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Introduction: Temporal bone chondroblastoma is a rare, locally aggressive tumour originating from immature cartilage, which recurs to a high degree. Treatment is surgical. Radiotherapy is reserved for recurrence. We describe a case of a 15-year-old-boy choosing a conservative surgical approach with reconstruction of the posterior canal wall. This study aims to report a rare pediatric case. Methods: A literature review was performed to better understand temporal bone chondroblastomas, to describe their histopathological and radiological characteristics and to establish the optimal surgical and non-surgical treatments. The research of previous published data was done using PubMed with keywords mentioned below. Results: Authors present a case of a 15-year-old boy with hearing impairment and facial nerve palsy. Conservative surgery with reconstruction of the tympanic membrane and posterior wall of the external auditory canal, restoring the hearing has been performed. We did not administer any adjuvant therapies. No sign of recurrence was observed 1 year after primary surgery. Facial nerve function is normal, and hearing is satisfactory. Conclusion: Chondroblastomas account for less than 1% of primary bone tumours. Temporal bone chondroblastoma is rare, locally aggressive, with a high prevalence of recurrence. This study describes specific histopathological and radiological findings, the chosen surgical approach and follow-up to improve the management and the prognosis of patients affected with this particular clinical entity.

The main role of research in medicine is to provide relevant knowledge which, after successful translation to clinical practice, improves the quality of healthcare. The sex bias which is still present in the majority of research disciplines prefers male subjects despite legislation changes in the US grant agencies and European research programme Horizon 2020. Male subjects (cells, animals) still dominate in preclinical research and it has detrimental consequences for women’s health and the quality of science. Opposite bias exists for data obtained mainly in animal models utilizing female subjects (e.g. research in multiple sclerosis, osteoporosis) with skewed outcomes for men affected by these diseases. Either way, scientists are producing results which compromise half of the population. Assumptions that females as cohorts are more variable and another assumption that the oestrous cycle should be tracked in case the females are enrolled in preclinical studies were proven wrong. Variability of male versus female cohorts are comparable and do not only stem from hormonal levels. The widespread prevalence of sex differences in human diseases ultimately requires detailed experiments performed on both sexes, unless the studies are specifically addressing reproduction or sex-related behaviors.

FeNO measurement is a validated non-invasive technique, which is used for diagnosis and monitoring of asthma. It would be desirable to find a reliable method to monitor allergic rhinitis (AR) via measurement of FeNO, and/or nasal nitric oxide (nNO). The aim of our study was the assessment of the efficacy of FeNO and nNO as markers in AR treatment. FeNO and nNO were measured with the portable NO analyser (NIOX MINO®) in healthy participants and in patients with AR. The patients were examined during the pollen season and out of it. The effect of local corticosteroids and antihistamine therapy was observed in patients with AR during pollen season after three weeks of therapy. There are significant differences between FeNO and nNO in patients with AR compared to healthy controls at all set points of measurements. While FeNO responded well to the treatment with both antihistamines and combined therapy, nNO decreased only after combined therapy with antihistamines and nasal corticosteroids. nNO monitoring alone is not a suitable method to monitor inflammation of the upper airways in AR and its suppression by anti-allergic treatment and should be correlated with other markers as FeNO or symptom scores.

Cough in chronic respiratory diseases is a common symptom associated with significant comorbidities including visceral pain. Available antitussive therapy still has limited efficacy. Recent advances in the understanding of voltage-gated sodium channels (Na

Introduction. Sarcoidosis is a multisystem granulomatous disease of unknown aetiology, commonly involving the lungs. Cough is a frequent and troublesome symptom of sarcoidosis that reduces patients’ quality of life. Aim. Retrospective analysis of different factors—smoking history, Scadding stage, results of lung function testing, calcium metabolism, endobronchial finding, CD4+/CD8+ T-cell ratio in bronchoalveolar lavage fluid (BALF), and other sarcoidosis symptoms in relationship to presence/absence of cough in sarcoidosis patients. Methods. We retrospectively studied sarcoidosis patients diagnosed at the Clinic of Pneumology and Phthisiology of Martin University Hospital between 1998 and 2018. Patients with a history of cough-relevant comorbidities were excluded from the study. GraphPad Prism 7.0 software was used to perform statistical analysis. Results. 101 sarcoidosis patients were included to the study: 65 patients reporting from cough and 36 without cough. The cough was slightly more frequent in nonsmokers (p=0.166) and in women (p=0.688). Cough was associated with dyspnoea (p=0.0007), fever (p=0.0324), and chest pain (p=0.0206) and did not associate with arthralgia (p=0.317) and erythema nodosum (p=0.505). Patients with cough had significantly a lower average value of calciuria (p=0.0014) and lower MEF25 (p=0.0304), MEF50 (p=0.0061), FEV1 (p=0.0025), and FVC (p=0.0025) in % of predicted values, and more often positive endobronchial finding (p=0.0206), compared to patients without cough. Calcemia, FEV1/FVC, DLCO, and CD4+/CD8+ T-cell ratio in BALF and occurrence of cough did not differ between different stages of the disease. Conclusions. We found significant differences between sarcoidosis patients with/without cough regarding symptoms, results of lung function tests, endobronchial finding, and calcium metabolism. Further research is needed to understand the etiopathogenesis of cough in sarcoidosis patients.

