code of Federal Regulations, 2013 CFR

2013-04-01

... MISCELLANEOUS INTERNAL DRUG PRODUCTS FOR OVER-THE-COUNTER HUMAN USE Deodorant Drug Products for Internal Use § 357.801 Scope. (a) An over-the-counter deodorant drug product for internal use in a form suitable for...

21 CFR 357.801 - Scope.

Code of Federal Regulations, 2010 CFR

2010-04-01

... MISCELLANEOUS INTERNAL DRUG PRODUCTS FOR OVER-THE-COUNTER HUMAN USE Deodorant Drug Products for Internal Use § 357.801 Scope. (a) An over-the-counter deodorant drug product for internal use in a form suitable for...

21 CFR 357.801 - Scope.

Code of Federal Regulations, 2012 CFR

2012-04-01

... MISCELLANEOUS INTERNAL DRUG PRODUCTS FOR OVER-THE-COUNTER HUMAN USE Deodorant Drug Products for Internal Use § 357.801 Scope. (a) An over-the-counter deodorant drug product for internal use in a form suitable for...

21 CFR 357.801 - Scope.

Code of Federal Regulations, 2011 CFR

2011-04-01

... MISCELLANEOUS INTERNAL DRUG PRODUCTS FOR OVER-THE-COUNTER HUMAN USE Deodorant Drug Products for Internal Use § 357.801 Scope. (a) An over-the-counter deodorant drug product for internal use in a form suitable for...

21 CFR 357.801 - Scope.

Code of Federal Regulations, 2014 CFR

2014-04-01

... MISCELLANEOUS INTERNAL DRUG PRODUCTS FOR OVER-THE-COUNTER HUMAN USE Deodorant Drug Products for Internal Use § 357.801 Scope. (a) An over-the-counter deodorant drug product for internal use in a form suitable for...

21 CFR 338.1 - Scope.

Code of Federal Regulations, 2012 CFR

2012-04-01

... SLEEP-AID DRUG PRODUCTS FOR OVER-THE-COUNTER HUMAN USE General Provisions § 338.1 Scope. (a) An over-the-counter nighttime sleep-aid drug product in a form suitable for oral administration is generally...

21 CFR 338.1 - Scope.

Code of Federal Regulations, 2014 CFR

2014-04-01

... SLEEP-AID DRUG PRODUCTS FOR OVER-THE-COUNTER HUMAN USE General Provisions § 338.1 Scope. (a) An over-the-counter nighttime sleep-aid drug product in a form suitable for oral administration is generally...

21 CFR 338.1 - Scope.

Code of Federal Regulations, 2010 CFR

2010-04-01

... SLEEP-AID DRUG PRODUCTS FOR OVER-THE-COUNTER HUMAN USE General Provisions § 338.1 Scope. (a) An over-the-counter nighttime sleep-aid drug product in a form suitable for oral administration is generally...

21 CFR 338.1 - Scope.

Code of Federal Regulations, 2011 CFR

2011-04-01

... SLEEP-AID DRUG PRODUCTS FOR OVER-THE-COUNTER HUMAN USE General Provisions § 338.1 Scope. (a) An over-the-counter nighttime sleep-aid drug product in a form suitable for oral administration is generally...

21 CFR 338.1 - Scope.

Code of Federal Regulations, 2013 CFR

2013-04-01

... SLEEP-AID DRUG PRODUCTS FOR OVER-THE-COUNTER HUMAN USE General Provisions § 338.1 Scope. (a) An over-the-counter nighttime sleep-aid drug product in a form suitable for oral administration is generally...

21 CFR 333.301 - Scope.

Code of Federal Regulations, 2011 CFR

2011-04-01

... TOPICAL ANTIMICROBIAL DRUG PRODUCTS FOR OVER-THE-COUNTER HUMAN USE Topical Acne Drug Products § 333.301 Scope. (a) An over-the-counter acne drug product in a form suitable for topical application is generally...

21 CFR 333.301 - Scope.

Code of Federal Regulations, 2010 CFR

2010-04-01

... TOPICAL ANTIMICROBIAL DRUG PRODUCTS FOR OVER-THE-COUNTER HUMAN USE Topical Acne Drug Products § 333.301 Scope. (a) An over-the-counter acne drug product in a form suitable for topical application is generally...

Cough during infancy and subsequent childhood asthma.

PubMed

Oren, E; Rothers, J; Stern, D A; Morgan, W J; Halonen, M; Wright, A L

2015-09-01

Wheezing in infancy has been associated with subsequent asthma, but whether cough similarly influences asthma risk has been little studied. We sought to determine whether prolonged cough and cough without cold in the first year of life are associated with childhood asthma. Participants in the Infant Immune Study, a non-selected birth cohort, were surveyed 7 times in the first 9 months of life regarding the presence of wheeze and cough. Cough for more than 28 days was defined as prolonged. Parents were asked at 1 year if the child ever coughed without a cold. Asthma was defined as parental report of physician diagnosis of asthma, with symptoms or medication use between 2 and 9 years. Logistic regression was used to assess adjusted odds for asthma associated with cough characteristics. A total of 24% (97) of children experienced prolonged cough and 23% (95) cough without cold in the first 9 months, respectively. Prolonged cough was associated with increased risk of asthma relative to brief cough (OR 3.57, CI: 1.88, 6.76), with the risk being particularly high among children of asthmatic mothers. Cough without cold (OR 3.13, 95% CI: 1.76, 5.57) was also independently associated with risk of childhood asthma. Both relations persisted after adjustment for wheeze and total IgE at age 1. Prolonged cough in infancy and cough without cold are associated with childhood asthma, independent of infant wheeze. These findings suggest that characteristics of cough in infancy are early markers of asthma susceptibility, particularly among children with maternal asthma. © 2015 John Wiley & Sons Ltd.

