Clinical presentation and disease course in patients with flu-like illness: does microbiological aetiology matter?

Background: There is little evidence about the relation between aetiology, illness severity and clinical course of respiratory tract infections (RTI) in primary care. Understanding these associations would aid to develop effective management strategies for these infections. Aim: To investigate whether the clinical presentation and illness course differ between RTI in whom a viral pathogen was detected and those in whom a potential bacterial pathogen was found. Design and setting: Post hoc analysis of data from a pragmatic randomised trial on the effects of oseltamivir in patients with influenza-like illness (ILI) in primary care (n=3266) in 15 European countries. Methods: Patient characteristics, signs and symptoms were registered at baseline. Naso-pharyngeal (adults) or nasal and pharyngeal (children) swabs were taken for PCR analysis. Patients were followed up until 28 days after inclusion. Regression models and Kaplan-Meier curves were used to analyse the relation between aetiology, clinical presentation at baseline and course of disease including complications. Results: Except for a less prominent congested nose (OR 0.55, CI 0.35 – 0.86) and acute cough (OR 0.52, CI 0.27 – 0.65) in ILI patients in whom a possible bacterial pathogen was isolated, there were no clear clinical differences in presentations between those with a possible bacterial aetiology than in those with a viral one. Also the course of disease and complications were not related to aetiology. Conclusion: Given the currently available microbiological tests and antimicrobial treatments, and outside pandemics like COVID-19, microbiological testing in primary care patients with ILI seems to have limited value.

Predictors of the Development of Protracted Bacterial Bronchitis following Presentation to Healthcare for an Acute Respiratory Illness with Cough: Analysis of Three Cohort Studies

We describe the prevalence and risk factors for protracted bacterial bronchitis (PBB) following healthcare presentation for an acute cough illness in children. Data from three studies of the development of chronic cough (CC) in children were combined. PBB was defined as a wet cough of at least 4-weeks duration with no identified specific cause of cough that resolved following 2–4 weeks of appropriate antibiotics. Anterior nasal swabs were tested for 17 viruses and bacteria by polymerase chain reaction. The study included 903 children. Childcare attendance (adjusted relative risk (aRR) = 2.32, 95% CI 1.48–3.63), prior history of chronic cough (aRR = 2.63, 95% CI 1.72–4.01) and age <2-years (<12-months: aRR = 4.31, 95% CI 1.42–13.10; 12-<24 months: aRR = 2.00, 95% CI 1.35–2.96) increased risk of PBB. Baseline diagnoses of asthma/reactive airways disease (aRR = 0.30, 95% CI 0.26–0.35) or bronchiolitis (aRR = 0.15, 95% CI 0.06–0.38) decreased risk. M. catarrhalis was the most common organism (52.4%) identified in all children (PBB = 72.1%; no PBB = 50.2%, p < 0.001). We provide the first data on risks for PBB in children following acute illness and a hypothesis for studies to further investigate the relationship with wheeze-related illnesses. Clinicians and parents/guardians should be aware of these risks and seek early review if a wet cough lasting more than 4-weeks develops the post-acute illness.

Possibilities of phyto preparations in treatment of patients with acute cough

Patients with complaints of coughing make up a significant percentage of doctors in various specialties. Cough is not an independent disease, in most clinical cases it is a symptom of a respiratory disease. In acute respiratory pathology, the cough is usually short-lived and stops after the eradication of the infectious agent and the relief of inflammatory changes. It is important therapeutically to provide a reduction in the duration and relief of cough, as well as the prevention of complications. An effective symptomatic agent in the treatment of coughs of various origins, including inflammatory diseases of the respiratory tract, are herbal preparations. The fairly widespread use of phytopreparations in clinical practice is due to their high safety, physiological action, availability and effectiveness. The pharmacological action of these drugs in respiratory infections is manifested by antiinflammatory, cytoprotective, antiviral and antioxidant effects, multifactorial improvement of mucociliary cleansing processes. One of these phytopreparations is a monocomponent syrup with expectorant, mucolytic and antispasmodic. The therapeutic effect of drug is explained by the presence in the composition of triterpene glycosides (saponins) from the leaves of Hedera helix . The effectiveness and safety of drug is proved by a sufficient volume of clinical studies and observations. Literature data show that Hedera helix leaf preparations significantly reduce the severity of acute respiratory infections of the upper respiratory tract.Virtually none of the patients had severe side effects. Allergic reactions were recorded in less than 0.5% of cases, with no mention of a severe allergic reaction of the anaphylaxis type. Thus, the drug of plant origin in the form of drops can be successfully used in patients with symptoms of acute respiratory diseases.

