hydrocodone and Cough

Current British Thoracic Society guidelines do not recommend routinely the combined use of a benzodiazepine and opiate during flexible bronchoscopy (FB). A randomised, placebo controlled, double blind study was undertaken to determine whether hydrocodone in combination with midazolan improves cough suppression during FB without increasing the risk of desaturation.. 120 patients were randomised to receive midazolam and 5 mg i.v. hydrocodone or midazolam and placebo with topical anaesthesia. Pulse oximetry was recorded continuously during FB. Bronchoscopists and nurses charted their perception of cough and the patients rated their discomfort during the procedure on a 10 cm visual analogue scale (VAS).. There was no significant difference between the two groups with regard to the indication for FB, duration of procedure (21 (11) min v 22 (10) min, p = 0.570), doses of supplemental lignocaine (171 (60) mg v 173 (66) mg, p = 0.766) and midazolam (4.5 (2.3) mg v 4.9 (2.7) mg, p = 0.309), lowest oxygen saturation (94.8 (2.7) v 94.9 (2.7), p = 0.433), and desaturations < or =90%. Perception of cough by both the bronchoscopist and the nurse was significantly lower in the hydrocodone group (3 (0-10) and 3 (0-10)) than in the placebo group (6 (0-10) and 6 (0-10)), respectively (p = 0.001). According to the VAS scale, patients' tolerance was also significantly better with hydrocodone than with placebo (2 (0-8) v 3 (0-9), p = 0.043).. The combination of midazolam and hydrocodone markedly reduces cough during FB without causing significant desaturation, especially when invasive diagnostic procedures are performed.

Topics: Antitussive Agents; Bronchoalveolar Lavage Fluid; Bronchoscopy; Cough; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Hydrocodone; Hypnotics and Sedatives; Male; Midazolam

Inhalation of l-menthol inhibits cough and has been shown to reduce respiratory discomfort associated with loaded breathing. We investigated the effect of the inhalation of a 1% l-menthol solution in the premedication of fiberoptic bronchoscopy (FB) on the frequency of cough and the irritability of the tracheobronchial mucosa during FB in a blinded, randomized and placebo controlled study.. 64 pat. (30-78 yrs, 55 males) underwent routine FB. Premediction: atropine and hydrocodone s.c., inhalation of oxybuprocain by means of a jet nebulizer, sedation on demand. Verum-group: inhalation of 3 ml 1% l-menthol-solution. Placebo-group: 3 ml 0.05% l-menthol (to provide the typical smell). Before and after inhalation peak respiratory flow (PEF) was registered, during FB the frequency of cough was measured. The bronchoscopist scored the irritability of the tracheobronchial mucosa using a visual analog scale. The patients answered a questionnaire addressing their perception of dyspnea and cough on the day after FB compared to the day before.. The cough counts didn't show a significant difference between the groups. The irritability of the mucosa was increased in the verum group (main bronchus verum 62.2 +/- 22, placebo 48.6 +/- 23 [mm vissual analog scale, p = 0.03]). Cough and dyspnea reported by the patients decreased on the day after FB significantly compared to the day before (no difference between the groups). The inhalation of 1% l-menthol induced a significant increase of the PEF (verum 307 +/- 103 pre, 329 +/- 84 post [l/min, p = 0.003]) compared to placebo.. The inhalation of 1% l-menthol did not enhance the tolerability of the FB. However, l-menthol induced a significant increase of the PEF immediately after inhalation. Finally sensation of dyspnea was decreased in both groups at the day post FB.

Topics: Administration, Inhalation; Adult; Aged; Antitussive Agents; Atropine; Bronchoscopy; Cough; Double-Blind Method; Dyspnea; Female; Fiber Optic Technology; Humans; Hydrocodone; Male; Menthol; Middle Aged; Placebos; Premedication; Procaine; Sensation

