Dr. Mandel Sher In North Carolina: New Concepts in Chronic Cough

Dr. Sher in North Carolina: Emerging Concepts in Chronic Cough “New Concepts in Chronic Cough”  presented by Dr. Sher to his North Carolina colleagues was just the invitation he needed to return to beautiful North Carolina.  Dr. Sher began his specialty training at Duke Health System in Durham, North Carolina, after graduating from Northwestern University’s medical school in Chicago, Illinois.  The scientific and medical community’s understanding of Chronic Cough causes and treatments are evolving rapidly and it was Dr. Sher’s pleasure to share these new concepts.     

Mandel Sher, MD, Medical Director of Center for Cough, spoke to the North Carolina Allergy, Asthma and Immunology Society’s annual meeting on Saturday, February 6, 2016 on “New Concepts in Chronic Cough”.  Dr. Sher is one of the nation’s leading investigators studying new scientific and clinical findings about the causes of Chronic Cough and effective cough treatments.  These new concepts in Chronic Cough have the promise of expanding our understanding of this debilitating medical condition and treating it effectively.

Chronic cough affects 12 to 15% of the population and has debilitating consequences:  Depression, Social Isolation, Fatigue, and Urinary Incontinence to name a few.  Dr. Sher spoke about the current unmet need in cough treatment and the promising cough treatments in the future.  Dr. Sher addressed the paradigm shift in the diagnostic and cough treatment approach to now focus on overly sensitive cough mechanism particularly in people who are hard-wired to cough. 

“The hypersensitive cough reflex is the primary cause of chronic cough triggered by multiple factors including viral respiratory infections, allergies, asthma and acid reflux”, Dr Sher told the group of North Carolina allergists.”

 

 

 

Can Talking be Contributing to your Chronic Cough?


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Can talking be contributing to your Chronic Cough?  Yes!  Talking by someone who has an overly sensitive cough mechanism can result in coughing fits.  The act of talking dries the throat and the dry throat acts as an irritant to the cough mechanism. So, it may not be surprising that Presidential Candidate Hillary Clinton experienced an “uncontrollable coughing fit” while speaking in Hanoi in 2012.  The coughing episode resulted in Mrs. Clinton concluding her remarks early.

Chronic Cough can diminish professional performance.  Physical fatigue and anxiety associated with cough occurring at an inopportune time can be distracting.  Chronic Cough can also cause colleagues to avoid working with you for fear that you are sick and contagious.

Sometimes, cough is an indication of an underlying and significant medical problem.  Sometimes, Chronic Cough is THE problem.  Dr. Mandel Sher, Medical Director and Founder of Center for Cough, is a Cough Doctor.  He understands the debilitating consequences of Chronic Cough.  A comprehensive diagnostic and cough treatment approach results in precise identification of your cough cause(s) and cough treatment that will be effective.

If you or someone you know is suffering with Chronic Cough, contact Dr. Mandel Sher:  727-393-8067.

 

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AF-219: Promising New Cough Treatment

Dr. Mandel Sher and Center for Cough are the nation’s leading site for clinical research trials for new cough treatments.  Currently, Center for Cough is enrolling eligible patients in Afferent Pharmaceuticals AF-219 clinical research trial. Preliminary results suggest AF-219 may be a promising new cough treatment.

Contact Amy, Center for Cough’s Clinical Research Coordinator, to learn more about this clinical research trial and other that may be available:  727-393-8067

“…Pathologic Cough – Debilitating & Potentially Chronic Neurogenic Disorder Affecting Millions Cough is the symptom for which patients most often seek medical attention. Pathologic cough or non-productive cough serves no functional purpose, and can occur following an upper respiratory infection. In most patients, this cough manifests itself as an acute cough lasting a few weeks. However, in some patients, sensitized nerve fibers fail to return to a normal quiescent state, resulting in sub-acute or chronic cough lasting months to years. The prevalence of chronic cough is estimated to be over 10% of adults in the U.S. While an underlying etiology may contribute to cough in some of these patients (such as GERD, asthma, COPD, etc.), many patients are not well-controlled for their cough even with treatment for such underlying etiology, or with the addition of currently available cough medications…” read more

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Positive Results in Chronic Cough Trial

Afferent Pharmaceuticals Announces Positive Results in Phase 2b Chronic Cough Trial

AF-219 Treatment Significantly Reduces Cough Frequency in Patients

SAN MATEO, Calif.–(BUSINESS WIRE)–Afferent Pharmaceuticals, a leader in the development of small molecule compounds targeting P2X3 for the treatment of poorly managed and common neurogenic disorders, such as chronic cough, today announced positive top-line results from its Phase 2b dose escalation clinical trial of AF-219 in chronic cough patients. AF-219 is a selective, non-narcotic and orally administered P2X3 antagonist that targets the mechanism by which certain nerve fibers become hyper-sensitized and can lead to chronic and debilitating symptoms. The results of this clinical trial will be presented at a scientific meeting in the future.

