***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Codeine is generally accepted as the st and ard antitussive against which new antitussive medications are compared . This presents a problem because the support for codeine 's antitussive activity comes from studies on cough in animals , and chronic and induced cough models in man , whereas antitussives are almost exclusively used for the treatment of cough associated with acute upper respiratory tract infection ( URTI ) . The aims of this study were twofold . Firstly , to study the antitussive efficacy of codeine in cough associated with URTI and , secondly , to vali date a sound meter as tool for quantifying cough . The efficacy of codeine was assessed in a double-blind , stratified , placebo-controlled , parallel-group , clinical trial using three different measures of cough : cough sound-pressure levels ( CSPLs ) measured on a sound meter ; subjective scores of cough severity ; and cough frequency recorded by means of a microphone  connected to an ink-pen recorder .  A group of 82 subjects ( 51 females and 31 males ; mean age 23.5 years , range 18 - 46 years ) with cough owing to acute URTI were included in the study . The study took place on two separate study days . On study day 1 cough measurements were made before and 90 min after treatment with a single dose of either 50 mg codeine or matched placebo in capsule form . The same three measures of cough were repeated 2 - 5 days later ( study day 2 ) . On study day 1 a highly significant ( P < 0.0001 ) decrease in all three measures of cough was found after treatment with both placebo and codeine yet there was no significant difference between the treatment groups . A highly significant ( P < 0.0001 ) decrease in the three measures of cough was also found between days 1 and 2 . The results demonstrate that codeine is no more effective than placebo in reducing cough associated with acute URTI , as measured by CSPLs , cough frequency or subjective symptom scores . This result might be explained on the basis of two central pathways for cough ; a reflex pathway via the brain-stem which is sensitive to codeine and a voluntary pathway via the cortex which is unaffected by codeine . The results also demonstrate that the sound-level meter appears to be a potentially useful investigative tool for the assessment of cough and antitussive efficacy BACKGROUND The role of certified respiratory educators ( CREs ) is to educate , assess , and help to manage patients with asthma and COPD in Canada . This study was undertaken to see whether CREs could assist pulmonologists ( MDs ) in managing patients with chronic cough . METHODS An 8-week prospect i ve , parallel design , r and omized , controlled trial to determine whether CREs using a protocol -driven algorithmic approach could assist in the management of patients referred to a university tertiary care medical center for the assessment and treatment of chronic cough . Patients were r and omly assigned to a CRE-led or MD study arm for the management of chronic cough . Patients were screened to exclude those patients whose cough was due to life-threatening conditions . The primary outcome was measured with the cough-specific quality -of-life question naire ( CQLQ ) . RESULTS A total of 198 patients were r and omized , and 8-week results were available on 151 patients ( mean [ + /- SD ] age , 49.8 + /- 13.4 years ; female gender , 70 % ; median cough duration , 16 months ) . At 8 weeks , total CQLQ scores improved in the CRE-led patients ( score [ + /- SD ] range , 58.1 + /- 14.9 to 50.0 + /- 15.8 ; p = 0.0003 ) . CQLQ scores improved in four of six domains but not in the physical or emotional domains . Improvements in CRE-led patients were similar to those in MD-managed patients ( initial CQLQ score , p = 0.261 [ CRE vs MD ] ; CQLQ score at 8 weeks , p = 0.42 [ CRE vs MD ] ) . In a composite analysis of both CRE and MD patient data , CQLQ scores improved in patients whose cough resolved ( 56.3 + /- 13.6 to 41.5 + /- 13.6 ; p < 0.0001 ) , in those whose cough improved but did not disappear ( 60.9 + /- 14.2 to 50.5 + /- 13.9 ; p < 0.0001 ) , but did not improve in those whose cough did not improve ( 58.1 + /- 13.3 to 58.6 + /- 12.7 ; difference not significant ) . CONCLUSIONS CREs can help to safely , economically , and effectively manage properly screened patients with chronic cough . The use of CREs may shorten wait times for specialist consultation for these patients OBJECTIVES : To