Primary ciliopathies are a group of disorders associated with abnormal formation and function of primary cilia. Many cilia-associated proteins found in primary cilia are also present in motile cilia. Such proteins are important for the ciliary base, such as the transition zone or basal bodies, and the intraflagellar transport. Their exact role in the respiratory motile cilia is unsettled. In this prospective clinical single-center study, we investigated the hypothesis that these proteins regulate the function of motile cilia. We addressed the issue by defining the motile cilia beat frequency in the respiratory tract of patients with primary ciliopathies accompanied by chronic kidney disease and comparing it in those without kidney involvement. Ciliary beat frequency in the nasal mucosa samples was evaluated by the ciliary analysis software LabVIEW. Both children and their parents with primary ciliopathies and kidney involvement had significantly lower median airway ciliary beat frequencies than those without kidney involvement who have normal ciliary motility. Further, the ciliary beat frequency is inversely associated with the serum creatinine level. These findings strongly suggest that kidney involvement in patients with primary ciliopathy may underlie the development of motile cilia dysfunction in the respiratory tract, potentially increasing respiratory morbidity.

Primary ciliopathies are a group of disorders associated with abnormal formation and function of primary cilia. Many cilia-associated proteins found in primary cilia are also present in motile cilia. Such proteins are important for the ciliary base, such as the transition zone or basal bodies, and the intraflagellar transport. Their exact role in the respiratory motile cilia is unsettled. In this prospective clinical single-center study, we investigated the hypothesis that these proteins regulate the function of motile cilia. We addressed the issue by defining the motile cilia beat frequency in the respiratory tract of patients with primary ciliopathies accompanied by chronic kidney disease and comparing it in those without kidney involvement. Ciliary beat frequency in the nasal mucosa samples was evaluated by the ciliary analysis software LabVIEW. Both children and their parents with primary ciliopathies and kidney involvement had significantly lower median airway ciliary beat frequencies than those without kidney involvement who have normal ciliary motility. Further, the ciliary beat frequency is inversely associated with the serum creatinine level. These findings strongly suggest that kidney involvement in patients with primary ciliopathy may underlie the development of motile cilia dysfunction in the respiratory tract, potentially increasing respiratory morbidity.

Cough is a vital airway reflex that keeps the respiratory tract wisely protected. It is also a sign of many diseases of the respiratory system and it may become a disease in its own right. Even though the efficacy of antitussive compounds is extensively studied in animal models with promising results, the treatment of pathological cough in humans is insufficient at the moment. The limited translational potential of animal models used to study cough causes, mechanisms and possible therapeutic targets stems from multiple sources. First of all, cough induced in the laboratory by mechanical or chemical stimuli is far from natural cough present in human disease. The main objective of this review is to provide a comprehensive summary of animal models currently used in cough research and to address their advantages and disadvantages. We also want to encourage cough researchers to call for precision is research by addressing the sex bias which has existed in basic cough research for decades and discuss the role of specific pathogen-free (SPF) animals.

Laboratory research of cough reflex utilizes almost exclusively male guinea pigs – a practice that represents a significant obstacle in the successful translation of results into clinical practice. Chronic hypersensitivity cough syndrome affects mostly postmenopausal women and it represents significant decrease in patient’s quality of life. No cause for such exaggerated cough can be found, therefore this condition cannot be treated appropriately. One of the reasons leading to the lack of relevant data about mechanisms responsible for hypersensitivity of cough related pathways is nowadays widely discussed gender bias, which is present in nearly all branches of biomedical research. Since gender differences in cough reflex physiology do exist in humans, it would be reasonable to study cough-related phenomena on both sexes of laboratory animals. In this study, we focused on detailed characterization of cough response of female guinea pigs to aerosols of commonly used tussive agents (capsaicin, distilled water, allyl isothiocyanate, cinnamaldehyde, citric acid). In pooled data from multiple challenges we found no statistical difference in number of cough and cough latency between sexes. Based on our results we conclude that the utilization of female guinea pigs model does not lead to messy data and can be used in basic cough research.