High Prevalence of Gastroesophageal Reflux Symptoms in Patients with both Acute and Nonacute Cough

Background and Aim: Gastro esophageal reflux disease (GERD) affects more than 30% of the Asian population, and its symptoms are common. The high prevalence of atrophic gastritis in the Pakistani population is exacerbated by gastro esophageal reflux disease. The present study aims was to assess the high prevalence of gastro esophageal reflux symptoms in patients with both acute and no acute cough. Materials and Methods: This cross-sectional study was conducted on 426 consecutive patients who attended the General Medicine and Emergency department of Sheikh Khalifa bin Zayed Hospital Rawalakot and Avicenna Hospital, Lahore from February 2021 to July 2021. Informed consent in written form was taken from all the patients. Patients with partial gastrectomy previous history and user of antagonist H2-receptor, steroids, proton pump inhibitor (PPI), and other inflammatory drugs two months prior to the investigation were excluded. Helsinki Declaration was utilized for this study with ethical approval taken from the hospital ethics committee. SPSS version 24 was used for data analysis. Results: Of the total 426 patients, GERD diagnosed patients were 248 (58.2%) and 178 (41.8%) had respiratory symptoms. The prevalence of GERD symptoms was higher in respiratory symptoms patients compared to without respiratory symptoms patients (p-value=0.05). Out of 178respiratory symptoms patients, GERD symptoms were present in 71 (39.9%) of acute cough while 107 (60.1%) of non-acute cough while 86 (34.7%) of 248 had no respiratory symptoms. The GERD development has no significant association with respiratory symptoms duration, however, patients having respiratory symptoms are at substantially elevated risk for GERD development. Conclusion: Our study found that respiratory symptoms patients are considerably more likely to develop GERD. GERD prevalence was similar in both acute and non-acute cough patients, implying that the presence of respiratory diseases is associated with the development of GERD regardless of the duration of respiratory symptoms. Keywords: Gastro esophageal reflux; Acute cough; Respiratory symptoms

Acute cough: for the first time, a clear recommendation for ambroxol as symptomatic treatment

According to the guidelines of the German Respiratory Society, an acute cold cough without clinical indications of pneumonia or other warning signs, is the domain of self-medication. The duration – up to two weeks – is pivotal for the classification "acute". From their assessment of randomised, controlled studies, the authors concluded that Ambroxol (like several herbal medicines), shortens the duration and/or reduces the intensity of cough in acute bronchitis. Dextromethorphan is recommended by the guideline authors for a dry, troublesome cough associated with an upper respiratory infection.

Non-pharmacological remedies for post-viral acute cough

The post-viral acute cough (PAC) is a widespread symptom, mainly in childhood and adolescence, and is usually associated with an acute upper respiratory infection, namely the common cold. The use of cough relievers is, therefore, impressive, as documented by the market data. There are many medical devices and dietary supplements for treating PAC, which contain non-pharmacological components. Ancient people used traditional herbs to treat PAC. Thus, a well-established tradition considers natural remedies as an effective and safe way to relieve PAC. The herbal agents include polyphenols, flavonoids, saponins, glucosides, and alkaloids. Also, the European Medicine Agency has recognized the value of plant extracts and other natural substances to treat PAC. Nevertheless, a few studies investigated the role of non-pharmacologic remedies for PAC. There is some evidence for honey, glycerol, Althea officinalis, Drosera rotundifolia, Grindelia, Hedera helix, Pelargonium sidoides, Sambucus nigra, Thymus vulgaris, hyaluronic acid, and saline solutions. However, further rigorous studies should confirm natural products' efficacy and safety to relieve PAC.