Coughing - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

COUGHING A 3-IN-1 MEDICAL REFERENCE Medical Dictionary Bibliography & Annotated Research Guide TO I NTERNET

R EFERENCES

COUGHING A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R EFERENCES

J AM ES N. P ARK ER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright ©2004 by ICON Group International, Inc. Copyright ©2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Coughing: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00307-4 1. Coughing-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on coughing. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON COUGHING................................................................................................ 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Coughing....................................................................................... 7 E-Journals: PubMed Central ....................................................................................................... 16 The National Library of Medicine: PubMed ................................................................................ 17 CHAPTER 2. NUTRITION AND COUGHING ...................................................................................... 39 Overview...................................................................................................................................... 39 Finding Nutrition Studies on Coughing ..................................................................................... 39 Federal Resources on Nutrition ................................................................................................... 41 Additional Web Resources ........................................................................................................... 42 CHAPTER 3. ALTERNATIVE MEDICINE AND COUGHING ............................................................... 43 Overview...................................................................................................................................... 43 National Center for Complementary and Alternative Medicine.................................................. 43 Additional Web Resources ........................................................................................................... 48 General References ....................................................................................................................... 77 CHAPTER 4. DISSERTATIONS ON COUGHING ................................................................................. 79 Overview...................................................................................................................................... 79 Dissertations on Coughing .......................................................................................................... 79 Keeping Current .......................................................................................................................... 79 CHAPTER 5. PATENTS ON COUGHING ............................................................................................ 81 Overview...................................................................................................................................... 81 Patents on Coughing.................................................................................................................... 81 Patent Applications on Coughing.............................................................................................. 105 Keeping Current ........................................................................................................................ 115 CHAPTER 6. BOOKS ON COUGHING .............................................................................................. 117 Overview.................................................................................................................................... 117 Book Summaries: Online Booksellers......................................................................................... 117 Chapters on Coughing ............................................................................................................... 118 CHAPTER 7. MULTIMEDIA ON COUGHING ................................................................................... 125 Overview.................................................................................................................................... 125 Video Recordings ....................................................................................................................... 125 CHAPTER 8. PERIODICALS AND NEWS ON COUGHING ................................................................ 129 Overview.................................................................................................................................... 129 News Services and Press Releases.............................................................................................. 129 Newsletter Articles .................................................................................................................... 131 Academic Periodicals covering Coughing.................................................................................. 134 CHAPTER 9. RESEARCHING MEDICATIONS .................................................................................. 137 Overview.................................................................................................................................... 137 U.S. Pharmacopeia..................................................................................................................... 137 Commercial Databases ............................................................................................................... 142 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 147 Overview.................................................................................................................................... 147 NIH Guidelines.......................................................................................................................... 147 NIH Databases........................................................................................................................... 149 Other Commercial Databases..................................................................................................... 151 APPENDIX B. PATIENT RESOURCES ............................................................................................... 153 Overview.................................................................................................................................... 153 Patient Guideline Sources.......................................................................................................... 153 Finding Associations.................................................................................................................. 168

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APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 171 Overview.................................................................................................................................... 171 Preparation................................................................................................................................. 171 Finding a Local Medical Library................................................................................................ 171 Medical Libraries in the U.S. and Canada ................................................................................. 171 ONLINE GLOSSARIES................................................................................................................ 177 Online Dictionary Directories ................................................................................................... 180 COUGHING DICTIONARY ....................................................................................................... 181 INDEX .............................................................................................................................................. 235

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with coughing is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about coughing, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to coughing, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on coughing. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to coughing, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on coughing. The Editors

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the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON COUGHING Overview In this chapter, we will show you how to locate peer-reviewed references and studies on coughing.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and coughing, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “coughing” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Drugs Used to Manage Asthma Source: Access. 15(10): 38-41. December 2001. Contact: Available from American Dental Hygienists' Association. 444 North Michigan Avenue, Chicago, IL 60611. Summary: Asthma is a chronic disease that affects approximately five percent of the population. Asthma is characterized by shortness of breath due to bronchoconstriction and bronchospasm, with a reduced expiratory outflow. Other symptoms include wheezing, coughing, rapid breathing, and tightness of the chest. Asthmatic attacks are triggered by inhaled irritants, respiratory infections, stress, exposure to cold air, and exercise. Symptoms may subside spontaneously or may require the use of an inhaler. This article reviews the drugs used to manage asthma. The goals of asthma therapy are