“Our promising Phase 2b results demonstrate AF-219’s potential to be a first-in-class therapy, with the potential to replace the current, often ad hoc treatments that have little impact on cough frequency or result in possibly serious side effects or carry abuse potential,” said Kathleen Sereda Glaub, Afferent’s chief executive officer. “With the robust reductions in cough frequency following AF-219 treatment confirmed in this second study, we are committed to a full development program to advance this non-narcotic treatment for the benefit of the many patients suffering from chronic cough.”

Jaclyn Smith, M.B., Ch.B., MRCP, Ph.D. and professor and honorary consultant in Respiratory Medicine, University of Manchester and University Hospital Manchester NHS Foundation Trust, a leading investigator in the field of chronic cough, said “Chronic cough has widespread effects on patients’ quality of life, and a new therapy with increased efficacy and substantially reduced adverse events will have a meaningful impact and address a significant unmet need. I am excited by the consistency of the findings demonstrated in the AF-219 program, and I look forward to the continuing progress of these efforts.”

Significant Efficacy and Improved Tolerability Shown With Lower Doses

The study randomized 29 chronic cough patients. Doses of 50 mg, 100 mg, 150 mg and 200 mg twice daily for 4 days demonstrated significant reduction in cough frequency, including at the lowest dose of 50 mg twice daily. Cough frequency was measured objectively utilizing a cough recording device, with periodic measurements following AF-219 treatment compared to a baseline recording.

All AF-219 doses, including the lowest dose of 50 mg twice daily, demonstrated a statistically significant reduction in awake cough frequency compared to placebo (p≤0.002).

AF-219 was generally well tolerated. The incidence of decreased taste acuity, as observed in the first study at 600 mg twice daily, was much less at the 50 mg dose. Only one patient discontinued treatment at any dose in the current study, due to the taste effect.

Afferent’s previous high-dose proof-of-concept trial demonstrated a 75% reduction in cough frequency (Intent-to-Treat population) in 24 refractory chronic cough patients with AF-219 treatment 600 mg twice daily for two weeks. In the first study, six of 24 patients discontinued treatment due to a change in taste acuity (published in the Lancet, March 2015; online November 2014).

About the Phase 2b Trial

The 29-patient randomized, double-blind, placebo controlled, Phase 2b crossover study was conducted at 10 clinical sites in the U.S. Patients were randomized to either AF-219 or placebo arms. Those in the treatment group received AF-219 50 mg, followed by a titration up to 100 mg, 150 mg and 200 mg, with each dose given twice daily for four days. Treatment period one was followed by a 3-5 day washout period. Patients were then crossed over to the alternate arm of the study and treated with either AF-219 or placebo for 16 more days.

Pathologic Cough – Debilitating & Potentially Chronic Neurogenic Disorder Affecting Millions

Cough is the symptom for which patients most often seek medical attention. Pathologic cough or non-productive cough serves no functional purpose, and can occur following an upper respiratory infection. In most patients, this cough manifests itself as an acute cough lasting a few weeks. However, in some patients, sensitized nerve fibers fail to return to a normal quiescent state, resulting in sub-acute or chronic cough lasting months to years. The prevalence of chronic cough is estimated to be over 10% of adults in the U.S. While an underlying etiology may contribute to cough in some of these patients (such as GERD, asthma, COPD, etc.), many patients are not well-controlled for their cough even with treatment for such underlying etiology, or with the addition of currently available cough medications.

P2X3 Receptors Role in Hyper-sensitization and Pathology

The P2X3 receptor, the target for Afferent’s lead AF-219, is predominantly expressed in nociceptive C-fiber primary afferent nerves that innervate most tissues and organs, including the skin, joints, and the hollow organs such as the airways and bladder. These primary afferent neurons are not important in normal physiological or defensive sensing processes, but rather become activated and sensitized under pathological conditions by a common cellular signal, ATP, such as following nerve injury, infection or inflammation.

P2X3 receptor-mediated sensitization has been implicated in inflammatory, visceral and neuropathic pain states, as well as airways hyper-reactivity, migraine, itch and cancer pain.

Afferent’s first-in-class compounds selectively target P2X3 channels in order to block the activation of these afferents by ATP.

About Afferent Pharmaceuticals

Afferent Pharmaceuticals is a clinical-stage biotechnology company and leader in the development of novel drugs for the treatment of a range of debilitating neurogenic disorders. These disorders affect millions of patients who suffer from chronic respiratory and urologic sensory pathologies as well as chronic pain and cardiovascular disorders, and who have limited, if any, treatment options. These chronic pathologies arise when certain nerve fibers become hyper-sensitized as a result of inflammation, distress, infection or tissue injury, and sometimes remain chronically sensitized for months and even years.