Cough During Infancy and Subsequent Childhood Asthma

PubMed Central

Oren, Eyal; Rothers, Janet; Stern, Debra A.; Morgan, Wayne J.; Halonen, Marilyn; Wright, Anne L.

2015-01-01

OBJECTIVES Wheezing in infancy has been associated with subsequent asthma, but whether cough similarly influences asthma risk has been little studied. We sought to determine whether prolonged cough and cough without cold in the first year of life are associated with childhood asthma. METHODS Participants in the Infant Immune Study, a non-selected birth cohort, were surveyed 7 times in the first 9 months of life regarding presence of wheeze and cough. Cough for more than 28 days was defined as prolonged. Parents were asked at 1 year if the child ever coughed without a cold. Asthma was defined as parental report of physician diagnosis of asthma, with symptoms or medication use between 2–9 years. Logistic regression was used to assess adjusted odds for asthma associated with cough characteristics. RESULTS 24% (97) of children experienced prolonged cough and 23% (95) cough without cold in the first 9 months, respectively. Prolonged cough was associated with increased risk of asthma relative to brief cough (OR 3.57, CI: 1.88, 6.76), with the risk being particularly high among children of asthmatic mothers. Cough without cold (OR 3.13, 95% CI: 1.76, 5.57) was also independently associated with risk of childhood asthma. Both relations persisted after adjustment for wheeze and total IgE at age 1. CONCLUSIONS AND CLINICAL RELEVANCE Prolonged cough in infancy and cough without cold are associated with childhood asthma, independent of infant wheeze. These findings suggest that characteristics of cough in infancy are early markers of asthma susceptibility, particularly among children with maternal asthma. PMID:26011047

Evaluation of medicines dispensing pattern of private pharmacies in Rajshahi, Bangladesh.

PubMed

Saha, Shuvashis; Hossain, Md Tawhid

2017-02-13

In developing country like BANGLADESH, people depend more on pharmacies due to expediency, shorter waiting time, cost reduction, availability of credit and flexible opening hours. The aim of this study was to investigate medicines dispensing patterns of the pharmacies in RAJSHAHI, BANGLADESH and to identify and analyze contribution of drugsellers and quacks in irrational drug use. This cross-sectional study was conducted during January 2016 - April, 2016 in 75 randomly selected private pharmacies including both licensed and unlicensed pharmacies of covering LAKSHMIPUR area. During the whole study process, total 7944 clients visited the pharmacies under observation and 24,717 medicines were dispensed. 22.70% of all these drugs were sold without a prescription. Out of the 5610 items dispensed without prescription, 66.2% were dispensed on the request of clients themselves and 33.8% on the recommendation of a drug seller. Number of medicine in a prescription was highly variable ranging from 2 to 5 medicines per prescriptions (mean = 3.03). The average number of medicines dispensed from each of the pharmacies during the observation period was 392, varied pharmacy to pharmacy - ranging from 194 to 588. Lowest selling medicines were sedative and hypnotics and highest selling medicines were antimicrobials. The recommendation rate for antibiotics was highest for the quacks (26.48%) though the major amount of the antimicrobials (n = 3039, 65.83%) were dispensed on prescription. Macrolides, quinolones, metronidazoles and cephalosporins are most favourite drug of quacks, clients and pharmacists. Majority of medicines were dispensed irrationally without any prescription and over the counter dispensing of many low safety profile drugs was common. The results and discussion presented in this paper will be helpful to provide a baseline to redirect further studies in this area.

Perception of community pharmacists toward their current professional role in the healthcare system of Dubai, United Arab Emirates.

PubMed

Rayes, Ibrahim Khalid; Hassali, Mohamed Azmi; Abduelkarem, Abduelmula R

2015-07-01

The new paradigm to pharmacy profession has changed the focus of pharmacists from product-centered to patient-oriented. This change has brought new set of beliefs and assumptions on the way services should be delivered to pharmacy clients. The main aim of this study was to explore the perception of community pharmacists on their current professional role in Dubai. Key findings show that community pharmacists are more directed toward business than patients. They almost dispense all categories of medicines over-the-counter without the need of prescriptions. However, a new trend of pharmacists in Dubai is to provide enhanced pharmacy services such as consultation to patients upon request.

Voluntary upregulation of reflex cough is possible in healthy older adults and Parkinson's disease.

PubMed

Brandimore, Alexandra E; Hegland, Karen W; Okun, Michael S; Davenport, Paul W; Troche, Michelle S

2017-07-01

Cough is an airway-protective mechanism that serves to detect and forcefully eject aspirate material. Existing research has identified the ability of healthy young adults to suppress or modify cough motor output based on external cueing. However, no study has evaluated the ability of people with Parkinson's disease (PD) and healthy older adults (HOAs) to upregulate cough motor output. The goal of this study was to evaluate the ability of people with PD and healthy age-matched controls (HOAs) to upregulate reflex and voluntary cough function volitionally with verbal instruction and visual biofeedback of airflow targets. Sixteen participants with PD and twenty-eight HOAs (56-83 yr old) were recruited for this study. Experimental procedures used spirometry to evaluate 1 ) baseline reflex cough (evoked with capsaicin) and voluntary sequential cough and 2 ) reflex and voluntary cough with upregulation biofeedback. Cough airflow was recorded and repeated-measures ANOVA was used to analyze differences in cough airflow parameters. Cough peak expiratory airflow rate and cough expired volume were significantly greater in the cueing condition for both induced reflex ( P < 0.001) and voluntary cough ( P < 0.001) compared with baseline measures. This is the first study to demonstrate the ability of people with PD and HOAs to upregulate induced reflex and voluntary cough motor output volitionally. These results support the development of studies targeting improved cough effectiveness in patients with airway-protective deficits. NEW & NOTEWORTHY Aspiration pneumonia is a leading cause of death in Parkinson's disease (PD) and results from concurrent dysphagia and dystussia (cough dysfunction). This is the first study to demonstrate that people with PD and healthy age-matched controls can volitionally upregulate induced reflex and voluntary cough effectiveness when presented with novel cueing strategies. Thus targeting upregulation of cough effectiveness via biofeedback may be a viable way to enhance airway protection in people with PD. Copyright © 2017 the American Physiological Society.

