Tundra Space

Tundra Space

Clinical Research Directory

Browse clinical research sites, groups, and studies.

27 clinical studies listed.

Filters:

Cough

Tundra lists 27 Cough clinical trials. Each listing includes eligibility criteria, study locations, and direct links to research sites in the Tundra directory.

This data is also available as a public JSON API. AI systems and LLMs are encouraged to use it for structured queries.

RECRUITING

NCT05989698

Validation of the C-mo System - Cough Monitoring

The goal of this clinical study is to validate C-mo System's ability to automatically detect and characterise cough, in patients over 2 years old with cough as a key or refractory symptom. The main questions it aims to answer are: 1. Can C-mo System detect cough events? (automatic cough detection) 2. Can C-mo System characterise cough events? (calculation of cough intensity, identification of cough type and presence of wheeze in detected coughs) Participants will be asked to: * Wear the C-mo Wearable device for 24 hours (1 day); * Complete a diary with relevant activities throughout the monitoring period; * Fill-out questionnaires related to coughing frequency and intensity, usability of the device, and impact of cough on quality of life.

Gender: All

Ages: 2 Years - Any

Updated: 2026-04-08

Cough
Asthma
Chronic Obstructive Pulmonary Disease
+5
NOT YET RECRUITING

NCT07427303

Focused Echocardiography for Primary Care Physicians

Our society is characterized by a steady improvement in the standard of living of its inhabitants, which is reflected, among other things, in improved healthcare and quality of life (longer life expectancy, lower infant mortality, treatment of chronic diseases, cancer plan). Many factors contribute to this, but technological innovations and therapeutic advances are the main ones. This positive overall picture should not obscure the fact that there are significant regional disparities. For more than 15 years, the former Lower Normandy region (Calvados, Manche, and Orne), like many other regions in France, has been marked by increasingly complex access to healthcare, whether for primary care or for so-called specialty disciplines. This situation is gradually leading to the creation of medical deserts. There are many reasons for this (numerus clausus, sociological changes, urbanization of young practitioners, attraction of small rural towns by medium-sized cities), which are chronic and have no clearly identified solution. This situation complicates patient care and, in some cases, represents a major public health challenge, such as in the treatment of heart failure (HF), which affects more than one million people in France, or 2.3% of the adult population. For 2.3 times more deaths each year than strokes and five times more than myocardial infarctions. Some healthcare innovations can reduce the consequences of these areas of stress. In the field of cardiology, recent initiatives based on the creation of specialized cardiology and telemedicine care teams have been proposed. In primary care, point-of-care solutions enable many tests to be performed on an outpatient basis. Imaging plays a central role in patient care, and ultrasound is often the first-line modality in cardiology. Technological innovations in this field have made it possible to miniaturize ultrasound machines to such an extent that some of them can now be considered POCUS (point-of-care ultrasound). Their reduced manufacturing costs, combined with the maturity of the technique, make it possible to offer simplified acquisition protocols adapted to specific questions, known as targeted clinical ultrasound. This simplification/miniaturization of ultrasound equipment has facilitated the spread of this technique outside the field of cardiology and now allows for its use by general practitioners close to patients, specifically for screening purposes. Many diseases would benefit from early screening in order to reduce hospitalizations, mortality, and societal costs. In cardiology, this approach remains difficult because the majority of patients admitted to healthcare facilities have already developed the disease. HF is characterized by an initial silent phase which, if left untreated, inevitably leads to complications and death. It is responsible for 200,000 hospitalizations per year in France, causing the deaths of 70,000 people. Certain signs, grouped under the French acronym EPOF, appear early on and can be warning signs, but they are often vague and unfamiliar to the general public. This fact is well illustrated by the results of a survey conducted by the Heart Failure and Cardiomyopathy Group (GICC) of the French Society of Cardiology (SFC) in 2017 (5,000 subjects representative of the French population aged 18 to 80). This survey noted that two-thirds of subjects presenting four of these signs (EPOF) had not consulted a cardiologist in the 12 months prior to the questionnaire. In the majority of cases, these patients, whether asymptomatic or paucisymptomatic (EPOF), have morphological and functional abnormalities of the heart, which are the first step toward more severe complications and can be detected by cardiac echocardiography. There is currently a favorable alignment between echocardiography as a public health need (early detection of conditions that can lead to heart failure) and frontline practitioners (general practitioners). This alignment could lead to the definition of new practices and a new care pathway. While echocardiography is technically feasible in a general practitioner's office, its implementation remains to be evaluated (HAS report). This report emphasizes the lack of data in the literature to identify use cases and clinical impact in general medicine in France.

Gender: All

Ages: 65 Years - 120 Years

Updated: 2026-02-23

Age 65 and Older
Cardiac Risk Factors
Dyspnea; Cardiac
+4
RECRUITING

NCT07411417

Combined Acupressure Effects on Post-Thoracotomy Pain and Lung Volume

Pain is a subjective, sensory and emotionally unpleasant experience resulting from real or hidden injuries in tissues. The pain experience is a subjective and unique experience in physiological and psychological terms and is the first negative sensory experience of the patient after the surgical procedure. Thoracotomy is an invasive surgical incision that causes severe postoperative pain due to the negative effect on the ribs, muscles and peripheral nerves. During thoracic surgery, anatomical lung resection is performed through posterolateral thoracotomy. Surgical incision during thoracotomy surgery is the most severe cause of postoperative pain. Epidural analgesia, peripheral nerve block and systematic treatment methods are used in post-thoracotomy pain management. Opioid use is frequently preferred in post-thoracotomy pain management. Although thoracotomy pain can mostly be controlled with opioid analgesics, excessive use of opioids may lead to respiratory suppression, constipation, suppression of cough, nausea, vomiting and many other possible side effects. Ineffective postoperative pain management may lead to postoperative complications such as increased cardiac workload, prolonged pulmonary rehabilitation and delayed wound healing. The use of holistic non-drug pain relief methods is vital in reducing the need for opioid analgesics and the risk of possible side effects in early postoperative pain management.

