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Purpose: To clarify the associations of climatic indices with chronic respiratory symptoms, with a final aim to approximate the effects of climate change on them., Methods: An e-mail survey was directed to the members of the Finnish Pensioners` Federation. The mean 20-years' precipitation and temperature in each subjects' home municipality were obtained from the Finnish Meteorological Institute, separately for summer and winter. Adjusted multivariate models were utilized to investigate the associations of the climatic indices with chronic rhinosinusitis, chronic cough, wheezing with dyspnea, and sleep apnea., Results: There were 6189 responders from 283 municipalities. Chronic rhinosinusitis and chronic cough were most prevalent in the southeastern regions of the country, where the precipitation counts were highest. In the multivariate models, winter precipitation in the home municipality increased the risks of chronic rhinosinusitis and chronic cough [adjusted OR 1.80 (1.30-2.51) per 100 mm, p < 0.001, and 1.57 (1.19-2.07) per 100 mm, p = 0.001, respectively]. Wheezing with dyspnea and sleep apnea were not associated with the climatic indices., Conclusion: Chronic rhinosinusitis and chronic cough were associated with long-term winter precipitation. Given the anticipated increase in winter precipitation in Northern America and Northern Europe, the prevalences of chronic rhinosinusitis and chronic cough may increase there., Competing Interests: Declarations. Conflict of Interests: Heikki O Koskela has received funding for the present study from Kuopion Seudun Hengityssäätiö and Hengityssairauksien Tutkimussäätiö Foundations, payments for lectures from Boehringer Ingelheim and MSD, and owns shares of a medical company Orion. Johanna T Kaulamo has received funding for the present study from Kuopion Seudun Hengityssäätiö, Hengityssairauksien Tutkimussäätiö, Suomen Tuberkuloosin vastustamisyhdistyksen Säätiö, Väinö ja Laina Kiven Säätiö, and Suomen Kulttuurirahasto foundations, and travel support from Boehringer-Ingelheim for attending a scientific meeting. Anne M Lätti has received funding for the present study from Kuopion Seudun Hengityssäätiö, Hengityssairauksien Tutkimussäätiö, KYS:n Tutkimussäätiö, Suomen Tuberkuloosin Vastustamisyhdistyksen Säätiö, and Väinö ja Laina Kiven Säätiö Foundations, travel support from Orion, Boehringer Ingelheim and Roche for attending a scientific meeting, and payment for lectures and Advisory Board participations from Farmasian oppimiskeskus, MSD and GlaxoSmithKline. The authors have no other financial or non-financial competing interests. Ethical Approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Kuopio University Hospital (289/2015). Consent to Participate: The decision to respond to the questionnaire was considered as an informed consent. Consent to Publish: Not applicable., (© 2024. The Author(s).)

Purpose: Inhaled mannitol induces bronchoconstriction and cough. This study aimed to describe the cough response to mannitol among healthy adult subjects., Methods: 125 healthy subjects (aged 18-82 years, 52% females, 50% skin prick test positive) underwent a mannitol test. The coughs were recorded both simultaneously and afterwards from video recordings by two researchers. Three indices were evaluated: The cumulative number of coughs per cumulative dose of mannitol (CDR), cumulative provocative dose of mannitol to cause at least 5 coughs, and the maximal number of coughs provoked by any single mannitol dose. The test was repeated in 26 subjects after 3-7 days., Results: CDR showed the best repeatability with an intraclass correlation coefficient of 0.829. Gender was the only characteristics that associated with the cough response: The median CDR was 2.53 (interquartile range 0.45-7.01) coughs/100 mg among females and 0.787 (0.0-3.29) coughs/100 mg among males (p = 0.002). The interquartile range upper limits were defined as the cut-off limits for a normal response. The threshold for a statistically significant change in CDR was 6.26 coughs/100 mg. There was a close correlation between simultaneous- and video-assessed CDR (intraclass correlation coefficient 0.985)., Conclusion: Females cough more than males in response to mannitol. CDR is the most suitable index to describe the cough responsiveness. The repeatability of the response is good. Video recording of the coughs is not mandatory. The cut-off limits for a normal cough response to mannitol were provided., Competing Interests: Declarations. Competing Interests: Hanna Nurmi has received funding from Foundation of the Finnish Anti-Tuberculosis Association and the North Savo Regional Fund of the Finnish Cultural Foundation. Anne Lätti declares no competing interest. Heikki Koskela has received funding from Suomen Tuberkuloosin Vastustamisyhdistyksen säätiö and Kuopion Seudun Hengityssäätiö and owns stocks of Orion Ltd. Ethics Approval: This study was performed in line with the principles of the Declaration of Helsinki. The study was approved by the Ethics Committee of the Kuopio University Hospital (473/2021) and registered at ClinicalTrials.gov database ( https://clinicaltrials.gov , NCT05034367). Consent to Participate: Written informed consent was gathered from all participants. Consent for Publication: Not applicable., (© 2024. The Author(s).)