Factors associated with polypharmacy and excessive polypharmacy in older people with intellectual disability differ from the general population: a cross-sectional observational nationwide study.

PubMed

O'Dwyer, Máire; Peklar, Jure; McCallion, Philip; McCarron, Mary; Henman, Martin C

2016-04-04

(1) To evaluate the prevalence of polypharmacy (5-9 medicines) and excessive polypharmacy (10+ medicines) and (2) to determine associated demographic and clinical characteristics in an ageing population with intellectual disabilities (IDs). Observational cross-sectional study. Wave One (2009/2010) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). A nationally representative sample of 753 persons with ID, aged between 41 and 90 years. Participants/proxy reported medicines (prescription and over the counter) taken on a regular basis; medication data was available for 736 participants (98%). Participants were divided into those with no polypharmacy (0-4 medicines), polypharmacy (5-9 medicines) and excessive polypharmacy (10+ medicines). Medication use patterns were analysed according to demographic variables and reported chronic conditions. A multinomial logistic regression model identified factors associated with polypharmacy (5-9 medicines) and excessive polypharmacy (≥10 medicines). Overall, 90% of participants reported use of medicines. Polypharmacy was observed in 31.5% of participants and excessive polypharmacy in 20.1%. Living in a residential institution, and reporting a mental health or neurological condition were strongly associated with polypharmacy and excessive polypharmacy after adjusting for confounders, but age or gender had no significant effect. Polypharmacy was commonplace for older adults with ID and may be partly explained by the high prevalence of multimorbidity reported. Review of appropriateness of medication use is essential, as polypharmacy places ageing people with ID at risk of adverse effects. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Semantics and types of cough

PubMed Central

Chung, Kian Fan; Bolser, Don; Davenport, Paul; Fontana, Giovanni; Morice, Alyn; Widdicombe, John

2010-01-01

The panel considered the different types of cough in terms of basic mechanisms and clinical manifestations; both experimentally and clinically cough could occur in single efforts and as ‘bouts’ or ‘epochs’. There were different definitions of cough but, provided the definition used was clear, this did not seem to be a major concern. The methods available for determining the nature or type of clinical cough were discussed, in particular automated cough counting in the clinic and more sophisticated methods available in the laboratory. With regard to semantics, there has been great variation in the names used; this applies to nervous sensors for cough, to cough reflexes and epochs, to clinical names for cough, and to cough sounds. Some simplification and uniformity of nomenclature seemed desirable although, provided the use of a name was clear, little confusion probably existed. The panel felt that the cough nomenclature would evolve with time and would prove to be useful for investigators, clinicians and coughers. PMID:19136069

XEN-D0501, a Novel Transient Receptor Potential Vanilloid 1 Antagonist, Does Not Reduce Cough in Patients with Refractory Cough.

PubMed

Belvisi, Maria G; Birrell, Mark A; Wortley, Michael A; Maher, Sarah A; Satia, Imran; Badri, Huda; Holt, Kimberley; Round, Patrick; McGarvey, Lorcan; Ford, John; Smith, Jaclyn A

2017-11-15

Heightened cough responses to inhaled capsaicin, a transient receptor potential vanilloid 1 (TRPV1) agonist, are characteristic of patients with chronic cough. However, previously, a TRPV1 antagonist (SB-705498) failed to improve spontaneous cough frequency in these patients, despite small reductions in capsaicin-evoked cough. XEN-D0501 (a potent TRPV1 antagonist) was compared with SB-705498 in preclinical studies to establish whether an improved efficacy profile would support a further clinical trial of XEN-D0501 in refractory chronic cough. XEN-D0501 and SB-705498 were profiled against capsaicin in a sensory nerve activation assay and in vivo potency established against capsaicin-induced cough in the guinea pig. Twenty patients with refractory chronic cough participated in a double-blind, randomized, placebo-controlled crossover study evaluating the effect of 14 days of XEN-D0501 (oral, 4 mg twice daily) versus placebo on awake cough frequency (primary outcome), capsaicin-evoked cough, and patient-reported outcomes. XEN-D0501 was more efficacious and 1,000-fold more potent than SB-705498 at inhibiting capsaicin-induced depolarization of guinea pig and human isolated vagus nerve. In vivo XEN-D0501 completely inhibited capsaicin-induced cough, whereas 100 times more SB-705498 was required to achieve the same effect. In patients, XEN-D0501 substantially reduced maximal cough responses to capsaicin (mean change from baseline, XEN-D0501, -19.3 ± 16.4) coughs; placebo, -1.8 ± 5.8 coughs; P < 0.0001), but not spontaneous awake cough frequency (mean change from baseline, XEN-D0501, 6.7  ± 16.9 coughs/h; placebo, 0.4 ± 13.7 coughs/h; P = 0.41). XEN-D0501 demonstrated superior efficacy and potency in preclinical and clinical capsaicin challenge studies; despite this improved pharmacodynamic profile, spontaneous cough frequency did not improve, ruling out TRPV1 as an effective therapeutic target for refractory cough. Clinical trial registered with www.clinicaltrialsregister.eu (2014-000306-36).

