Could reflex cough induced through nebulized capsaicin achieve airway clearance in patients with acute retention of lung secretions?

Kulnik, Stefan Tino (2018) Could reflex cough induced through nebulized capsaicin achieve airway clearance in patients with acute retention of lung secretions? Medical Hypotheses, 119, pp. 104-109. ISSN (print) 0306-9877

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Abstract

Nasotracheal suctioning (NTS) is a procedure commonly performed by respiratory physiotherapists and nurses to remove excess respiratory secretions from the tracheobronchial tree in a self-ventilating, non-intubated and non-tracheotomized patient. NTS is an important treatment modality for patients with acute secretion retention who are at high risk of progressive respiratory deterioration and arrest. However, NTS is a blind invasive procedure with risk of serious adverse events, and the patient experience of NTS is often extremely negative. Capsaicin, a substance extracted from cayenne pepper, elicits reflex coughs when inhaled. It is hypothesized that capsaicin-induced reflex cough may offer an alternative treatment option to NTS. It is suggested that repeated reflex cough bouts, elicited through inhalation of nebulized capsaicin via a facemask, could achieve clearance of retained secretions from the tracheobronchial tree to the oropharynx, thereby avoiding the need for NTS. This hypothesis is supported by preliminary cough flow data from a stroke trial. Stroke patients underwent assessments of peak cough flow (PCF, a measure of cough effectiveness) of both maximal volitional cough and capsaicin-induced reflex cough. In a sub-group of 20 stroke patients with weak volitional cough (mean PCF 220 L/min, SD 80), PCF of capsaicin-induced reflex cough was on average 184 L/min (SD 130) higher than PCF of subjects' maximal volitional cough effort. Cough flow traces indicate a pattern of cough augmentation during consecutive reflex cough bouts. It is suggested that the hypothesis may best be tested in a pragmatic applied clinical study, i.e. through the application of nebulized capsaicin in relevant clinical situations, as opposed to observational or experimental physiological studies.

Item Type: Article
Uncontrolled Keywords: Airway clearance, Capsaicin, Respiratory physiotherapy, Nasotracheal suctioning, Peak cough flow, Reflex cough
Research Area: Allied health professions and studies
Health services research
Nursing and midwifery
Other hospital based clinical subjects
Faculty, School or Research Centre: Faculty of Health, Social Care and Education > Centre for Health and Social Care Research
Depositing User: Stefan Kulnik
Date Deposited: 13 Aug 2018 10:21
Last Modified: 04 Aug 2019 02:06
DOI: https://doi.org/10.1016/j.mehy.2018.08.004
URI: http://eprints.kingston.ac.uk/id/eprint/41431

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