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to improve airflow, reduce symptoms caused by inflammation, and prevent acute exacerbations. The author discusses beta 2 adrenergic agonists, anticholinergics, corticosteroids, methylxanthines, mast cell degranulation inhibitors, and leukotriene pathway inhibitors. The article concludes with a discussion of dental hygiene practice considerations for working with patients who have asthma. 2 tables. 8 references. •

Asthma and Reflux: When GI and Pulmonary Symptoms Are Linked Source: Consultant. 36(4): 705-707, 712-715, 719-720. April 1996. Contact: Available from Consultant. Cliggott Publishing Company. 55 Holly Hill Lane, Box 4010, Greenwich, CT 06831-0010. Summary: Gastroesophageal reflux disease (GERD) in asthmatic patients may be promoted by bronchodilator usage, supine positions, overeating, and increases in transdiaphragmatic pressures induced by asthma or coughing. In this article, the author summarizes the evidence that links asthma and GERD. Clinical features that suggest a cause-and-effect relationship between GERD and asthma include reflux symptoms that precipitate pulmonary symptoms, nocturnal asthma, laryngeal irritation, and a favorable pulmonary response to antireflux therapy. The author recommends a diagnostic approach that features five essential studies. Treatment options include longterm acid-suppression therapy and surgery. 9 figures. 3 tables. 34 references. (AA-M).

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Risk and Prevention of Transmission of Infectious Diseases in Dentistry Source: Quintessence International. 33(5): 376-382. May 2002. Contact: Available from Quintessence Publishing Co, Inc. 551 Kimberly Drive, Carol Stream, IL 60188-9981. (800) 621-0387 or (630) 682-3223. Fax (630) 682-3288. E-mail: [email protected]. Website: www.quintpub.com. Summary: Health care providers are at risk for infection with bloodborne pathogens, including hepatitis B virus, human immunodeficiency virus (HIV), and hepatitis C virus. This article reviews the risk and prevention of transmission of infectious diseases in dentistry. Recommended infection control practices are applicable to all settings in which dental treatment is provided. Dentists remain at low risk for occupationally acquired HIV. Dental health care workers, through occupational exposure, may have a 10 times greater risk of becoming a chronic hepatitis B carrier than the average citizen. Tuberculosis is caused by Mycobacterium tuberculosis. In general, persons suspected of having pulmonary or laryngeal tuberculosis should be considered infectious if they are coughing, are undergoing cough-inducing or aerosol-generating procedures, or have sputum smears positive for acid-fast bacilli. Although the possibility of transmission of bloodborne infections from dental health care workers to patients is considered to be small, precise risks have not been quantified by carefully designed epidemiologic studies. Emphasis should be placed on consistent adherence to recommended infection control strategies, including the use of protective barriers and appropriate methods of sterilization or disinfection. Each dental facility should develop a written protocol for instrument reprocessing, operatory cleanup, and management of injuries. Such efforts may lead to the development of safer and more effective medical devices, work practices, and personal protective equipment. 14 references.

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Patient Selection and Education for Use of the CapSure (Re/Stor) Continence Shield Source: Urologic Nursing. 19(2): 135-140. June 1999.

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Contact: Available from Society of Urologic Nurses and Associates, Inc. East Holly Avenue, Box 56, Pitman, NJ 08071-0056. (609) 256-2335. E-mail: [email protected]. Summary: Stress urinary incontinence affects millions of women, and many treatment options are available, ranging from behavioral or nonsurgical therapies to surgical intervention. This article reports the clinical findings of a multicenter trial using the CapSure (ReStor) continence shield, a study undertaken to evaluate the safety and efficacy of this device for treating women with stress urinary incontinence (SUI). Additionally, the authors discuss the role of patient education and selection. The CapSure continence shield is a limited, reuse soft suction cup made of silicone, which is placed externally over the urinary meatal area. The shield is designed so that the suction from the device creates negative pressure, which enables coaptation of the urethral walls, thereby increasing urethral resistance. The negative pressure within the device counteracts the pressure created by activities that would usually cause SUI in the female patient (such as sneezing, coughing, running), thereby keeping her dry. The device is not a reservoir that collects the urine during leakage. Overall, data indicated that patients were very satisfied with areas such as ease of placement and removal, ability of the device to remain in place during activity, improved enjoyment in life and self confidence, and degree of comfort. Sixteen of 100 patients withdrew from the study because of device irritation, inability to position the device properly, inability to keep followup appointments, or decision to undergo alternative treatment. The authors conclude with a discussion about patient selection and determining for which patients the CapSure shield would be most appropriate. 5 figures. 2 tables. 11 references. (AAM). •