Afferent is developing molecules that selectively block P2X3, a purinergic receptor, which plays a key role in the sensitization of these nerves. Afferent’s lead molecule, AF-219, is a first-in-class P2X3 antagonist, and is being developed for the treatment of chronic cough. For more information on the company, please visit Afferent’s website atwww.afferentpharma.com.

Contacts

Afferent Pharmaceuticals Amy Pfeiffer, 650-286-1276 info@afferentpharma.com or Media: Burns McClellan, Inc. Justin Jackson, 212-213-0006, Ext. 327 jjackson@burnsmc.com

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What’s Causing You to Cough?

We all cough.  Cough is an important function.  But like many things, too much of a good thing is no good.  The first and most important step toward effective cough treatment is understanding what’s causing cough.  And there’s a meaningful difference between identifying the underlying cause of your cough and the triggers or irritants or stimuli that tickle your body’s cough mechanism and produce  cough.  Real and lasting success relies on addressing what’s causing cough rather than the symptom.

Dr. Mandel Sher and Center for Cough team accurately diagnose the cause and triggers of your unique cough. Accurate diagnosis is the foundation of an individualized and effective cough treatment plan.

Cough evaluation includes a thorough medical history and physical exam exploring your cough symptoms and their effects on your daily activities. Previous physician visits, laboratory testing, X-rays, and diagnostic procedures will be reviewed. Based on this evaluation, further testing may be performed at the initial visit using advanced diagnostic tools. These tools include:

  • Rhinolaryngoscopy
  • Pulmonary function studies
  • Pulmonary inflammatory testing (expired nitric oxide)
  • Allergy testing
  • Oropharyngeal pH (acid) probe

Precision cough diagnosis avoids a trial and error approach with cough treatments that prove to be ineffective.  Accurate diagnosis and targeted cough treatment also shortens the time it takes for people suffering with Chronic Cough to feel better.  More than 8 out of 10 Center for Cough patients demonstrate measurable improvement in their cough and life. 

Dr. Sher is a Cough Specialist.  He is the only doctor in the southeastern United States, and one of only a few in the nation, who focuses on being a cough doctor.  Dr. Sher and Center for Cough team have a comprehensive approach to cough diagnosis and cough treatment.  In almost all cases, cough evaluation and recommendation of cough treatment occurs during a single outpatient visit to the Center for Cough  office.

If you or someone you know suffers with Chronic Cough, contact Dr. Mandel Sher at Center for Cough: 727-393-8067.

 

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Chronic Cough and Upper Airway Cough Syndrome

There are many irritants that can trigger Chronic Cough.  That is why it is so important to see a Cough Doctor who can precisely diagnose the cause(s) and trigger(s) of your Chronic Cough.  Upper Airway Cough Syndrome is a common contributor to Chronic Cough.  Examples of upper airway irritants include: Allergic rhinitis, vasomotor rhinitis, and sinusitis.

Imagine a game of dominoes.  Upper Airway Cough Syndrome and Chronic Cough can mimic a game of dominoes.  Nasal inflammation from allergies and/or infection contribute to irritating the cough mechanism.  Symptoms of Upper Airway Cough Syndrome are a sensation of post nasal drip at the back of the throat, nasal discharge, or throat clearing. Treatment often includes nasal saline, antihistamines, nasal steroids, and ipratropium bromide.

If you have a persistent cough that won’t go away, contact Dr. Mandel Sher at Center for Cough to have your cough evaluated and begin cough treatment targeted specifically to your cough:  727-393-8067.

Sometimes, cough is a symptom of an underlying and serious medical problem.  Sometimes, Chronic Cough is THE problem.  A cough that won’t go away should not be ignored.  Prompt cough evaluation and cough treatment plan minimize your and your loved ones’ concerns that something more serious can be going on.

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Chronic Cough and GERD with Symptoms or Silent

Did you know that GERD can be a silent contributor to Chronic Cough?  While there are often classic symptoms associated with GERD, sometimes GERD is silent and there are no telltale symptoms.  That is why it is important to see a Cough Doctor who carefully reviews your medical history with you and looks for clues.  Questions about diet, reclining or lying down position, time of day, and cough while or after eating may offer you and the Cough Doctor clues about the role of GERD in Chronic Cough.

Dr. Mandel Sher, Medical Director and Founder of Center for Cough, is a Cough Doctor.  Dr. Sher offers patients a comprehensive diagnostic and cough treatment approach.  Over 8 out of 10 Center for Cough patients demonstrate a remarkable reduction in the frequency and intensity of cough.  When Chronic  Cough is normalized, patients report an overall improvement in daily living activities.  Professional performance, energy level, social engagement, and personal relationships improve when cough is normalized.