Sarcoidosis is a multi-system disease of unknown aetiology characterized by presence of non-caseating granulomatous inflammation. Cough is a common and significant symptom in sarcoidosis, reducing quality of life. Objective 24 h cough monitoring proved that sarcoidosis patients have significantly higher cough frequency compared to controls and their cough has diurnal variation, it is gender-specific and shows racial differences. It correlates with the presence of inflammation in the airways, but is not influenced by the X-ray staging of the disease, nor the degree of airway obstruction. Subjects with sarcoidosis have heightened cough reflex sensitivity, which is a result of interaction between the airway cough sensors and consequences of pathological process, detailed pathogenesis of cough in this demographic is unclear. The airway hyperresponsiveness, sarcoidosis of the upper airways and sensitivity to biomechanical forces play a role. More studies should be performed to understand pathogenesis of cough in sarcoidosis patients to improve the management of this troublesome symptom.

Chronic hypersensitivity cough syndrome affects mainly postmenopausal women; however, the pathogenesis of cough hypersensitivity in this demographic is not entirely understood. The role of sex hormones in cough has never been studied in detail; however, sex hormones seem to play an important role in the lung health of women. Our study was aimed to analyse the effect of female sex hormones (oestrogen – E2 and progesterone – Pg) on cough sensitivity measured by inhalation of capsaicin in follicular and luteal phases of menstrual cycle, characterized by significantly different concentrations of sex hormones. These data were compared with a matched group of women taking oral contraceptives. Cough sensitivity to capsaicin increased in luteal phase in subjects with normal menstrual cycle, and this functional change was not present in group with contraceptive pills. The cough sensitivity correlates with the Pg/E2 ratio, and relative lack of oestrogen in luteal phase is associated with higher cough sensitivity to capsaicin.

Majority of patients visiting cough clinics are postmenopausal women, who are affected by intractable cough for years. Why the cough reflex becomes exaggerated in women is not known. Basic research excludes females from the studies contributing to the sex bias which may be responsible for lack of understanding of "hypersensitive" cough in women. Biological and behavioural differences between women and men are the factors affecting cough physiology. Gender also shapes the patterns of behaviour and determines the character of environmental exposures which differs between sexes. The article offers an insight into the physiology of the cough, differences in the maturation of it and biological, social and behavioural factors contributing to the sex differences in cough.

Cough hypersensitivity affects mainly postmenopausal women. Pathogenesis remains unknown in their case; therefore, an optimal treatment is unavailable. Only male guinea pigs are used in basic cough research and exclusion of females leads to gender bias. Nowadays, the efforts of grant agencies aim to support projects which take gender into account and involve both sexes to reduce gender bias. The aim of our pilot study is to assess the suitability of female guinea pig model in cough research. Cough response to citric acid (0.4 M) was obtained in female and male guinea pigs (n = 12 each). Reproducibility of cough response was tested four times a week apart. The cough was detected from the airflow traces and cough sound analysis. Our initial results show that cough response of female guinea pigs is higher than in males. Variability of females is also higher than in males. Further investigations are necessary to validate this model in different conditions to achieve gender equality in cough studies.

Pathological cough is an unwanted and debilitating symptom of a range of chronic respiratory diseases. Currently used antitussive therapies are ineffective and act largely through the central nervous system, having a number of dangerous adverse effects. There is an urgent need for new, better peripherally acting antitussive drugs with minimal adverse effects. Significant progress has recently been achieved in the understanding of voltage-gated sodium channels (NaVs), which points to the biological plausibility that blocking specific NaV sybtypes (NaV1.1 - NaV1.9) in the airway sensory nerves may lead to the inhibition of pathological coughing. In this study we investigated the effect of lidocaine, a non-selective NaVs blocker, on citric acid- and capsaicin-induced cough in the awake naïve guinea pig experimental model. We found that pre-inhalation followed by continuous inhalation of nebulized lidocaine (10 mM) during citric acid (0.8 M) cough challenge was effective in suppressing the cough response (number of coughs, median [IQR]) - (5 [3.8-6.3] pre-lidocaine vs. 1 [0.3-3.8] post-lidocaine; p = 0.002, n = 11). Likewise, lidocaine during capsaicin (50 μM) cough challenge reduced the number of coughs (6 [4.1-7.9] pre-lidocaine vs. 1 [0.5-1.5] post-lidocaine; p = 0.0005, n = 12). We conclude that nebulized lidocaine effectively blocks chemically induced cough. These findings lend support to the notion that NaVs may become a novel neural target in antitussive treatment.