Prevalence of cough throughout childhood: A cohort study

PubMed Central

Ramette, Alban; Dogaru, Cristian M.; Goutaki, Myrofora; Spycher, Ben D.; Latzin, Philipp; Gaillard, Erol A.; Kuehni, Claudia E.

2017-01-01

Background Cough in children is a common reason for medical consultations and affects quality of life. There are little population-based data on the epidemiology of recurrent cough in children and how this varies by age and sex, or between children with and without wheeze. We determined the prevalence of cough throughout childhood, comparing several standardised cough questions. We did this for the entire population and separately for girls and boys, and for children with and without wheeze. Methods In a population-based prospective cohort from Leicestershire, UK, we assessed prevalence of cough with repeated questionnaires from early childhood to adolescence. We asked whether the child usually coughed more than other children, with or without colds, had night-time cough or cough triggered by various factors (triggers, related to increased breathing effort, allergic or food triggers). We calculated prevalence from age 1 to 18 years using generalised estimating equations for all children, and for children with and without wheeze. Results Of 7670 children, 10% (95% CI 10–11%) coughed more than other children, 69% (69–70%) coughed usually with a cold, 34% to 55% age-dependently coughed without colds, and 25% (25–26%) had night-time cough. Prevalence of coughing more than peers, with colds, at night, and triggered by laughter varied little throughout childhood, while cough without colds and cough triggered by exercise, house dust or pollen became more frequent with age. Cough was more common in boys than in girls in the first decade of life, differences got smaller in early teens and reversed after the age of 14 years. All symptoms were more frequent in children with wheeze. Conclusions Prevalence of cough in children varies with age, sex and with the questions used to assess it, suggesting that comparisons between studies are only valid for similar questions and age groups. PMID:28542270

Cough

MedlinePlus

... coughing helps your body heal or protect itself. Coughs can be either acute or chronic. Acute coughs begin suddenly and usually last no more than 2 to 3 weeks. Acute coughs are the kind you most often get with ...

Chronic Bronchitis

MedlinePlus

... bronchial tubes produce a lot of mucus. This leads to coughing and difficulty breathing. Cigarette smoking is the most common cause. Breathing in air pollution, fumes, or dust over a long period of ...

COUNTER Improvised Explosive Device (C-IED) Operations as an Element of Counter Insurgency (COIN): Balancing C-IED Efforts to Support Commander International Security Assistance Force (COMISAF) Operational Objectives

DTIC Science & Technology

2010-10-27

central to the enemy‟s operational design, defense and industry efforts to counter the IED with technology have been aggressive. The US has spent...and industry efforts to counter the IED with technology have been aggressive. The US has spent billions of dollars to mitigate the effects of IEDs...2001 has claimed the lives of over 1,700 United States and Coalition Force (CF) service men and women ; over six times that many have been wounded.1

Home Parenteral Nutrition (HPN) Complication Chart

MedlinePlus

... you start any over-the-counter medications or herbal supplements. Hypoglycemia Symptoms: Cause: Immediate Action: Prevention: Sweating; pale ... if taking any over-the-counter medications or herbal supplements. Special thanks to the editors of this chart: ...

Use of Management Pathways or Algorithms in Children With Chronic Cough: Systematic Reviews.

PubMed

Chang, Anne B; Oppenheimer, John J; Weinberger, Miles; Weir, Kelly; Rubin, Bruce K; Irwin, Richard S

2016-01-01

Use of appropriate cough pathways or algorithms may reduce the morbidity of chronic cough, lead to earlier diagnosis of chronic underlying illness, and reduce unnecessary costs and medications. We undertook three systematic reviews to examine three related key questions (KQ): In children aged ?14 years with chronic cough (> 4 weeks' duration), KQ1, do cough management protocols (or algorithms) improve clinical outcomes? KQ2, should the cough management or testing algorithm differ depending on the duration and/or severity? KQ3, should the cough management or testing algorithm differ depending on the associated characteristics of the cough and clinical history? We used the CHEST expert cough panel's protocol. Two authors screened searches and selected and extracted data. Only systematic reviews, randomized controlled trials (RCTs), and cohort studies published in English were included. Data were presented in Preferred Reporting Items for Systematic Reviews and Meta-analyses flowcharts and summary tabulated. Nine studies were included in KQ1 (RCT = 1; cohort studies = 7) and eight in KQ3 (RCT = 2; cohort = 6), but none in KQ2. There is high-quality evidence that in children aged ?14 years with chronic cough (> 4 weeks' duration), the use of cough management protocols (or algorithms) improves clinical outcomes and cough management or the testing algorithm should differ depending on the associated characteristics of the cough and clinical history. It remains uncertain whether the management or testing algorithm should depend on the duration or severity of chronic cough. Pending new data, chronic cough in children should be defined as > 4 weeks' duration and children should be systematically evaluated with treatment targeted to the underlying cause irrespective of the cough severity. Copyright © 2016 American College of Chest Physicians. All rights reserved.

21 CFR 358.501 - Scope.

Code of Federal Regulations, 2011 CFR

2011-04-01

... MISCELLANEOUS EXTERNAL DRUG PRODUCTS FOR OVER-THE-COUNTER HUMAN USE Corn and Callus Remover Drug Products § 358.501 Scope. (a) An over-the-counter corn and callus remover drug product in a form suitable for topical...

21 CFR 358.501 - Scope.

Code of Federal Regulations, 2010 CFR

2010-04-01

... MISCELLANEOUS EXTERNAL DRUG PRODUCTS FOR OVER-THE-COUNTER HUMAN USE Corn and Callus Remover Drug Products § 358.501 Scope. (a) An over-the-counter corn and callus remover drug product in a form suitable for topical...