To evaluate side effects and patients' assessment of fiberoptic bronchoscopy under local anesthesia, 122 consecutive patients answered questions from an outside interviewer (an experienced psychiatrist) and not from the endoscopists themselves. The effect of premedication with midazolam (5 mg i.m.) and hydrocodonum (15 mg i.m.) was compared in a randomized study. In a multiple choice questionnaire 68% of all patients indicated considerable fear in the days before bronchoscopy. They were more afraid of the possible diagnosis of cancer (23%) than of dyspnea or asphyxiation (14%). Coughing is considered the worst side effect of bronchoscopy by 25% of patients (36% of the endoscopists) followed by dyspnea during insertion of the scope (21%) and discomfort during local anesthesia. Although the patients premedicated with midazolam are more sedated (p = 0.025 by physicians' assessment vs. p = 0.11 in patients' view), they cough more (p = 0.001 vs. p = 0.22) and usually tolerate the examination less well (p = 0.009 vs. p = 0.08) than patients premedicated with hydrocodonum. 42% of patients premedicated with midazolam had anterograde amnesia. Although they did not remember all the unpleasant side effects, only 77% said they would repeat the procedure with the same premedication, compared with 90% of patients premedicated with hydrocodonum (p = 0.08). Before and two hours after premedication the reaction times had not changed (optical sign, Wiener reaction device) and were identical in the two patient groups. At that time 37% of the patients premedicated with midazolam and 27% of those premedicated with hydrocodonum were still sleepy and could not be regarded as fit for any form of travel.

Topics: Adult; Aged; Bronchoscopy; Codeine; Consumer Behavior; Cough; Dyspnea; Female; Fiber Optic Technology; Humans; Hydrocodone; Male; Midazolam; Middle Aged; Optical Fibers; Premedication; Random Allocation

Topics: Adolescent; Child; Child, Preschool; Codeine; Common Cold; Cough; Cross-Sectional Studies; Drug Prescriptions; Female; Humans; Hydrocodone; Infant; Infant, Newborn; Interrupted Time Series Analysis; Longitudinal Studies; Male; Practice Patterns, Physicians'; United States; United States Food and Drug Administration

Topics: Adult; Anti-Allergic Agents; Antitussive Agents; Chlorpheniramine; Cough; Drug Combinations; Drug Interactions; Humans; Hydrocodone

In this study, the activity of the delta-opioid receptor subtype-selective agonist, SB 227122, was investigated in a guinea pig model of citric acid-induced cough. Parenteral administration of selective agonists of the delta-opioid receptor (SB 227122), mu-opioid receptor (codeine and hydrocodone), and kappa-opioid receptor (BRL 52974) produced dose-related inhibition of citric acid-induced cough with ED(50) values of 7.3, 5.2, 5.1, and 5.3 mg/kg, respectively. The nonselective opioid receptor antagonist, naloxone (3 mg/kg, i.m.), attenuated the antitussive effects of codeine or SB 227122, indicating that the antitussive activity of both compounds is opioid receptor-mediated. The delta-receptor antagonist, SB 244525 (10 mg/kg, i.p.), inhibited the antitussive effect of SB 227122 (20 mg/kg, i.p.). In contrast, combined pretreatment with beta-funaltrexamine (mu-receptor antagonist; 20 mg/kg, s.c.) and norbinaltorphimine (kappa-receptor antagonist; 20 mg/kg, s.c.), at doses that inhibited the antitussive activity of mu- and kappa-receptor agonists, respectively, was without effect on the antitussive response of SB 227122 (20 mg/kg, i.p.). The sigma-receptor antagonist rimcazole (3 mg/kg, i.p.) inhibited the antitussive effect of dextromethorphan (30 mg/kg, i.p.), a sigma-receptor agonist, but not that of SB 227122. These studies provide compelling evidence that the antitussive effects of SB 227122 in this guinea pig cough model are mediated by agonist activity at the delta-opioid receptor.

Topics: Animals; Carbazoles; Cell Line; CHO Cells; Cloning, Organism; Codeine; Cough; Cricetinae; Dextromethorphan; Disease Models, Animal; Dose-Response Relationship, Drug; Drug Interactions; Guinea Pigs; Humans; Hydrocodone; Levallorphan; Male; Naloxone; Narcotic Antagonists; Protein Binding; Pyridines; Pyrroles; Pyrrolidines; Receptors, Opioid, delta; Receptors, Opioid, kappa; Receptors, Opioid, mu

A 3-year-old child died of the combined effects of a bacterial superinfection and a relative overdose of hydrocodone prescribed for a cough due to a presumed viral respiratory tract infection. This case illustrates the importance of evaluating the effects of prescribed medication in assessing the cause and mechanism of death in children dying suddenly of presumed natural disease.

Topics: Bronchitis; Bronchopneumonia; Child, Preschool; Codeine; Cough; Humans; Hydrocodone; Male; Respiratory Tract Infections; Streptococcal Infections; Streptococcus pyogenes; Tracheitis

Topics: Child; Cough; Humans; Hydrocodone; Infant; Methods

Topics: Adult; Child; Codeine; Cough; Humans; Hydrocodone; Infant; Substance-Related Disorders

Topics: Antitussive Agents; Codeine; Cough; Heroin; Hydrocodone; Thebaine