Pathological cough is an unwanted and debilitating symptom of a range of chronic respiratory diseases. Currently used antitussive therapies are ineffective and act largely through the central nervous system, having a number of dangerous adverse effects. There is an urgent need for new, better peripherally acting antitussive drugs with minimal adverse effects. Significant progress has recently been achieved in the understanding of voltage-gated sodium channels (NaVs), which points to the biological plausibility that blocking specific NaV sybtypes (NaV1.1 – NaV1.9) in the airway sensory nerves may lead to the inhibition of pathological coughing. In this study we investigated the effect of lidocaine, a non–selective NaVs blocker, on citric acid– and capsaicin–induced cough in the awake naive guinea pig experimental model. We found that pre–inhalation followed by continuous inhalation of nebulized lidocaine (10 mM) during citric acid (0.8 M) cough challenge was effective in suppressing the cough response (number of coughs, median [IQR]) – (5 [3.8–6.3] pre–lidocaine vs. 1 [0.3–3.8] post–lidocaine; p = 0.002, n = 11). Likewise, lidocaine during capsaicin (50 μM) cough challenge reduced the number of coughs (6 [4.1–7.9] pre–lidocaine vs. 1 [0.5–1.5] post–lidocaine; p = 0.0005, n = 12). We conclude that nebulized lidocaine effectively blocks chemically induced cough. These findings lend support to the notion that NaVs may become a novel neural target in antitussive treatment.

Simulation-based learning in medicine has gained substantial importance. It is complementary to often limited clinical practice, and helps interconnect theoretical knowledge with practical training. Simulations are implicated in clinical subjects, but based on recent understanding, simulation can also be used in preclinical subjects, where it can support presented tasks. Simulation technology was used for elective practical sessions in a pathophysiology course, with both measurable outcomes and students’ feedback evaluated. This study was conducted in Slovakia with volunteers (n = 22), who were 3rd-year students of General Medicine (simulation group), paired with classmates in traditional seminars (control group; n = 22) with the same achievement grades. The control group had completed traditional seminars, whereas the simulation group had completed simulation-based seminars in cardiovascular pathophysiology. A standardized student feedback survey, visual analogue scale, and credit tests for regular pathophysiology were used to perform the analysis. Subjective feedback suggested positive outcomes in approximately 80% of students. An objective assessment showed that simulation-based seminars did not increase the theoretical knowledge as documented by 1st credit test (simulation vs control; 42 ± 6 vs 41 ± 4; p > 0.05), but rather their approach to clinical application of obtained information and motivation to study.

Chronic cough is a troublesome problem and it is frequently associated with diseases such as gastroesophageal reflux, asthma and upper airway diseases—so called diagnostic triade. The magnitude and severity of cough is strongly associated with the ongoing nasal inflammation in subjects with rhinosinusitis and treatment of nasal inflammation leads to the down regulation of pathologically up-regulated cough. Histamine plays a key role in the inflammation of the upper airways of different aetiologies; therefore histamine receptors seem to be promising targets. The aim of our study was to ascertain the effect of H3R agonist imetit and H3R antagonist thioperamide on cough and symptoms of allergic rhinitis (AR) in an animal model of upper airway cough syndrome in ovalbumin sensitized guinea pigs. OVA sensitized guinea pigs (n = 10) were repeatedly challenged with i.n. allergen-OVA to induce allergic rhinitis and to enhance cough reflex according to the validated model of experimental allergic rhinitis. Animals were pre-treated by i.p. administration of imetit (1 mg/kg and 2 mg/kg of body weight) and thioperamide 30 min. prior i.n. OVA administration. Rhinitis evaluation was based on the occurrence of typical symptoms. The effect on cough was assessed from the response to inhalation of citric acid (0.4 M, 10 min), final cough count and cough latency were analysed from the airflow traces, cough motor pattern and the cough sound. AR up-regulated the cough response from 9 ± 2 to 16 ± 1 cough per provocation, med ± IQR, p < 0.05 and shortened cough latency. Imetit (1 mg/kg) suppressed nasal symptoms and decreased number of cough from 16 ± 1 to 12 ± 1; however the data did not reach significance. Imetit (2 mg/kg) significantly suppressed the nasal symptoms, and number of coughs from 16 ± 1 to 6 ± 2, med ± IQR, p < 0.05. Thioperamide (5 mg/kg of body weight) did not have expected effects on tested parameters. H3R agonist imetit, unlike H3R antagonist thioperamide has antitussive potential and ability to suppress nasal symptoms in animal model of allergic rhinitis.