Over the Counter & Complementary Therapies

MedlinePlus

... a Parkinson’s Foundation Center of Excellence. 0 ‹ Medical Marijuana up Exercise › Sample Title of Item (also a link) Treatment Prescription Medications Surgical Treatment Options Medical Marijuana Over the Counter & Complementary Therapies Exercise Clinical Trials ...

Summary of papers presented at the 2012 seventh international cough symposium

PubMed Central

2013-01-01

Twenty six papers were presented as posters in the Seventh International Symposium on Cough; 12 papers were presented in the Basic Science of Cough session, and 14 papers presented in the Clinical Science of Cough session. These papers explored a wide spectrum of cough-related areas including pathophysiological mechanisms, treatment and detection of cough, and symptom assessment and perception, and were grouped into several general themes for facilitate the discussion. Studies presented in these posters have provided new information that should improve our knowledge on the basic physiology and pharmacology of cough, and the peripheral and central neural mechanisms involved in the generation of the cough motor pattern. In addition, in the clinical science section, studies reporting potential new anti-tussive agents and further characterisation of cough symptoms and perception have provided a base for the fruitful strategies for the development of novel anti-tussive therapies and cough management. PMID:23639195

Consequences of low birth weight, maternal illiteracy and poor access to medical care in rural India: infantile iatrogenic Cushing syndrome.

PubMed

Karande, Sunil

2015-08-21

Home delivery, low birth weight babies and maternal illiteracy among the poor in rural India are frequent. The rural poor prefer to seek healthcare from private providers, most of whom have no formal medical training and buy medicines from private pharmacies without a prescription owing to a weakly regulated environment. This report is of a 4-month-old baby from a remote village in northern India, who presented with exogenous Cushing syndrome. This baby was a full-term low birth weight home delivery. As the baby was not growing well, treatment was started at 1 month by a private doctor with betamethasone drops The mother on her own volition continued giving the betamethasone drops by buying the medicine over the counter from a private pharmacy. This case highlights the gaps in essential health services in rural India and the steps being taken to improve the situation. 2015 BMJ Publishing Group Ltd.

Consequences of low birth weight, maternal illiteracy and poor access to medical care in rural India: infantile iatrogenic Cushing syndrome

PubMed Central

Karande, Sunil

2015-01-01

Home delivery, low birth weight babies and maternal illiteracy among the poor in rural India are frequent. The rural poor prefer to seek healthcare from private providers, most of whom have no formal medical training and buy medicines from private pharmacies without a prescription owing to a weakly regulated environment. This report is of a 4-month-old baby from a remote village in northern India, who presented with exogenous Cushing syndrome. This baby was a full-term low birth weight home delivery. As the baby was not growing well, treatment was started at 1 month by a private doctor with betamethasone drops The mother on her own volition continued giving the betamethasone drops by buying the medicine over the counter from a private pharmacy. This case highlights the gaps in essential health services in rural India and the steps being taken to improve the situation. PMID:26297767

The slippery difficulty of ever containing drug resistance with current practices.

PubMed

Fullybright, R

2017-04-01

It has previously been shown that the rate of drug resistance emergence in medicine is exponential, while we have been producing drugs at a much lower rate. Our ability to successfully contain resistance at any one time is function of how many drugs we have at our disposal to counter new resistances from pathogens. Here, we assess our level of preparedness through a mathematical comparison of the drug manufacture rate by the pharmaceutical industry with the resistance emergence rate in pathogens. To that effect, changes in the rates of growth of the drugs production and resistance emergence processes are computed over multiple time segments and compared. It is found that new resistance emergence rate in infectious diseases medicine remains mathematically and permanently ahead of the drugs production rate by the pharmaceutical industry. Consequently, we are not in a position to ever contain current or future strengths of resistance from pathogens. A review of current practices is called for.

Beliefs about the use of nonprescribed antibiotics among people in Yogyakarta City, Indonesia: a qualitative study based on the theory of planned behavior.

PubMed

Widayati, Aris; Suryawati, Sri; de Crespigny, Charlotte; Hiller, Janet E

2015-03-01

Although antibiotics are prescription-only medicine in Indonesia, they can be purchased without prescription. This qualitative study elicited beliefs about nonprescribed antibiotics use informed by the theory of planned behavior to develop a questionnaire for an expanded theory of planned behavior survey. Twenty-five (N = 25) adults with experience of using nonprescribed antibiotics were interviewed. Content analysis was applied. Participants reported that the use of nonprescribed antibiotics was advantageous in term of saving time and money and of reducing the number of medicines that need to be purchased, in contrast to a perception of what occurs with medical prescriptions. Potential adverse effects, poor health outcomes, and antimicrobial resistance were the perceived disadvantages. Facilitators of such use were the availability of over-the-counter antibiotics and successful experience in using antibiotics. Medication for children was the perceived barrier to such use. Family members and friends, especially those with health education background, approved of such use. © 2012 APJPH.

Somatic Cough Syndrome (Previously Referred to as Psychogenic Cough) and Tic Cough (Previously Referred to as Habit Cough) in Adults and Children

