Document Detail

Unexplained chronic cough and vitamin B-12 deficiency.
MedLine Citation:
PMID:  21248188     Owner:  NLM     Status:  Publisher    
BACKGROUND: Chronic cough is characterized by sensory neuropathy. Vitamin B-12 (cobalamin) deficiency (Cbl-D) causes central and peripheral nervous system damage and has been implicated in sensory neuropathy and autonomic nervous system dysfunction. OBJECTIVE: We evaluated whether Cbl-D has a role in chronic, unexplained cough. DESIGN: Laryngeal threshold (histamine concentration that provokes a 25% decrease in the midinspiratory flow), bronchial threshold (histamine concentration that provokes a 20% decrease in the forced expiratory volume in 1 s), and cough threshold (histamine concentration that causes ≥5 coughs) in response to an inhaled histamine were assessed in 42 patients with chronic, unexplained cough [27 Cbl-D patients and 15 patients without Cbl-D (Cbl-N)] before and after intramuscular injections of cobalamin for 2 mo. Laryngeal, bronchial, and cough hyperresponsiveness was diagnosed when histamine concentration thresholds were ≤8 mg/mL. Seven Clb-D and 3 Cbl-N patients underwent an oropharyngeal biopsy before treatment. RESULTS: Cbl-D patients had a higher prevalence of laryngeal hyperresponsiveness than did Cbl-N patients (92.6% compared with 66.7%, respectively; P = 0.03), a thinner oropharyngeal epithelium [133.7 μm (95% CI: 95, 172 μm) compared with 230.8 μm (95% CI: 224, 237), respectively; P = 0.002], a lower number of myelinated nerve fibers [2.25/mm(2) (95% CI: 1.8, 2.7/mm(2)) compared with 3.44/mm(2) (95% CI: 3, 3.8/mm(2)), respectively; P = 0.05], and a higher immunoreactive score for nerve growth factor (NGF) [6.7 (95% CI: 6, 7.3) compared with 2.8 (95% CI: 2.5, 3.1), respectively; P = 0.02]. After cobalamin supplementation, symptoms and laryngeal, bronchial, and cough thresholds were significantly improved in Cbl-D but not in Cbl-N patients. CONCLUSIONS: This study suggests that Cbl-D may contribute to chronic cough by favoring sensory neuropathy as indicated by laryngeal hyperresponsiveness and increased NGF expression in pharyngeal biopsies of Cbl-D patients. Cbl-D should be considered among factors that sustain chronic cough, particularly when cough triggers cannot be identified.
Caterina B Bucca; Beatrice Culla; Giuseppe Guida; Savino Sciascia; Graziella Bellone; Antonella Moretto; Enrico Heffler; Massimiliano Bugiani; Giovanni Rolla; Luisa Brussino
Related Documents :
7221498 - Clinical experience with the kay-shiley mitral valve prosthesis: an eleven-year follow-...
21329628 - Effects of peritoneal dialysis and hemodialysis on arterial stiffness compared with pre...
19926838 - Internal jugular vein valve incompetence is highly prevalent in transient global amnesia.
6872198 - Mitral valvuloplasty: a learning curve.
16187628 - Using the patient as messenger, novel approach delivers clinical and financial gains.
23314558 - Red blood cell distribution width is a potential prognostic index for liver disease.
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-1-19
Journal Detail:
Title:  The American journal of clinical nutrition     Volume:  -     ISSN:  1938-3207     ISO Abbreviation:  -     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-1-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376027     Medline TA:  Am J Clin Nutr     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Departments of Clinical Pathophysiology and Biomedical Science and Human Oncology, University of Turin, Turin, Italy, and the Unit of Pneumology, Consorzio Provinciale Antitubercolare, Local Health Agency Turin 2, Turin, Italy.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Body mass index, medical qualification status, and discharge during the first year of US Army servic...
Next Document:  Scaling of body composition to height: relevance to height-normalized indexes.