compare the effects of a single nocturnal dose of 3 honey products ( eucalyptus honey , citrus honey , or labiatae honey ) to placebo ( silan date extract ) on  nocturnal cough and difficulty sleeping associated with childhood upper respiratory tract infections ( URIs ) . METHODS : A survey was administered to parents on 2 consecutive days , first on the day of presentation , when no medication had been given the previous evening , and the following day , when the study preparation was given before bedtime , based on a double-blind r and omization plan . Participants included 300 children aged 1 to 5 years with URIs , nocturnal cough , and illness duration of ≤7 days from 6 general pediatric community clinics . Eligible children received a single dose of 10 g of eucalyptus honey , citrus honey , labiatae honey , or placebo administered 30 minutes before bedtime . Main outcome measures were cough frequency , cough severity , bothersome nature of cough , and child and parent sleep quality . RESULTS : In all 3 honey products and the placebo group , there was a significant improvement from the night before treatment to the night of treatment . However , the improvement was greater in the honey groups for all the main outcome measures . CONCLUSIONS : Parents rated the honey products higher than the silan date extract for symptomatic relief of their children ’s nocturnal cough and sleep difficulty due to URI . Honey may be a preferable treatment for cough and sleep difficulty associated with childhood URI A double-blind cross-over trial was carried out to evaluate the antitussive activity of viminol p-hydroxybenzoate ; the comparison was done with three preparations : a placebo and the drug at two doses , 70 and 140 mg respectively . The responses were scored hourly up to 4 hours after the administration of single doses in the morning to subjects with persistent cough . The highest dose of viminol showed a definite antitussive activity , whereas the lowest did not differ from the placebo . The antitussive effect appears clinical ly useful for the treatment of cough , but further studies are indicated to define optimal dosage schedules BACKGROUND Cough is a frequent complaint of patients with a variety of respiratory disorders , including seasonal allergic rhinitis ( SAR ) , and it is often evaluated subjectively to determine disease status and response to treatment . However , it is not known whether subjective reports of cough from patients with SAR are accurate . OBJECTIVE To compare a novel objective measurement with subjective reports of cough frequency in a subset of 28 patients ( aged > or = 12 years ) with active SAR who were enrolled in a large , multicenter trial examining the efficacy of an active treatment for SAR . METHODS In this supplemental pilot study , subjective data  were collected on a diary card and objective data were collected using home-based telemetry . Three 24-hour recording sessions were conducted with each patient : 2 consecutive baseline sessions ( day 1 and day 2 ) and 1 session after r and omization to placebo or active cough treatment ( day 3 ) . RESULTS Strong correlations existed between cough frequency data for days 1 and 2 ( Spearman correlation coefficient = 0.91 ; P < .001 ) and between subjective and objective data for days 1 , 2 , and 3 ( daytime greater than nighttime ) ( Spearman correlation coefficient = 0.51 ; P < .001 ) . CONCLUSION These results have implication s for the design and interpretation of results from clinical trials that evaluate cough frequency as a treatment outcome OBJECTIVES The goals of this study were to : ( 1 ) determine if management according to a st and ardized clinical management pathway/algorithm ( compared with usual treatment ) improves clinical outcomes by 6 weeks ; and ( 2 ) assess the reliability and validity of a st and ardized clinical management pathway for chronic cough in children . METHODS : A total of 272 children ( mean ± SD age : 4.5 ± 3.7 years ) were enrolled in a pragmatic , multicenter , r and omized controlled trial in 5 Australian centers . Children were r and omly allocated to 1 of 2 arms : ( 1 ) early review and use of cough algorithm ( “ early-arm ” ) ; or ( 2 ) usual care until review and use of cough algorithm ( “ delayed-arm ” ) . The primary outcomes were proportion of children whose cough resolved and cough-specific quality of life scores at week 6 . Secondary measures included cough duration postr and omization and the algorithm ’s