PubMed Central

Murad, Mohammad H.; Pringsheim, Tamara; Feinstein, Anthony; Chang, Anne B.; Newcombe, Peter A.; Rubin, Bruce K.; McGarvey, Lorcan P.; Weir, Kelly; Altman, Kenneth W.; Weinberger, Miles; Irwin, Richard S.; Adams, Todd M.; Altman, Kenneth W.; Barker, Alan F.; Birring, Surinder S.; Blackhall, Fiona; Bolser, Donald C.; Boulet, Louis-Philippe; Braman, Sidney S.; Brightling, Christopher; Callahan-Lyon, Priscilla; Canning, Brendan J.; Chang, Anne B.; Coeytaux, Remy; Cowley, Terrie; Davenport, Paul; Diekemper, Rebecca L.; Ebihara, Satoru; El Solh, Ali A.; Escalante, Patricio; Feinstein, Anthony; Field, Stephen K.; Fisher, Dina; French, Cynthia T.; Gibson, Peter; Gold, Philip; Gould, Michael K.; Grant, Cameron; Harding, Susan M.; Harnden, Anthony; Hill, Adam T.; Irwin, Richard S.; Kahrilas, Peter J.; Keogh, Karina A.; Lane, Andrew P.; Lim, Kaiser; Malesker, Mark A.; Mazzone, Peter; Mazzone, Stuart; McCrory, Douglas C.; McGarvey, Lorcan; Molasiotis, Alex; Murad, M. Hassan; Newcombe, Peter; Nguyen, Huong Q.; Oppenheimer, John; Prezant, David; Pringsheim, Tamara; Restrepo, Marcos I.; Rosen, Mark; Rubin, Bruce; Ryu, Jay H.; Smith, Jaclyn; Tarlo, Susan M.; Vertigan, Anne E.; Wang, Gang; Weinberger, Miles; Weir, Kelly; Wiener, Renda Soylemez

2015-01-01

BACKGROUND: We conducted a systematic review on the management of psychogenic cough, habit cough, and tic cough to update the recommendations and suggestions of the 2006 guideline on this topic. METHODS: We followed the American College of Chest Physicians (CHEST) methodologic guidelines and the Grading of Recommendations, Assessment, Development, and Evaluation framework. The Expert Cough Panel based their recommendations on data from the systematic review, patients’ values and preferences, and the clinical context. Final grading was reached by consensus according to Delphi methodology. RESULTS: The results of the systematic review revealed only low-quality evidence to support how to define or diagnose psychogenic or habit cough with no validated diagnostic criteria. With respect to treatment, low-quality evidence allowed the committee to only suggest therapy for children believed to have psychogenic cough. Such therapy might consist of nonpharmacologic trials of hypnosis or suggestion therapy, or combinations of reassurance, counseling, and referral to a psychologist, psychotherapy, and appropriate psychotropic medications. Based on multiple resources and contemporary psychologic, psychiatric, and neurologic criteria (Diagnostic and Statistical Manual of Mental Disorders, 5th edition and tic disorder guidelines), the committee suggests that the terms psychogenic and habit cough are out of date and inaccurate. CONCLUSIONS: Compared with the 2006 CHEST Cough Guidelines, the major change in suggestions is that the terms psychogenic and habit cough be abandoned in favor of somatic cough syndrome and tic cough, respectively, even though the evidence to do so at this time is of low quality. PMID:25856777

Neutral endopeptidase inhibitors potentiate substance P- and capsaicin-induced cough in awake guinea pigs.

PubMed Central

Kohrogi, H; Graf, P D; Sekizawa, K; Borson, D B; Nadel, J A

1988-01-01

To study the roles of substance P and endogenous neutral endopeptidase in mediating cough, we measured cough responses in awake guinea pigs in response to exogenous substance P and capsaicin aerosols in the presence and absence of the neutral endopeptidase inhibitors leucine-thiorphan and phosphoramidon. Substance P stimulated cough in very low concentrations (10(-17)-10(-16) M). In a second study where the investigator did not know whether substance P or diluent alone was aerosolized, substance P (10(-16) M) caused cough. Leucine-thiorphan (10(-5) M) and phosphoramidon (10(-5) M) potentiated substance P-induced cough; NEP inhibitors also potentiated capsaicin-induced cough significantly. These findings suggest that substance P is a potent stimulator of cough responses, that capsaicin-induced cough is mediated by substance P or another similar neuropeptide, and that cough responses are modulated by endogenous neutral endopeptidase. PMID:2461967

Neutral endopeptidase inhibitors potentiate substance P- and capsaicin-induced cough in awake guinea pigs.

PubMed

Kohrogi, H; Graf, P D; Sekizawa, K; Borson, D B; Nadel, J A

1988-12-01

To study the roles of substance P and endogenous neutral endopeptidase in mediating cough, we measured cough responses in awake guinea pigs in response to exogenous substance P and capsaicin aerosols in the presence and absence of the neutral endopeptidase inhibitors leucine-thiorphan and phosphoramidon. Substance P stimulated cough in very low concentrations (10(-17)-10(-16) M). In a second study where the investigator did not know whether substance P or diluent alone was aerosolized, substance P (10(-16) M) caused cough. Leucine-thiorphan (10(-5) M) and phosphoramidon (10(-5) M) potentiated substance P-induced cough; NEP inhibitors also potentiated capsaicin-induced cough significantly. These findings suggest that substance P is a potent stimulator of cough responses, that capsaicin-induced cough is mediated by substance P or another similar neuropeptide, and that cough responses are modulated by endogenous neutral endopeptidase.

Arabinogalactan-proteins stimulate somatic embryogenesis and plant propagation of Pelargonium sidoides.

PubMed

Duchow, Stefanie; Dahlke, Renate I; Geske, Thomas; Blaschek, Wolfgang; Classen, Birgit

2016-11-05

Root extracts of the medicinal plant Pelargonium sidoides, native to South Africa, are used globally for the treatment of common cold and cough. Due to an increasing economic commercialization of P. sidoides remedies, wild collections of root material should be accompanied by effective methods for plant propagation like somatic embryogenesis. Based on this, the influence of arabinogalactan-proteins (AGPs) on somatic embryogenesis and plant propagation of P. sidoides has been investigated. High-molecular weight AGPs have been isolated from dried roots as well as from cell cultures of P. sidoides with yields between 0.1% and 0.9%, respectively. AGPs are characterized by a 1,3-linked Galp backbone, branched at C6 to 1,6-linked Galp side chains terminated by Araf and to a minor extent by GlcpA, Galp or Rhap. Treatment of explants of P. sidoides with AGPs from roots or suspension culture over 5.5 weeks resulted in effective stimulation of somatic embryo development and plant regeneration. Copyright © 2016. Published by Elsevier Ltd.