The efficacy of H4R antagonist JNJ7777120 on nasal symptoms, cough, airway resistance (Raw), inflammatory cell count in bronchoalveolar lavage (BAL) and blood in ovalbumin (OVA) induced allergic rhinitis (AR) was studied in guinea pigs. Animals (n=8) were sensitized by i.p. OVA and were repeatedly challenged with nasal OVA to induce rhinitis, seven animals were not sensitized. Animals were pre-treated with JNJ7777120 2.5 and 5mg/kg i.p. 30 min prior OVA. Cough was induced by inhalation of citric acid, Raw was measured in vivo by Pennock's method as baseline, during AR and after JNJ7777120 treatment. Leucocyte count in BAL and blood was analyzed. JNJ7777120 (5mg/kg) significantly suppressed nasal symptoms and the number of coughs. This compound significantly inhibited airway reactivity to histamine, but not methacholine. Pre-treatment with JNJ7777120 5mg/kg did not influence significantly the leucocyte count in BAL and blood except for a significant decrease in monocyte count in blood compared to the control group (p

Extensive research of respiratory physiology and diseases of the airways and lungs provides better understanding of mechanisms of diseases and it is a source of new data with potential clinical application. The majority of the data in the field of airway defensive reflexes were obtained from guinea pig model, as the most convenient one. Neurophysiology and neuropharma-cology of the cough reflex—which is exclusively mediated by the vagus nerve, share close similarities between guinea pigs and humans. The models used to study pathological processes and their influence on airway-defensive reflexes use sensitization with ovalbumin—the protein from chicken egg, which does not mimic allergies within human respiratory system. House dust mites (HDM) (Dermatophagoides pteronyssius and Dermatophagoides farinae) represent frequent human aeroallergens, however the HDM models are used considerably less than ovalbumin models. The primary objective of this review is to focus on already validated models of HDM-induced airway diseases to see, whether some of them are suitable to study mechanisms of peripheral cough plasticity in a condition of HDM-induced pathological processes. The main purpose of future use and validation of HDM model is to produce higher ability to translate the results obtained in animal models to human cough research.

Eighteen healthy volunteers with normal lung function were tested for cough. Before and after nasal administration of thymol (0.025 ml, 10(-3) M) into both nostrils, urge-to-cough, cough threshold, cumulative and total count of coughs per provocation were estimated during standardized and validated capsaicin cough challenge. Nasal thymol challenges induced pleasant olfactory sensation and in 6 out of the 18 subjects also mild cooling sensation. Cough threshold was not influenced when compared with intranasal saline and vehicle challenges (12.5 vs. 13.2 vs. 10.2 μM of capsaicin to induce two or more coughs (C2), respectively), but the total count of coughs after nasal thymol challenge was significantly lower than that obtained after saline or vehicle (19 vs. 20 vs. 14 coughs/provocation, respectively; p

Menthol is frequently used in over the counter medications for common colds and coughs. It was formerly considered to be under the class of herbal medicine, but identification of menthol receptor (TRPM8) moved it from the class of herbal medicine to the molecular pharmacology. It has been documented that menthol reduces dyspnoea and nasal obstruction via stimulation of nasal cold or flow receptors. It has also antitussive and antiirritative effect. Menthol can also induce adverse reactions such as airway irritation, dyspnoea, chest tightness and potentially respiratory failure, mainly in children. The mechanisms responsible for adverse reactions of menthol are not known completely. The adverse reactions of menthol could be due to its effects on TRPA1 channel, relevant to airway irritation. Higher concentrations of menthol stimulate TRPA1 channel causing airway irritation. It also increases mucus production and at the same time reduces cilliary activity leading to mucus stagnation. As the adverse effects were reported mainly at the night it is supposed that suppressed cough reflex during sleep potentiated by menthol induced cough suppression might be responsible for lack of airway mucus clearing and obliteration of small airways. Adverse effects could also be due to consequences of reflexes induced by the menthol action on trigeminal afferents, like apnoea or bronchoconstriction. Menthol is effective in relieving respiratory symptoms, but cough and cold medications should be used with caution. Recommendations are low concentrations of menthol used locally (intranasal) and not combined with camphor or cineole, as they may have additive effects and should be avoided in children under 2 years. Further data are necessary to completely elucidate potential risks of over the counter menthol medication in children but based on the meta analysis of documented case reports, menthol can be used safely if its contraindications for use are followed as with any other over the counter medications.