Intermediate Term Failure of Pubovaginal Slings Using Cadaveric Fascia Lata: A Case Series Source: Journal of Urology. 167(3): 1356-1358. March 2002. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: The pubovaginal sling procedure using autologous (the patient's own) fascia has become the gold standard for treating intrinsic sphincter deficiency and stress urinary incontinence (SUI, involuntary loss of urine upon coughing, laughing, jumping, etc.) in women. A recent modification has been the use of cadaveric fascia as the sling material. The authors recently reported similar results for cadaveric fascia lata in 121 women and autologous fascia lata in 46 women at a mean followup of 12 months. In this article, the authors identify 8 patients who experienced intermediate term failure at 4 to 13 months using cadaveric fascia lata. The authors retrospectively reviewed the records of 8 of 121 patients who received a pubovaginal sling using cadaveric fascia lata between February 1997 and June 1999 and who had recurrent stress incontinence after 4 to 13 months (mean of 6.5 months). Fresh frozen fascia from a local tissue bank was used and the surgical technique was identical in all cases. Postoperatively, urodynamics confirmed recurrent intrinsic sphincter deficiency. Previous incontinence surgery had been done in 7 of the 8 patients. Patient comorbidities (the presence of other illnesses) included neurological disease, diabetes mellitus, previous pelvic irradiation, and previous pelvic surgery. The authors note that the risk of intermediate term failure must be weighed against the advantages of decreased operative time and patient morbidity using cadaveric fascia lata. Longer followup and larger numbers are necessary to determine how much of a problem exists and what patient characteristics are relevant when selecting cadaver grafts. 1 table. 15 references.

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Sling Procedures for SUI: What's New in the 21 Century? Source: Contemporary Urology. 14(11): 34-36, 38,43-44,46-48. November 2002. Contact: Available from Medical Economics Publishing Inc. Montvale, NJ 07645. (800) 432-4570. Summary: The term stress urinary incontinence (SUI) is commonly used to describe the symptom of involuntary urine loss during coughing, sneezing, or other physical activities that increase abdominal pressure. 'Genuine' SUI is defined as the involuntary loss of urine per urethra with no change in detrusor pressure. This article describes the use of the vaginal sling procedure to surgically correct some of the problems that result in SUI. The author discusses the indications for this surgery, including proximal sphincter failure, proximal urethral failure with severe incontinence, and stress urinary incontinence; considers the different types of slings available, including proximal urethral slings, synthetic slings with bladder neck or proximal urethral placement, midurethral slings, autologous slings, modified autologous fascia slings, and other natural tissue materials; and describes the use of sling procedures in males. 9 figures. 21 references.

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Orofacial Pain as the Sole Manifestation of Syringobulbia-Syringomyelia Associated with Arnold-Chiari Malformation Source: Journal of Orofacial Pain. 15(2): 170-173. Spring 2001. Contact: Available from Quintessence Publishing Co, Inc. 551 Kimberly Drive, Carol Stream, IL 60188-1881. (800) 621-0387 or (630) 682-3223. Fax (630) 682-3288. Website: www.quintpub.com. Summary: This article presents a case report of a male patient (age 45 years) who presented with orofacial pain for a year as the only manifestation of syringobulbiasyringomyelia (cavitation within the spinal cord, a chronic and progressive disorder) associated with Arnold-Chiari malformation. The authors emphasize the clinical presentation and possible differential diagnoses of this case. The pain was continuous and affected the left side of the face. The pain was exacerbated by coughing and physical effort, possibly as a consequence of an increase in intracranial pressure. Paroxysymal (episodic) pain crises developed over this background of continuous pain, compatible with neurogenic trigeminal pain of the left second branch, together with pain episodes similar to cluster headache on the same side. The symptoms were resolved following neurosurgical management with amplification of the foramen magnum. Follow up MRI (magnetic resonance imaging) showed improvement of the syringomyelia. Two years later, the patient remained asymptomatic and was receiving no pharmacologic treatment. 3 figures. 8 references.