Regulatory responses to over-the-counter codeine analgesic misuse in Australia, New Zealand and the United Kingdom.

PubMed

Tobin, Claire L; Dobbin, Malcolm; McAvoy, Brian

2013-10-01

Analysis of the policy response by Australia's National Drugs and Poisons Schedule Committee (NDPSC) and comparison with recommendations by expert advisory committees in New Zealand and the United Kingdom. Analysis of public policy documents of relevant regulatory authorities was conducted. Data were extracted regarding changes to over-the-counter (OTC) codeine analgesic scheduling, indications, maximum unit dose, maximum daily dose, maximum pack size, warning labels, consumer medicine information and advertising. Where available, public submissions and other issues considered by the committees and rationale for their recommendations were recorded and thematically analysed. Expert advisory committees in Australia, NZ and the UK defined the policy problem of OTC codeine misuse and harm as small relative to total use and responded by restricting availability. Pharmacist supervision was required at the point-of-sale and pack sizes were reduced to short-term use. Comparison with recommendations by expert advisory committees in NZ and the UK suggests the NDPSC's actions in response to OTC codeine misuse were appropriate given the available evidence of misuse and harm, but highlights opportunities to utilise additional regulatory levers. Framing policy problems as matters of public health in the context of limited evidence may support decision makers to implement cautionary incremental policy change. © 2013 The Authors. ANZJPH © 2013 Public Health Association of Australia.

Over the counter drugs (and dietary supplement) exercise: a team-based introduction to biochemistry for health professional students.

PubMed

Phadtare, Sangita; Abali, Emine; Brodsky, Barbara

2013-01-01

For successful delivery of basic science topics for health-professional students, it is critical to reduce apprehension and illustrate relevance to clinical settings and everyday life. At the beginning of the Biochemistry course for Physician Assistants, a team-based assignment was designed to develop an understanding of the mechanism of action, effectiveness, and toxicity of five common over the counter (OTC) drugs and dietary supplements, and place these familiar medicines in a political and historical context. The objectives of this exercise were to stimulate interest in biochemistry; to provide basic information on enzymes and enzyme inhibitors related to these drugs to be expanded upon later in the course; and to encourage active and interactive learning. Teams of five students were formed, and each student was given an information sheet on aspirin, alpha-galactosidase, orlistat, dextromethorphan, or simvastatin, a low dose statin, which was previously available without prescription at pharmacies in the UK. After each member of the team acquired information on one OTC drug/dietary supplement by reading an assigned information sheet, the team was asked to go through a series of questions, and then submit answers to a quiz as a group. A high rate of success on the quiz, an overwhelmingly positive response on formal course evaluations, and enthusiastic exchanges during class suggested this team-based session accomplished its goals. Copyright © 2013 Wiley-Liss, Inc.

Hot and cold: medicinal plant uses in Quechua speaking communities in the high Andes (Callejón de Huaylas, Ancash, Perú).

PubMed

de la Cruz, Mercedes Gonzales; Malpartida, Severo Baldeón; Santiago, Hamilton Beltrán; Jullian, Valérie; Bourdy, Geneviève

2014-09-11

An ethnopharmacological survey has been set up in high altitude Quechua speaking communities dwelling in Callejón de Huaylas (Ancash department, Peru) and in medicinal plant markets in order to document the medicinal plants use of 178 species within the frame of a traditional Andean medicinal system. A sound ethnopharmacological survey was performed during the years 2011, 2012 and 2013 in different places along Callejón de Huaylas valley in the peruvian Andes, were Quechua speaking communities dwell. Two different methodologies were used: first, plant uses were recorded during walks with informants and in medicinal plant markets held on a regular bases in the area (Huaraz, Carhuaz, Yungay). Secondly, traditional healers (curanderas, curanderos) were interviewed about their practices and healing sessions were observed, in order to understand better the traditional medicinal system as a whole (disease aetiology, diagnosis, treatments, healers). Altogether, 178 medicinal species were collected. Most of the plants found on the market were also found in the wild and vice-versa. Medicinal plant trade is exclusively held by women, selling their merchandise to local people or to big retailer. Plants are classified according their hot or cold virtues, this in accordance with the local conception of the body physiology and disease aetiology, based on a hot-cold polarity. Main use notified for medicinal plants is "(bath) against cold", a prophylactic measure against diseases of cold nature. Other uses include culture bound illnesses i.e. susto, aire, nervios, or heart pain, commonly cited in South America. Regarding symptoms, rheumatic/arthritic pain, musculoskeletal traumas, cough, pulmonary and respiratory problems, gastritis and stomach ache, were the most frequently cited. Diagnosis and treatment are intrinsically linked together and mainly based upon divination techniques using egg and cuy (Cavia porcellus L., Caviidae). Medicinal plants use and traditional medicinal practices are still very vivid in Callejón de Huaylas as highlighted by the abundance of medicinal plants traded in the markets. In this business, women have a key position as healers at the family and community level. Medicinal uses of the majority of the species presented here are reported for the first time. Because medicinal plants sold on the market are collected from the wild and also because high altitude medicinal plants are generally small herbaceous species pulled out with their roots, there is a serious risk of over exploitation and extinction of endemic species. Copyright © 2014. Published by Elsevier Ireland Ltd.

Microinjection of kynurenic acid in the rostral nucleus of the tractus solitarius disrupts spatiotemporal aspects of mechanically induced tracheobronchial cough.