Leicester Cough Questionnaire total scores were graded to severe (3.00-12.28), moderate (12.29-17.53) and mild (17.54-21.00), based on the prevalence of multiple self-reported doctor's visits due to cough among 1248 subjects with current cough https://bit.ly/3UkCe4i., Competing Interests: Conflict of interest: H.O. Koskela reports support for the present manuscript from Kuopion Seudun Hengityssäätiö and Hengityssairauksien tutkimussäätiö; payment for lectures from Boehringer Ingelheim Ltd, MSD Ltd and Chiesi Pharma Ltd, outside the submitted work; and stock ownership in Orion Ltd, outside the submitted work. Conflict of interest: J.T. Kaulamo reports support for the present manuscript from Foundation of the Finnish Anti-Tuberculosis Association/Suomen Tuberkuloosin Vastustamisyhdistyksen Säätiö, Kuopio Area Respiratory Foundation/Kuopion Seudun Hengityssäätiö, The Research Foundation of the Pulmonary Diseases/Hengityssairauksien Tutkimussäätiö, Väinö and Laina Kivi Foundation/Väinö ja Laina Kiven Säätiö and Suomen Kulttuurirahasto/The Finnish Cultural Foundation. Conflict of interest: A.M. Lätti reports support for the present manuscript from Kuopion Seudun Hengityssäätiö, Hengityssairauksien tutkimussäätiö, KYS:n Tutkimussäätiö, Suomen Tuberkuloosin Vastustamisyhdistyksen Säätiö SR and Väinö ja Laina Kiven Säätiö; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events for Farmasian Oppimiskeskus/Pharmaceutical Learning Centre, GlaxoSmithKline, Chiesi, MSD, AstraZeneca and Hengitysliitto, outside the submitted work; and support for attending a scientific meeting from Novartis, Boehringer Ingelheim and Chiesi, outside the submitted work., (Copyright ©The authors 2024.)

Background: Cross-country skiers train and compete during the winter for long periods of time in subfreezing conditions, which strains the airways and provokes respiratory symptoms. This study aimed to compare the prevalence of exercise-related symptoms and prolonged cough in competitive cross-country skiers versus the general population and to investigate the association between these symptoms and asthma., Methods: A questionnaire was sent to Finnish cross-country skiers (n=1282) and a random sample of the general population (n=1754), with response rates of 26.9% and 19.0%, respectively., Results: Both groups were mostly asymptomatic at rest, but symptoms were increased in both groups during and after exercise. Cough was more prevalent after exercise in skiers and phlegm production was more common during and after exercise in skiers. Asthma did not provoke specific symptoms, but symptom prevalence was higher in asthmatic individuals. Skiers had a higher prevalence of cough after exercise (60.6% vs 22.8%, p<0.001) compared with controls, but controls had a higher prevalence of prolonged cough (4.1% vs 9.6%, p=0.004). In participants without asthma, cold air triggered symptoms more often in skiers than controls, while strong odours triggered symptoms more often in asthmatic controls than skiers. Chronic cough lasting more than 8 weeks was rare, reported by 4.8% of controls and 2.0% of skiers., Conclusion: Cross-country skiers, especially those with asthma, experience a higher burden of exercise-related respiratory symptoms compared with controls. However, repeated exposure to cold air does not appear to result in long-term hypersensitivity of the cough reflex arc., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

An efficient therapy for cough usually requires identification and treatment of the underlying disease, like asthma. However an underlying disease in cough is not found in all cases and conventional treatment of the underlying disease is ineffective against cough. Drug therapy options are available also for these situations. Honey or menthol can be tried for cough associated with respitatory infections, antihistamines for cough associated with allergic rhinitis, blockers of the leukotriene receptor or muscarinic receptor for asthma-associated cough and morphine for cough associated with a malignant disease. Menthol, blockers of the muscarinic receptor, or dextrometorphan can be tried for prolonged idiopathic cough. Codeine is not necessary in the treatment of cough. Refraining from drug treatment should always be considered.