Persistent cough that won’t go away should not be ignored.  Sometimes, cough is an indication of an underlying and serious medical problem.  Sometimes, Chronic Cough is THE problem!

Cough can be triggered by gastro esophogeal reflex disease (GERD) or can be associated, but not triggered, by GERD. GERD triggered or associated coughs sometimes have symptoms of hoarseness, throat clearing, and sore throat, or is asymptomatic in others. Treatment often includes simple and effective dietary changes and Proton Pump Inhibitor (PPI) medications aimed at reducing gastric acid production.

Do not guess or make assumptions about the cause of your cough.  Do not waste time and money on cough treatments that are not targeted to your type of cough.  Contact Dr. Mandel Sher at Center for Cough for a comprehensive cough evaluation and cough treatment plan:  727-393-8067.

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Your Medicine May Be Making You Cough

Angiotensin-Converting Enzyme (ACE) Inhibitors found in some prescription medications can be associated with Chronic Cough.  It is important to never stop a medication without first discussing the consequences with the ordering physician.  But a Cough Doctor can precisely diagnose the cause(s) of your Chronic Cough and the role of ACE Inhibitor medication in your situation.

A persistent, dry, tickling cough is a relatively common result of ACE inhibitors, such as lisinopril, which are used to treat hypertension, heart and kidney diseases. Cough may occur within hours of the first dose of medication, or its onset can be delayed for weeks to months after the initiation of therapy. Treatment with ACE inhibitors may sensitize the cough reflex, thereby potentiating other causes of chronic cough.

The mechanism of ACE inhibitor induced cough is not fully understood but probably is associated with increases in bradykinins that activate the cough reflex. Although cough usually resolves within 1 to 4 weeks of the cessation of therapy with the offending drug, in a subgroup of individuals cough may linger for up to three months. A different drug class, angiotensin receptor blockers (ARBs), do not cause cough, even in those patients with a history of ACE inhibitor-induced cough.

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Cough Treatment

Did you know that not all coughs are created equal? Different types of cough require different diagnostic approaches and different cough treatments.  So, when it comes to cough treatment, there is no universal solution.

To be effective, cough treatment must target the specific cause(s) and trigger(s) of your unique cough.  Do not waste time and money and expose yourself to risks or side effects with the wrong cough treatment.

Dr. Mandel Sher is a Cough Doctor.  He understands the debilitating impact of Chronic Cough on living life to the fullest.  As a Chronic Cough specialist, he and the Center for Cough team offer people suffering with Chronic Cough a comprehensive diagnostic and cough treatment approach.  At Center for Cough, Dr. Sher balances innovation with evidence-based medicine.  All his services are recognized by Medicare and other major insurance companies and are covered medical services.  Contact Dr. Mandel Sher if you or someone you know has a cough that won’t go away:  727-393-8067. 

Chronic Cough is a complex medical condition with multiple contributing factors.  Cough treatment for Chronic Cough involves medical detective work upfront to establish an individualized profile of your unique cough.  Then, a choreography of prescription and over-the-counter medications and voice exercises and therapy can begin.

A common cause of Chronic Cough is an overly sensitive cough mechanism that is easily irritated to produce cough.  This syndrome is called “hypersensitive cough reflex” in the medical literature.  The cough reflex has three components: neurogenic, inflammatory, and behavioral. Generally, medication aimed at cooling down the cough reflex is part of the cough treatment plan.

The importance of beginning with a precise diagnosis of the cause(s) and trigger(s) of your cough cannot be overstated.  A sequential, trial and error approach to cough treatment is often ineffective, wastes time and money, and includes unnecessary risks and side effects of the medication.  A comprehensive cough treatment approach expedites relief from cough and is based on each unique patient’s situation.

 

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Chronic Cough and Triggers

Our body’s cough mechanism is stimulated by irritants that produce cough.  These irritants are also known as Chronic Cough and its triggers.  Upon learning about Chronic Cough and Triggers, a Center for Cough patient declared, “I’m trigger happy.”

Dr. Sher and Center for Cough team identify the precise Chronic Cough cause and Chronic Cough triggers.  Each person has a unique cough profile.  Understanding your cough profile is the first and most important step toward effective cough treatment.  Chronic Cough can be triggered by a variety of medical conditions.  Below are the  most common Chronic Cough triggers.

Persistent cough that does not go away can be an indication of an underlying serious medical problem. Only precise diagnosis of your cough’s cause and its triggers can reveal if cough is a symptom or if cough is THE problem.

If you or someone you know has Chronic Cough, contact Dr. Mandel Sher at Center for Cough.  A comprehensive cough diagnostic approach and cough treatment plan is the first step toward measurable and lasting cough relief.  Please call:  727-393-8067.