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      Characterization of Ethyl Butyrate–Induced Cough Before and After Breath Control Techniques in Healthy Adults

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          Abstract

          Purpose:

          Methods for cough elicitation frequently involve aerosolized tussive agents. Here, we sought to determine whether healthy individuals demonstrate a quantifiable cough response after inhaling a volatile ester and if breath control techniques modify this chemically induced cough response.

          Method:

          Sixty adult male and female participants inhaled prepared liquid dilutions of ethyl butyrate dissolved in paraffin oil at 20%, 40%, and 60% v/v concentrations in triplicate, with presentation order randomized. We delivered stimuli through a face mask connected to an olfactometer and respiratory pneumotachograph. Participants rated sensations of their urge to cough and pleasantness of the odor while cough airflow was measured. Following baseline testing, participants were randomized to implement pursed-lip breathing or slow-paced breathing after inhaling ethyl butyrate to determine the effects of breath control on cough measures.

          Results:

          Inhaled ethyl butyrate elicited cough in 70% of participants. Higher concentrations of ethyl butyrate resulted in significantly greater sensation of the urge to cough, F(2, 80) = 10.72, p < .001, and significantly more generated coughs, F(2, 63) = 13.14, p < .001. Compared to baseline, participants rated significantly decreased urge to cough during breath control techniques, F(1, 40) = 11.01, p = .0019. No significant changes were observed in the number of generated coughs between baseline and breath control techniques, F(1, 31) = 7.23, p = .01.

          Conclusions:

          Airborne ethyl butyrate is a tussigenic agent in humans. Our findings provide opportunities for future research directions in normal and disordered cough responses to volatile compounds.

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          Most cited references71

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          Validity and reliability of the reflux symptom index (RSI).

          Laryngopharyngeal reflux (LPR) is present in up to 50% of patients with voice disorders. Currently, there is no validated instrument that documents symptom severity in LPR. We developed the reflux symptom index (RSI), a self-administered nine-item outcomes instrument for LPR. The purpose of this investigation was to evaluate the psychometric properties of the RSI. For validity assessment, 25 patients with LPR were evaluated prospectively before and six months after b.i.d. treatment with proton pump inhibitors (PPI). Each patient completed the RSI as well as the 30-item voice handicap index (VHI). For reliability assessment, the study patients were given the RSI on two separate occasions before the initiation of treatment. Normative RSI data were derived from 25 age-matched and gender-matched controls taken from an existing database of asymptomatic individuals without any evidence of LPR. The mean RSI (+/- standard deviation) of patients with LPR improved from 21.2 (+/- 10.7) to 12.8 (+/- 10.0), and the mean VHI improved from 52.2 (+/- 24.7) to 41.5 (+/- 25.0) after 6 months of therapy (p = 0.001 and 0.065, respectively). Of the three VHI subscales (emotional, physical, functional), only the functional subscale improved significantly (p = 0.037). Patients who experienced a five point or better improvement in RSI were 11 times more likely to experience a five-point improvement in VHI (95% confidence interval = 1.7, 76.8). For reliability assessment, the first and second pretreatment RSIs were 19.9 (+/- 11.1) and 20.9 (+/- 9.6), respectively (correlation coefficient = 0.81, p 0.05). The RSI is easily administered, highly reproducible, and exhibits excellent construct and criterion-based validity.
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            How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing

            Background: The psycho-physiological changes in brain-body interaction observed in most of meditative and relaxing practices rely on voluntary slowing down of breath frequency. However, the identification of mechanisms linking breath control to its psychophysiological effects is still under debate. This systematic review is aimed at unveiling psychophysiological mechanisms underlying slow breathing techniques (<10 breaths/minute) and their effects on healthy subjects. Methods: A systematic search of MEDLINE and SCOPUS databases, using keywords related to both breathing techniques and to their psychophysiological outcomes, focusing on cardio-respiratory and central nervous system, has been conducted. From a pool of 2,461 abstracts only 15 articles met eligibility criteria and were included in the review. The present systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: The main effects of slow breathing techniques cover autonomic and central nervous systems activities as well as the psychological status. Slow breathing techniques promote autonomic changes increasing Heart Rate Variability and Respiratory Sinus Arrhythmia paralleled by Central Nervous System (CNS) activity modifications. EEG studies show an increase in alpha and a decrease in theta power. Anatomically, the only available fMRI study highlights increased activity in cortical (e.g., prefrontal, motor, and parietal cortices) and subcortical (e.g., pons, thalamus, sub-parabrachial nucleus, periaqueductal gray, and hypothalamus) structures. Psychological/behavioral outputs related to the abovementioned changes are increased comfort, relaxation, pleasantness, vigor and alertness, and reduced symptoms of arousal, anxiety, depression, anger, and confusion. Conclusions: Slow breathing techniques act enhancing autonomic, cerebral and psychological flexibility in a scenario of mutual interactions: we found evidence of links between parasympathetic activity (increased HRV and LF power), CNS activities (increased EEG alpha power and decreased EEG theta power) related to emotional control and psychological well-being in healthy subjects. Our hypothesis considers two different mechanisms for explaining psychophysiological changes induced by voluntary control of slow breathing: one is related to a voluntary regulation of internal bodily states (enteroception), the other is associated to the role of mechanoceptors within the nasal vault in translating slow breathing in a modulation of olfactory bulb activity, which in turn tunes the activity of the entire cortical mantle.
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              The Voice Handicap Index (VHI)

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                Author and article information

                Journal
                Am J Speech Lang Pathol
                Am J Speech Lang Pathol
                AJSLP
                American Journal of Speech-Language Pathology
                American Speech-Language-Hearing Association
                1058-0360
                1558-9110
                March 2023
                12 January 2023
                1 September 2023
                : 32
                : 2
                : 675-687
                Affiliations
                [a ]Monell Chemical Senses Center, Philadelphia, PA
                [b ]Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
                [c ]Health Services, College of General Studies, University of Pittsburgh, PA
                [d ]Department of Neuroscience, University of Pennsylvania, Philadelphia
                Author notes

                Disclosure: The authors have declared that no competing financial or nonfinancial interests existed at the time of publication.

                Correspondence to Carolyn K. Novaleski, who is now at Michigan State University: cnova@ 123456msu.edu

                Editor-in-Chief: Katherine C. Hustad

                Editor: Heather Shaw Bonilha

                Author information
                https://orcid.org/0000-0001-9232-2274
                Article
                23814764000300140072
                10.1044/2022_AJSLP-22-00233
                10171842
                36634229
                48360f97-476e-40dd-b12e-d4e143d463b3
                Copyright © 2023 The Authors

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 26 July 2022
                : 23 September 2022
                : 22 October 2022
                Page count
                Pages: 13
                Funding
                This research was supported by National Institute on Deafness and Other Communication Disorders Award Numbers F32DC016805 (Novaleski) and T32DC000014 (Mainland and Dalton) and National Institute of Neurological Disorders and Stroke Award Number U19NS112953 (Mainland). Additional research support was provided by a generous gift to the Monell Chemical Senses Center from Louise Slade, an honorarium, and individual contributions to the Monell Science Apprenticeship Program. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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                research-article, Research Article
                Research Articles
                Custom metadata
                Basic research

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