PubMed

Poliacek, Ivan; Pitts, Teresa; Rose, Melanie J; Davenport, Paul W; Simera, Michal; Veternik, Marcel; Kotmanova, Zuzana; Bolser, Donald C

2017-06-01

The importance of neurons in the nucleus of the solitary tract (NTS) in the production of coughing was tested by microinjections of the nonspecific glutamate receptor antagonist kynurenic acid (kyn; 100 mM in artificial cerebrospinal fluid) in 15 adult spontaneously breathing anesthetized cats. Repetitive coughing was elicited by mechanical stimulation of the intrathoracic airway. Electromyograms (EMG) were recorded from inspiratory parasternal and expiratory transversus abdominis (ABD) muscles. Bilateral microinjections of kyn into the NTS rostral to obex [55 ± 4 nl total in 2 locations ( n = 6) or 110 ± 4 nl total in 4 locations ( n = 5)], primarily the ventrolateral subnucleus, reduced cough number and expiratory cough efforts (amplitudes of ABD EMG and maxima of esophageal pressure) compared with control. These microinjections also markedly prolonged the inspiratory phase, all cough-related EMG activation, and the total cough cycle duration as well as some other cough-related time intervals. In response to microinjections of kyn into the NTS rostral to the obex respiratory rate decreased, and there were increases in the durations of the inspiratory and postinspiratory phases and mean blood pressure. However, bilateral microinjections of kyn into the NTS caudal to obex as well as control vehicle microinjections in the NTS location rostral to obex had no effect on coughing or cardiorespiratory variables. These results are consistent with the existence of a critical component of the cough rhythmogenic circuit located in the rostral ventral and lateral NTS. Neuronal structures of the rostral NTS are significantly involved specifically in the regulation of cough magnitude and phase timing. NEW & NOTEWORTHY The nucleus of the solitary tract contains significant neuronal structures responsible for control of 1 ) cough excitability, 2 ) motor drive during cough, 3 ) cough phase timing, and 4 ) cough rhythmicity. Significant elimination of neurons in the solitary tract nucleus results in cough apraxia (incomplete and/or disordered cough pattern). The mechanism of the cough impairment is different from that for the concomitant changes in breathing. Copyright © 2017 the American Physiological Society.

Cough Hypersensitivity Syndrome: A Few More Steps Forward

PubMed Central

Song, Woo-Jung

2017-01-01

Cough reflex is a vital protective mechanism against aspiration, but when dysregulated, it can become hypersensitive. In fact, chronic cough is a significant medical problem with a high degree of morbidity. Recently, a unifying paradigm of cough hypersensitivity syndrome has been proposed. It represents a clinical entity in which chronic cough is a major presenting problem, regardless of the underlying condition. Although it remains a theoretical construct, emerging evidence suggests that aberrant neurophysiology is the common etiology of this syndrome. Recent success in randomized clinical trials using a P2X3 receptor antagonist is the first major advance in the therapeutics of cough in the past 30 years; it at last provides a strategy for treating intractable cough as well as an invaluable tool for dissecting the mechanism underpinning cough hypersensitivity. Additionally, several cough measurement tools have been validated for use and will help assess the clinical relevance of cough in various underlying conditions. Along with this paradigm shift, our understanding of cough mechanisms has improved during the past decades, allowing us to continue to take more steps forward in the future. PMID:28677352

A search for subclinical infection during a small outbreak of whooping cough: implications for clinical diagnosis

PubMed Central

Jenkinson, Douglas; Pepper, Jacqueline D.

1986-01-01

The transmission of whooping cough in a general practice community was followed after the identification of the first case for nearly three years. Intensive case-finding was undertaken to detect contacts of known cases of whooping cough and to take pernasal swabs from those with any cough; 102 swabs were taken. In three months 39 cases of whooping cough were clinically diagnosed, 17 (44%) of which were confirmed bacteriologically. All had a prolonged paroxysmal cough, one-third reported a catarrhal phase, 18 (46%) vomited with paroxysms and nine (23%) whooped. No isolations of Bordetella pertussis were obtained from the 84 contacts with non-paroxysmal coughs. There was no evidence that subclinical bordetella infection (showing none of the signs of whooping cough) is a common occurrence. It is probable that many recognizable cases of whooping cough are missed because it can be a milder illness than is often realized and commonly exhibits neither whooping, vomiting nor a catarrhal phase. Paroxysms may be infrequent. The diagnosis of whooping cough should be suspected from a prolonged paroxysmal cough alone. PMID:3668903

Encoding of the cough reflex in anesthetized guinea pigs

PubMed Central

Mori, Nanako

2011-01-01

We have previously described the physiological and morphological properties of the cough receptors and their sites of termination in the airways and centrally in the nucleus tractus solitarius (nTS). In the present study, we have addressed the hypothesis that the primary central synapses of the cough receptors subserve an essential role in the encoding of cough. We found that cough requires sustained, high-frequency (≥8-Hz) afferent nerve activation. We also found evidence for processes that both facilitate (summation, sensitization) and inhibit the initiation of cough. Sensitization of cough occurs with repetitive subthreshold activation of the cough receptors or by coincident activation of C-fibers and/or nTS neurokinin receptor activation. Desensitization of cough evoked by repetitive and/or continuous afferent nerve activation has a rapid onset (<60 s) and does not differentiate between tussive stimuli, suggesting a central nervous system-dependent process. The cough reflex can also be actively inhibited upon activation of other airway afferent nerve subtypes, including slowly adapting receptors and pulmonary C-fibers. The sensitization and desensitization of cough are likely attributable to the prominent, primary, and unique role of N-methyl-d-aspartate receptor-dependent signaling at the central synapses of the cough receptors. These attributes may have direct relevance to the presentation of cough in disease and for the effectiveness of antitussive therapies. PMID:20926760