Terminals of the trigeminal afferents innervating nasal mucosa are called gate keepers, since these fibres detect substances entering the airways. Trigeminal excitation by irritants initiates airway defensive mechanisms, and it is also attributed to the influence of lower airways resistance in a term of nasobronchial reflex. This phenomenon is frequently under debate, because some investigators were unable to confirm its existence. The aim of our study was to determine, whether pharmacological approach could be useful to reach high accuracy and better interpretation of the data obtained by Pennock’s method. Pennock’s method, which is frequently used to measure airway resistance in vivo (Raw) in fact measures total airway resistance, however, the data are usually interpreted in a terms of bronchomotor response. The upper airway component, which represents approximately 40% of Raw, is commonly not considered as being important in this method. 30 Dunkin Hartley guinea pigs were exposed to nasal stimuli (TRPA1 agonist—irritant allylisothiocyanate (10 mM, AITC), TRPM8 agonist with cooling potential menthol (10-3 M) and saline as a control). Raw was measured pre challenge as baseline, after nasal provocation and further, after nasal inhalation of histamine and methacholine (10-6 M) each. The data showed rise of Raw only after nasal AITC challenge, with further increased responsiveness to histamine and methacholine (5.3 vs 10.18 vs 11.26 vs 17.32 cmH2O.s-1, p 0.05). No significant changes were detected after saline, or menthol respectively. Data obtained in further experiment and its analysis showed that pre-treatment with nasal administration of 1% oxymetazoline but without salbutamol inhalation prevented the rise of Raw after nasal irritant challenges. Raw after nasal irritant challenges rises rather due to nasal response than due to narrowing of the lower airways.

Osmolarity changes of airway superficial fluid are associated with cough and are used in research. TRPV4 is calcium channel initially described as osmosensor. In the airways, it can play role in increasing cough reflex sensitivity. The aim of our study was to test whether cough to osmotic stimuli is mediated via TRPV4 channel. Cough response was measured in 12 male guinea pigs by inhalation of saline, distilled water, hypertonic solution and citric acid for 10 min in whole-body plethysmograph. Data were obtained in naive animals and after pre-treatment with selective TRPV4 antagonist GSK2193874 in doses 300 μg/kg (GSK300) and 900 μg/kg (GSK900). Cough response to all tested aerosols was significantly higher than to saline. Pre-treatment with GSK300 did not influence response to osmotic stimuli − only reduced cough to citric acid. GSK900 reduced cough response to hypotonic stimuli and citric acid. TRPV4 mediated activation of airway afferents does not seem to be the exclusive mechanism responsible for cough to osmotic stimuli.

The guinea pig sensitized by ovalbumin is the most widely used model to study cough experimentally, as the neurophysiology of the vagus nerve in the guinea pig is closest to humans. Nonetheless, the choice of the antigen remains questionable, which influences the translation of results into clinical medicine. The present study seeks to develop an alternative model of cough study using house dust mite sensitization (HDM). Thirty guinea pigs were divided into the HDM group, ovalbumin (OVA) group, and control group based on their cough response to 0.4 M citric acid. In the HDM group animals were sensitized by 0.25 %HDM aerosol, which they inhaled for 5 min over 5 days, followed by inhalation of 0.5 %HDM in the same protocol. Sensitization was confirmed by a skin test. Symptoms of allergic rhinitis were induced by intranasal application of 15 μl 0.5 %HDM and cough challenges with citric acid were performed. Airway resistance was measured in vivo by Pennock’s method. We found that both HDM and OVA-sensitized groups showed a significantly enhanced nasal reactivity and cough response compared with controls. The airway resistance data did not show significant differences. We conclude that the HDM cough model replicates functional aspects of the OVA model, which may make it an alternative to the latter. However, the superiority of the HDM model for experimental cough studies remains to be further explored.

It is known that females cough more than males and have heightened cough sensitivity. What has not been elucidated are the mechanisms of gender differences, although they are believed to be caused by hormones as they occur at puberty with highlight in late adolescence. Chronic cough patients are more often females, some of them experiencing premenstrual worsening of cough. The aim of our study was to determine the effect of female sexual hormones on cough sensitivity, urge to cough, cough sound, laryngeal sensitivity and FeNO in healthy volunteers with normal menstrual cycle (MC) and females taking oral contraceptives (OC). Healthy females with normal MC (11) and females taking OC (11) underwent ENT exam and lung functions test to meet the inclusion criteria. Cough sensitivity and other parameters were examined in follicular and luteal phase. Level of oestrogen, progesterone,prolactin, LH and FSH were determined from blood and phase of MC was confirmed by USG. Cough sensitivity expressed as C2 and C5 increased significantly in luteal phase. FeNO and FEV1/FVC also followed the cyclic pattern in MC group, but not in OC. Urge to cough is similar in both groups, with premenstrual drop. Correlation analysis showed negative correlation of C2 & C5 with oestrogen levels in follicular phase and luteal phase (r=-0.44) and also negative correlation between C2 & C5 and progesterone in luteal phase (r=-0.19). Our data document hormonal influences on the cough sensitivity and indicate that premenstrual worsening of chronic cough could be caused by hormonally influenced rise of TRP channels activity with stronger correlation to oestrogen then progesterone.

