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Hot-Wired to Cough: Your Throat’s Nerve Endings are on Fire!

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If you think of your body like a map of a city, you may visualize cough living in the following neighborhoods:  lungs, chest, and upper respiratory system.  But some coughs have a different address: some coughs live in the nerve endings in the back of the throat. Neighborhoods are all different. They dress different. Have different slang. Perhaps they have different shops and restaurants. And all these differences create a unique environment.  Let’s take Jane Smith, for example. Read more

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10 Questions to Test Your Medical IQ

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How much about chronic cough do you know? Do you suffer from persistent coughing or a nagging itch at the back of your throat? How about a friend? A loved one? A colleague?

Knowledge is power. Knowing what your symptoms mean can help to restore health and happiness!

So…do you consider yourself a medical wizard? Test your knowledge today!

 

Take the Chronic Cough Quiz! Read more

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Dr. Sher Leads National Conversation on Chronic Cough

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“Cough is the most frequent illness-related reason people visit their doctor,” according to the Centers for Disease Control and Prevention’s National Center for Health Statistics.

But not all coughs are created equal.   Some people are dealing with an active upper respiratory infection or the aftermath, and others have a cough that just won’t go away.  A cough that lasts eight weeks or longer is considered a “chronic cough.” 10% of the population have a chronic cough and a large number from this group cannot find effective treatment because their physicians are diagnosing and treating the symptoms rather than the underlying cause. Read more

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Did you know chronic cough could be asthma?

Did You Know?

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Persistent cough is an often overlooked sign of asthma according to a study by National Jewish Health in Denver, Colorado.  Persistent, or better known as chronic cough, affects approximately 10% of the population and can be a symptom of many underlying causes, some of which are unexplained. Patients who are treated for their symptoms rather than their root cause often become frustrated and feel hopeless because they just can’t seem to get better. In reality, these root causes are not always obvious. Read more

Yankees’ Teixeira’s Problem: Damaged vocal cords

New York Yankees Mark Teixeira was suffering with a lingering cough.  He had seen doctors to have his cough evaluated, but it wasn’t until he saw a doctor who used a rhinoscope, an advanced diagnostic tool,  that a diagnosis of damaged vocal cords was made.  Dr. Mandel Sher at Center for Cough is specially trained in the use of rhinoscope and is one of the very few doctors in the Tampa Bay area offering this test. A rhinoscope is a thin tube-like instrument with a light to examine the inside of the nose.

Contact Dr. Sher to schedule a comprehensive cough evaluation that will yield a precise diagnosis and result in a cough treatment plan:  727-393-8067.

“When you have damaged vocal cords,” the doctor told  Teixeira, “you’re always having a cough-gag reflex. So it’s actually really good news for me because we think we’ve found the reason for all this.”

“She gave me some medicine that will hopefully calm the nerve down. It kind of puts my mind at ease” said Mark Teixeira.

“In other words, some of his more severe coughing fits triggered the damage.” continued the ear, nose, and throat doctor.

“That’s why all of my blood tests were clear, that’s why my chest X-rays were clear,” said Teixeira, who had seen several doctors, including a chest specialist in mid-May who diagnosed him with “inflamed bronchial airways”

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.

 

read more from abcnews.com

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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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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