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Assessment of the Early Surgical Outcome and Urodynamic Effects of the Tensionfree Vaginal Tape (TVT) Source: International Urogynecology Journal. 11(5): 282-284. 2000. Contact: Available from Springer-Verlag New York Inc. 175 Fifth Avenue, New York, NY 10010. (212) 460-1500. Fax (212) 473-6272. Summary: This article reports on a study in which 52 women underwent a tension free vaginal tape (TVT) procedure for genuine stress incontinence (GSI, involuntary loss of urine under conditions such as laughing or coughing). Preoperative assessment included a detailed medical history, pelvic examination, a 1 hour pad test with a

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comfortably full bladder, and urinary culture. Thirteen of the 52 women were excluded for various reasons. Both before and 12 to 24 months postoperatively all patients had a full urodynamic (measurement of urinary flow during urination) investigation using microtip transducer catheters. The study subjects were instructed to maintain a 1 week baseline urinary diary before the operation, and postoperative urodynamic assessment as well. The period of followup ranged from 12 to 24 months (median 19 months). Another 1 hour pad test with a comfortably full bladder and urinary culture were carried out thereafter. Comparisons of the 39 women pre and postoperatively found a significantly improved 1 hour pad test. Analyzing the urodynamic effects of surgery revealed no significant postoperative changes except for the maximal urethral closure pressure (MUCP) at rest. An objective assessment using a pad test revealed the success rate (cure plus improved) to be 90 percent (35 out of 39 patients) and the failure rate 10 percent (4 out of 39 patients). The author concludes that TVT can thus be considered a safe and effective procedure for GSI in women. 2 tables. 10 references. •

Achalasia: Treatment Options Revisited Source: Canadian Journal of Gastroenterology. 14(5): 406-409. May 2000. Contact: Available from Pulsus Group, Inc. 2902 South Sheridan Way, Oakville, Ontario, Canada L6J 7L6. Fax (905) 829-4799. E-mail: [email protected]. Summary: This article reviews the treatment options for achalasia, (swallowing disorder) results from the inability of a muscle to relax. The aim of all forms of treatment of achalasia is to enable the patient to eat without disabling symptoms such as dysphagia (difficulty swallowing), regurgitation, coughing, or choking. Historically, this has been accomplished by mechanical disruption of the lower esophageal sphincter (LES) fibers, either by means of pneumatic dilation (PD) or by open surgical myotomy (cutting the muscle). The addition of laparoscopic myotomy and botulinum toxin (BTX) injection to the therapeutic armamentarium has triggered a recent series of reviews to determine the optimal therapeutic approach. Both PD and BTX have excellent short term (less than 3 months) efficacy in the majority of patients. New data have been published that suggest that PD and BTX (with repeat injections) can potentially obtain long term efficacy. PD is still considered the first line treatment by most physicians; its main disadvantage is risk of perforation. BTX injection is evolving as an excellent, safe option for patients who are considered high risk for more invasive procedures. Laparoscopic myotomy with combined antireflux surgery is an increasingly attractive option in younger patients with achalasia, but long term followup studies are required to establish its efficacy and the potential for reflux related sequelae. 2 figures. 1 table. 34 references.

Federally Funded Research on Coughing The U.S. Government supports a variety of research studies relating to coughing. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. 2

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to coughing. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore coughing. The following is typical of the type of information found when searching the CRISP database for coughing: •