Background Nowadays, the vast majority of research focusing on cough in sensitive and/or hyperreactive airways is done on an animal model of guinea pigs intraperitoneally sensitized by ovalbumin. There are no objections to model animal – the neurophysiology and neuropharmacology of their n. X are closest to humans. However, the choice of ovalbumin as model antigen together with the route of administration remains questionable – allergy to chicken eggs in humans manifests as food allergy, not respiratory allergy. These limitations may represent possible obstacles in translation of results in daily clinical practice. Therefore there is need to develop and validate new model of airway hypersensitivity, which would simulate real-life conditions more closely and new model could improve translation of results. Most important indoor allergen for people are house dust mites (HDM), most common species being D. pteronyssius and D. farinae. Their allergenic potential is complex – it includes immunogenic epitopes, faecal pellets, lipopolysaccharides, betaglucans and chitin.

Background Upper airway diseases (e.g. allergic rhinitis (AR)) are one of most common causes of chronic cough in subjects with negative X-ray finding. In UACS (upper airway cough syndrome), cough is strongly associated with the ongoing nasal inflammation. Effective treatment of nasal inflammation may lead to down regulation of pathologically enhanced chronic cough. Histamine plays a critical role in upper airway diseases. All known histamine receptors (H1R, H2R, H3R, and H4R) have been demonstrated in the nasal mucosa. Old generation of antihistamines (inverse agonists of H1R) are empirically used in treatment of UACS, although their clinical use is limited by their serious adverse effects. The aim of our study was to ascertain the effect of H3R selective agonist imetit known to suppress release of substance P from afferent nerves in allergic nasal inflammation on cough and symptoms of AR in an animal model.

Excessive accumulation of histamine in the body leads to miscellaneous symptoms mediated by its bond to corresponding receptors (H1-H4). Increased concentration of histamine in blood can occur in healthy individuals after ingestion of foods with high contents of histamine, leading to histamine intoxication. In individuals with histamine intolerance (HIT) ingestion of food with normal contents of histamine causes histamine-mediated symptoms. HIT is a pathological process, in which the enzymatic activity of histamine-degrading enzymes is decreased or inhibited and they are insufficient to inactivate histamine from food and to prevent its passage to blood-stream. Diagnosis of HIT is difficult. Multi-faced, non-specific clinical symptoms provoked by certain kinds of foods, beverages and drugs are often attributed to different diseases, such as allergy and food intolerance, mastocytosis, psychosomatic diseases, anorexia nervosa or adverse drug reactions. Correct diagnosis of HIT followed by therapy based on histamine-free diet and supplementation of diamine oxidase can improve patient's quality of life.

Cough accompanying acute respiratory tract disorders is a self-limiting phenomenon, and it usually does not require sophisticated management. Chronic cough, in contrast, is a bothersome problem, considerably influencing the quality of life of affected individuals. Specialized cough clinics report that substantial proportion of their patients are middle aged-to-postmenopausal females who cough for years in response to otherwise non-tussigenic stimuli, without a clear underlying disease reason. A newly established entity – ‘cough hypersensitivity syndrome’ explains pathogenesis of this problem. However, the syndrome has not been generally accepted, and the guidelines regarding the diagnostic protocols and treatment are not yet available. The reason why females cough more than males do is unclear, but the analysis of literature and experience with the chronic cough patients allows selecting three main targets of hormonal background which can contribute to the enhanced coughing in females. They are as follows: increased activity of transient receptor potential (TRP) channels expressed on vagal C-fibers mediating cough, laryngeal hypersensitivity and laryngeal dysfunction with paradoxical vocal cord movement, and mast cells which are known to express receptors for female sexual hormones and are frequently found in the bronchoalveolar lavage in chronic cough patients. In this review we analyze the potential contribution of the factors above outlined to excessive cough in female subjects.

Background Cough, the most important airways defensive mechanism is modulated by many afferent inputs either from respiratory tussigenic areas, but also by afferent drive from other organs. In animal models, modulation of cough by nasal afferent inputs can either facilitate or inhibit the cough response, depending on the type of trigeminal afferents stimulated. Methods In this study we addressed the question of possible bidirectional modulation of cough response in human healthy volunteers by nasal challenges with TRPA1 and TRPM8 agonists respectively. After nasal challenges with isocyanate (AITC), cinnamaldehyde, (−) menthol and (+) menthol (all 10-3 M) nasal symptom score, cough threshold (C2), urge to cough (Cu) and cumulative cough response were measured). Results Nasal challenges with TRPA1 relevant agonists induced considerable nasal symptoms, significantly enhanced urge to cough (p Conclusions In addition to trigeminal afferents expressing TRP channels, olfactory nerve endings, trigemino – olfactoric relationships, the smell perception process and other supramedullar influences should be considered as potential modulators of the cough response in humans.