The prevalence of chronic cough is 10 to 15%. It has a strong negative impact on the patients' quality of life and it often causes depression. Many patients find medications unhelpful. Successful management of chronic cough requires the identification of the underlying condition like chronic rhinosinusitis, asthma, and asthma-like syndrome, and esophageal reflux disease. If the underlying condition cannot be identified or if the drug trials fail to help, the patient probably suffers from idiopathic chronic cough. A new paradigm has been introduced in which chronic cough is regarded as a primary condition.

Typical symptoms of bronchiectasis include cough, sliminess of the airways and recurrent respiratory infections which lead to lung injury and impaired quality of life when untreated. High-resolution computer tomography is the most important examination to detect bronchiectasias. Cornerstones of the treatment are elucidation of the etiology of the disease, taking care of vaccinations, management of physical fitness, treating sliminess, and careful treatment of periods of exacerbation with antibiotics according to bacterial growth and susceptibility testing determined from sputum. Hypertonic saline inhalation can be used to potentiate the treatment of sliminess and achieve a positive effect on the quality of life.

Asthmatic patients are hypersensitive to the cough-provoking effect of hypertonic aerosols. 15- hydroxyeicosatetraenoic acid (15(S)-HETE) and leukotriene (LT) B4 are asthma-related mediators which can be released upon hypertonic stimuli, and both are potent agonists of the transient receptor potential vanilloid subfamily member 1 (TRPV1), a major cough receptor. Therefore, they are potential mediators for hypertonicity-provoked cough. Twenty-six asthmatic and ten healthy subjects underwent a hypertonic saline cough provocation test. Exhaled breath condensate was collected before and after the test, and the concentrations of 15(S)-HETE and LTB4 were analysed. Neither the baseline concentrations of these mediators nor the saline test-induced changes in them were associated with cough responsiveness to hypertonicity. High baseline 15(S)-HETE was associated with aspirin hypersensitivity and high LTB4 with male sex and large variability in ambulatory peak flow measurements. The TRPV1 agonists 15(S)-HETE and LTB4 seem not to be involved in the cough response to hypertonicity in asthmatic patients.

Mycoplasma pneumoniae causes up to 10-40 % of community-acquired pneumonias. The incidence of M. pneumoniae pneumonia is greatest among children and young adults. The symptoms of M. pneumoniae upper and lower respiratory infections are usually mild and often self-limited. The most frequent extrapulmonary complications present in CNS, heart and skin. The skin affiliations are usually transient erythematous maculopapular or vesicular rashes but may sometimes evolve into Stevens-Johnson syndrome. M. pneumoniae is one of the most common microbe behind the infectious causes of SJS. We present a patient who developed incomplete Stevens-Johnson syndrome concomitant of Mycoplasma pneumoniae pneumonia.

Pleural infections constitute a group of diseases, among which the most severe one is empyema. Their incidence is increasing. The major predisposing factor is alcoholism. The pleura becomes most commonly infected in connection with pneumonia. The condition always requires an effective antibiotic therapy. With the exception of an effusion of less than one centimeter, a sample should always be taken from the pleural fluid. The appearance and acidity of the fluid dictate the need for drainage. If the disease does not seem to improve, the need for surgical treatment should be assessed without delay.

Background: Accumulation of mucus into the lungs in bronchiectasis lowers the patients' quality of life. Hypertonic aerosols stimulate the removal of mucus., Material and Methods: 37 bronchiectasis patients without cystic fibrosis inhaled 4 ml of a 6 per cent saline solution twice a day for three months. Amount of coughs, PEF values and oxygen saturation associated with the first inhalation were measured. Quality of life was assessed by the SGRQ (St George's Respiratory Questionnaire)., Results: Inhalation did not decrease oxygen saturation but did lower slightly the PEF value. SGRQ score decreased by 9.2 points on the average (p = 0.002) indicating clinically significant improvement in quality of life., Conclusions: Hypertonic saline inhalations in patients with brochiectasis are safe and may also improve quality of life.

Long-term oxygen therapy extends the life span of hypoxemic patients with chronic obstructive pulmonary disease (COPD). The patients often have great expectations concerning the quality of life, but oxygen therapy does neither relieve dyspnea nor reduce the need for hospital treatments. Oxygen therapy in diseases other than COPD lacks scientific basis. It is worthwhile to start in-hospital oxygen therapy by determining the oxygen flow with a device given to the patient, and the effect of the therapy on the nocturnal accumulation of carbon dioxide is checked. In the future, focus should be on other forms of therapy, such as rehabilitation.