reliability , validity , and feasibility . RESULTS : Cough resolution ( at week 6 ) was significantly more likely in the early-arm group compared with the delayed-arm group ( absolute risk reduction : 24.7 % [ 95 % confidence interval : 13–35 ] ) . The difference between cough-specific quality of life scores at week 6 compared with baseline was significantly better in the early-arm group ( mean difference between groups : 0.6 [ 95 % confidence interval : 0.29–1.0 ] ) . Duration of cough postr and omization was significantly shorter in the early-arm group than in the delayed-arm group ( P = .001 ) . The cough algorithm was reliable ( κ = 1 in key steps ) . Feasibility was demonstrated by the algorithm ’s validity ( 93%–100 % ) and efficacy ( 99.6 % ) . Eighty-five percent of children had etiologies easily diagnosed in primary care . CONCLUSIONS : Management of children with chronic cough , in accordance with a st and ardized algorithm , improves clinical outcomes irrespective of when it is implemented . Further testing of this st and ardized clinical algorithm in different setting s is recommended RATIONALE Cough is the most common complaint for which medical attention is sought , and chronic cough can be both physically and mentally debilitating . There is currently no evidence supporting the use of antitussives in chronic treatment-resistant cough . OBJECTIVES We tested the hypothesis that morphine sulfate in the dose of 5 mg twice daily would bring about a reduction in cough frequency and severity in patients failing to respond to specific measures . METHODS Patients recruited from the Hull Cough Clinic were enrolled into a r and omized double-blind placebo-controlled study using 4 weeks of slow-release morphine sulfate and a corresponding period of matched placebo . An open-labeled extension of the core study allowed dose escalation to 10 mg twice daily . Cough was assessed using the Leicester Cough Question naire , daily symptom diary , and citric acid cough challenge . RESULTS Twenty-seven patients completed the core study . A significant improvement of 3.2 points over baseline was noted on the Leicester Cough Question naire ( p < 0.01 ) . A rapid and highly significant reduction by 40 % in daily cough scores was noted among patients on slow-release morphine sulfate ( p < 0.01 ) . Objective testing of the cough reflex using citric acid cough challenge tests did not show any significant changes . Eighteen patients continued into the extension study . Two-thirds of these patients opted to increase the morphine to 10 mg twice daily . At the end of 3 months , there was a similar improvement in cough between the 5- and 10-mg groups . CONCLUSION Morphine sulfate is an effective antitussive in intractable chronic cough at the doses of 5 to 10 mg twice daily Background Chronic cough patients are rendered therapies for gastro-esophageal reflux ( GERD ) , upper airway cough syndrome ( UACS ) and cough-variant asthma ( CVA ) with varying benefit . Idiopathic or unexplained cough has emerged as an important clinical entity in both primary care and subspecialty clinics . Recent evidence points to a link between chronic cough and untreated obstructive sleep apnea ( OSA ) . Methods A prospect i ve observational study was done to evaluate the effect of OSA therapy in patients with chronic cough . Patients enrolled into the study underwent question naires to evaluate for GERD , UACS and CVA along with screening question naires for OSA and daytime sleepiness . The Leicester cough question naire ( LCQ ) was done at baseline and during serial visits to evaluate cough intensity and was used as the primary outcome measure of the effect of CPAP therapy on chronic cough . Results Out of 37 patients enrolled into the study , only 28 patients had follow up LCQ scores available and therefore underwent analysis . 22/28 patients were suspected to have OSA based on abnormal STOP-BANG screening question naire scores and overnight oximetry abnormalities . Of these 19/28 patients had overnight attended polysomnography with definitive diagnosis of OSA yielding a 68 % prevalence of OSA in our chronic cough population . Chronic cough patients treated for OSA tended to be older with a significantly higher BMI than chronic cough patients without OSA . Significant improvement of LCQ scores occurred with CPAP therapy for OSA in chronic cough 
    Output:
    
Finally , in research setting s , tussigenic challenges play a role in underst and ing mechanisms of cough