哮喘联盟

   摘要
   背景：目前市面上一些年代久远的非处方咳嗽药物被评价为缺乏科学证据支持其有效性。虽然第一代抗组胺药苯海拉明被美国食品和药物管理局列为镇咳药物，据作者所知，目前为止尚未能证实它在病态咳嗽中能够抑制咳嗽反射敏感性。
   目的：探讨苯海拉明对咳嗽反射敏感性的影响。
   设置：蒙蒂菲奥里医疗中心，纽约市的学术医疗中心。
   方法：测量22例急性病毒性上呼吸道感染患者（普通感冒）的咳嗽反射敏感性，分别选取3个独立的天数，采用辣椒素刺激试验，摄入单剂量研究药物2小时后（与血浆药物峰浓度一致），按照随机、双盲方式给药：一个多组分糖浆，包含苯海拉明的（25毫克）、苯福林（10毫克），使用天然可可粉剂型; 右美沙芬（30毫克）糖浆、安慰剂糖浆。使用咳嗽判断的标准终点指标：辣椒素诱导下咳嗽次数≥5时的浓度（C5）。主要终点：对咳嗽反射敏感性的影响（C5）。
   结果：确立组间具有显著性差异（P= 0.0024），成对分析揭示：含苯海拉明的药物组与安慰剂组相比，平均对数logC5显著增加（0.4±0.55（SD）; P <0.01），但右美沙芬组与安慰剂组相比，并无此表现。
   结论：我们的研究结果为苯海拉明在病理性咳嗽中，具有抑制咳嗽反射敏感性的能力提供了初步证据。咳嗽反射敏感性测量的时间性可能不会允许右美沙芬的镇咳作用得到最大的发挥。

 

（苏欣 审校）
Int J Clin Pharm. 2015 Feb 12. [Epub ahead of print]


 

Inhibition of cough reflex sensitivity by diphenhydramine during acute viral respiratory tract infection.
 

Dicpinigaitis PV1, Dhar S, Johnson A, Gayle Y, Brew J, Caparros-Wanderley W.

ABSTRACT
BACKGROUND: Currently available over-the-counter cough remedies historically have been criticized for lack of scientific evidence supporting their efficacy. Although the first-generation antihistamine diphenhydramine is classified as an antitussive by the United States Food and Drug Administration, to the authors' knowledge it has never been shown to inhibit cough reflex sensitivity in subjects with pathological cough.
OBJECTIVE: To evaluate the effect of diphenhydramine on cough reflex sensitivity.
SETTING: Montefiore Medical Center, an academic medical center in New York City.
METHODS: Twenty two subjects with acute viral upper respiratory tract infection (common cold) underwent cough reflex sensitivity measurement employing capsaicin challenge on 3 separate days, 2 h after ingesting single doses of study drug (to coincide with peak blood concentrations), administered in randomized, double-blind manner: a multicomponent syrup containing diphenhydramine (25 mg), phenylephrine (10 mg), in a natural cocoa formulation; dextromethorphan (30 mg) syrup; and, placebo syrup. The standard endpoint of cough challenge was used: concentration of capsaicin inducing ≥5 coughs (C5). Main outcome measure: Effect on cough reflex sensitivity (C5).
RESULTS: A significant difference (p = 0.0024) was established among groups, with pairwise analysis revealing a significant increase in mean log C5 (0.4 ± 0.55 (SD); p < 0.01) for the diphenhydramine-containing medication versus placebo, but not for dextromethorphan versus placebo.
CONCLUSIONS: Our results provide the initial evidence of the ability of diphenhydramine to inhibit cough reflex sensitivity in subjects with acute pathological cough. Timing of cough reflex sensitivity measurement may not have allowed demonstration of maximal antitussive effect of dextromethorphan.

Int J Clin Pharm. 2015 Feb 12. [Epub ahead of print]