Project Title: AEROSOL BASED NANOPARTICAL DRUG DELIVERY SYSTEM--TB Principal Investigator & Institution: Ng, Lawrence K.; Associate Professor; Pharmaceutical Sciences; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, Co 800450508 Timing: Fiscal Year 2002; Project Start 01-APR-1999; Project End 31-MAR-2004 Summary: (Verbatim from Investigator's Abstract): Tuberculosis (TB) is a communicable infectious disease caused by inhalation of tubercle bacilli, Mycobacterium tuberculosis, in airborne droplets (< 10 um in size) emitted by the coughing pulmonary patient. Upon deposition in the alveolus, the tubercle bacilli can be phagocytosed and grow within the alveolar macrophages (AMs), and be eventually released causing widespread infections in the lungs and other body sites. Despite the fact that therapies are available for controlling the vast majority of existing cases, the incidence of TB is increasing. This is because many TB patients (AIDS patients, elderly, drug abusers and the urban poor) have significant social problems, and compliance with multi-month drug therapy is frequently difficult. Further, current therapies, which require patients to take large oral doses of drugs, such as isoniazid, can often produce significant side effects. This further compounds the compliance problem. Therefore, the major objectives of this research proposal are to improve the overall treatment rate of TB by developing specific pulmonary sustained drug delivery systems that would (1) improve patient's compliance with drug therapy, (2) reduce the manifestation of associated side effects, and (3) target the therapy to AM which plays an important role in the pathogenesis of TB. These objectives will be accomplished by pursuing the following specific aims: (1) developing drug-impregnated biodegradable nanoparticles of different size, shape, loading factor, and crystallinity and to determine the effects of these parameters on the release kinetics of the model antitubercular drug, isoniazid, (2) characterizing nanoparticle interaction with alveolar macrophages, (3) determining the pulmonary disposition of inhaled nanoparticles and nanoparticle-associated drugs in vivo, (4) identifying acute and chronic effects of inhaled nanoparticles on lung function and morphology, and (5) evaluating the ability of inhaled isoniazid-impregnated nanoparticles to arrest or reverse the progression of TB in an experimental animal model. It is expected this multidisciplinary approach will provide significant advances in the treatment of TB and other airway diseases in which sustained drug release or targeting AMs would be advantageous. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CAREGIVER COPING SKILLS TRAINING FOR LUNG CANCER Principal Investigator & Institution: Keefe, Francis J.; Professor and Associate Director; Psychiatry; Duke University Durham, Nc 27710 Timing: Fiscal Year 2002; Project Start 06-JUN-2002; Project End 31-MAY-2007

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Summary: (provided by investigator): Symptoms such as pain, fatigue, paroxysmal coughing, and dyspnea are major concerns of lung cancer patients and their caregivers. The focus in management of such symptoms traditionally has been on the patient. Studies of caregivers, however, have documented that the psychosocial impact of providing care to family members with lung cancer is profound. The ultimate goal of this research is to develop more effective ways to help patients and caregivers cope more effectively with problematic symptoms experienced by lung cancer patients. The proposed study seeks to evaluate the efficacy of a new, caregiver assisted coping skills training protocol. 500 early stage lung cancer patients (Stages I to IIIA) and their caregivers will be randomly assigned to one of two conditions: 1) Caregiver-assisted coping skills training-systematically trains caregivers in methods for guiding the patient in use of coping skills for symptom management (i.e. relaxation training, imagery, activity pacing, and communication skills), or 2) Cancer education and support-a comparison condition that provides patients and caregivers with information on the nature of lung cancer and treatment methods and controls for attention and contact. Assessment measures to be collected before and after treatment and at 4- and 14-months follow-up will include patient reports of major symptoms (pain, fatigue, coughing, and dyspnea), quality of life, depression, anxiety, self efficacy and quality of relationship with the caregiver and caregivers' ratings of mood, strain, and quality of relationship with the patient. If caregiver-assisted CST is effective, future studies could evaluate this training in other cancer populations (e.g. breast cancer, prostate cancer). Future studies could also identify the particular caregiver-assisted CST components (e.g. relaxation training, imagery training, or activity pacing methods) that contribute most to treatment effects. By isolating the active ingredients of training, one can streamline it, making it more cost-effective and more readily available to the larger population of patients having lung cancer. The proposed study rigorously evaluations methods for enhancing the effects of caregiver-assisted coping skills training in cancer patients and their caregivers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DIAGNOSIS & PATHOGENESIS OF TUBERCULOSIS: AIDS OPPORTUNISTIC INFECTION Principal Investigator & Institution: Didier, Peter J.; Tulane University of Louisiana New Orleans, La New Orleans, La 70112 Timing: Fiscal Year 2002 Summary: The objective of this pilot project is to continue the characterization of the tuberculosis model in rhesus monkeys. We previously found that high dose inoculation (six million bacteria) of Mycobacterium tuberculosis H37Rv and Erdman strains produced lethal lung disease within five to ten weeks. Monkeys developed clinical signs of dyspnea, coughing, anorexia, and weight loss 4-6 weeks after inoculation. Skin testing with Old tuberculin became mildly positive after 5 weeks while PPD skin tests remained negative. Animals developed extensive necrotizing granulomatous lesions in the inoculated half of the lung with spread to the contralateral lung and bronchial lymph node in animals with H37Rv, and to the liver and kidney in animals with the Erdman strain. Animals vaccinated with culture filtrate from H37Rv and challenged with two million bacteria developed the same clinical disease as unvaccinated controls. However, low dosage inoculation of a pair of animals with each strain (