Worldwide more than several hundred million humans are exposed to severe air pollution, and a significant part of them also smoke. The effect of air pollution on human health has been recognized for many years. The nose, as the first portal of entry to the respiratory system is constantly exposed to a large volumes of air, which is composed of a mixture of gases, particulate matter and infectious agent, and any material other than physiological amount of oxygen, nitrogen, carbon dioxide and water is considered as pollutant. Being exposed to critical amount of air pollutants, nasal cavity shares sophisticated system of protective and defensive mechanisms regarding the lower airways and lungs, however the highest risk of direct exposure to relevant air pollutants is just within the nose. Air pollution is considered to be responsible for some of the pathological processes affecting airways prone to allergic reactions in predisposed subjects, onset of nasal sensorineural hyperresponsiveness, nonspecific inflammation, sinonasal cancer and definitely, the risk is not limited just to the nasal mucosa, but can proceed toward the lower airways. The broad spectrum of irritants probably shares very similar molecular background of action. They are capable to activate the cation channenl tranisient receptor potential A1-TRPA1 by covalent modification of the channel protein, because many of them are highly reactive and nonstable molecules with possibilities for various chemical reactions. Activation of this channel is responsible for nociceptive reactions mediated by stimulation of afferent trigeminal nerves, retrograde release of tachykinins, activation of parasympathetic afferent drive leading to increase of mucus output and decrease of nasal patency, with subsequent alteration of nasal functions. Based on the recently described neuro-immune bidirectional relationships, air pollutants may be responsible for recruitment of immune cells with infiltration of the nasal mucosa possibly leading to the inflammatory processes and allergies. Our paper is discussing the nose as the target for air pollution, and focuses on the relevance of TRPA1 channel on trigeminal afferents in pollution mediated responses.

Cough is a phenomenon frequently associated with upper airway diseases and as a reflex is modulated by many afferent inputs either from respiratory tussigenic areas, but also by afferent drive from other organs. Modulation of cough by nasal afferent inputs could either facilitate cough response or inhibit it in animal models, depending on the type of trigeminal afferents which are stimulated. In recent study we focused on afferents expressing TRPA1, TRPM8 & TRPV3 channels -- channels known as relevant for airway irritants (TRPA1), menthol and other cooling substances (TRPM8) and thymol (TRPV3). Particularly menthol and thymol are substances which are frequently used in over-the-counter medication for cough and common cold based on empirical approach. Objective evidence regarding the modulation of cough in humans has never been reported. 60 human healthy volunteers participated in the study, and they have been challenged by intranasal drops containing agonists of selected ion channels: isocyanate (AITC) & cinnamaldehyde for TRPA1, (-) menthol and (+) menthol for TRPM8 and thymol for TRPV3 ion channels in randomized order (all 10-3 M). Nasal symptom score, cough threshold (C2), urge to cough (Cu) and cumulative cough response had been assessed using capsaicin cough challenge tests. Nasal challenges of TRPA1 relevant agonists induced considerable nasal symptoms, significantly enhanced urge to cough (p < 0.05) but modulation of C2 and cumulative cough response did not reach significance level. Both TRPM8 agonists and TRPV3 agonist thymol administered to the nose significantly modulated all parameters including C2 (p

Nitric oxide (NO) is an important endogenous mediator with significant role in the respiratory system. Many endogenous and exogenous factors influence the synthesis of NO and its level is significantly changed during the inflammation. Analysis of nasal nitric oxide (nNO) is not validated so far as the diagnostic method. There is a lack of reference values with possible identification of factors modulating the nNO levels. In healthy adult volunteers (n=141) we studied nasal NO values by NIOX MINO® (Aerocrine, Sweden) according to the recommendations of the ATS & ERS. Gender, age, height, body weight, waist-to-hip ratio, FEV1/FVC, PEF and numbers of leukocytes, eosinophils, basophils and monocytes were studied as potential variables influencing the levels of nNO. The complexity of the results allowed us to create a homogenous group for nasal NO monitoring and these data can be used further as the reference data for given variables. Because of significant correlation between nNO and exhaled NO, our results support the “one airway – one disease” concept. Reference values of nasal NO and emphasis of the individual parameters of tested young healthy population may serve as a starting point in the non-invasive monitoring of the upper airway inflammation.