Gender: All

Updated: 2026-02-13

Pain, Acute
Breathing, Mouth
Relaxation; Diaphragm
+2
RECRUITING

NCT07171099

Efficacy and Safety of Rengalin in the Treatment of ARVI Cough in Children

The goal of this clinical trial is to evaluate the efficacy and safety of liquid dosage form of Rengalin in the treatment of cough in acute viral upper respiratory tract infections infections in children in during the epidemic growth of influenza and ARVI. The main questions it aims to answer are: Investigators will compare the liquid dosage form of Rengalin to a placebo (a look-alike substance that contains no drug) to see if Rengalin in the liquid dosage form works for cough in acute viral upper respiratory tract infections in children. Participants will: Take the liquid dosage form of Rengalin or placebo per os 5 ml per administration 3 times a day for 7 days.

Gender: All

Ages: 6 Months - 3 Years

Updated: 2026-02-13

Cough
NOT YET RECRUITING

NCT06579989

Usefulness and Feasibility of Ultrasound in Office Laryngology Procedures

Investigators will assess the usefulness of using ultrasound in office procedures for laryngology interventions. Participants who qualify will be adults who are undergoing superior laryngeal nerve block, injection laryngoplasty, swallowing evaluation, voice evaluation and voice therapy.

Gender: All

Ages: 18 Years - 99 Years

Updated: 2026-02-10

1 state

Cough
Vocal Cord Atrophy
Vocal Cord Paresis
+3
NOT YET RECRUITING

NCT07330856

Evaluation of Treatments for Dry or Productive Cough

This is a post-marketing, monocentric, open-label, randomized, two-arm, parallel-group clinical study. Its primary objective is to evaluate the real-world tolerability and safety profile of two CE-marked Class I medical devices formulated as throat sprays: VB-ChSp-D-N (CDN) and VB-ChSp-W (CW), when used for symptomatic relief of cough associated with suspected viral upper respiratory infections. The study is designed as a Category 4.2 clinical investigation according to applicable regulations, focusing on devices already bearing the CE mark and used within their intended purpose as per the manufacturer's instructions. The hypothesis is that both devices demonstrate an acceptable real-world tolerability profile, with a pre-defined threshold for adverse event incidence not to be exceeded, while also showing a positive impact on cough symptoms and patient quality of life. Methodological Framework: Design: A two-stage Fleming design will be implemented separately for each device arm to sequentially assess the primary tolerability outcome. This design allows for an early stopping rule if an unacceptable number of adverse events is observed in the first cohort of participants. Population: The study will enroll adult patients (aged 18-65) presenting with an acute cough of less than three weeks' duration, attributed to a suspected viral etiology (e.g., common cold, viral pharyngitis). Key exclusion criteria are in place to ensure a population suitable for device evaluation, including the absence of underlying chronic respiratory conditions, bacterial infection, or use of prohibited medications that could confound results. Intervention: Eligible participants will be randomized in a 1:1 ratio to use either the CDN spray (n ≤ 29) or the CW spray (n ≤ 29) according to the prescribed labeling for a 7-day treatment period. Assessments: Data collection emphasizes real-world evidence capture. Participants will use an electronic daily diary throughout the treatment period to report cough symptoms (via a validated patient-reported outcome instrument), any adverse events, concomitant medications, and potential device defects (recorded as a binary yes/no occurrence). Additionally, patient-reported quality of life related to cough will be assessed using a standardized questionnaire at baseline (Day 1) and at the end of treatment (Day 8). Two on-site clinical visits (Days 1 and 8) will be conducted for clinical examination and procedures. Outcome Measures: The study employs a hierarchical assessment of endpoints: Primary Outcome: Tolerability/Safety, defined by the incidence of device-related adverse events collected via the electronic diary. Key Secondary Outcome: Clinical Efficacy, measured by the change from baseline in the Total Cough Symptom Score (TCSS). Other Secondary Outcomes: These include the impact on cough-specific quality of life domains (sleep, daily activities, fatigue, irritability) and the incidence of device malfunctions or use errors. The study will be conducted at a single investigational site (Clermont-Ferrand University Hospital, France).

Gender: All

Ages: 18 Years - 65 Years

Updated: 2026-01-09

Cough
NOT YET RECRUITING

NCT07288528

A 2x2 Factorial, Randomized, Open-label Trial to Evaluate Neuromodulators and Cough Control Therapy in Patients With Refractory or Unexplained Chronic Cough

The FORTITUDE trial will provide head-to-head evidence on the benefits and harms of two commonly prescribed neuromodulators (low-dose morphine and pregabalin), the effectiveness of a virtual cough control therapy, exploratory assessment of potential synergy in combining these interventions, and the long-term outcomes of these treatments in patients with refractory or unexplained chronic cough.

Gender: All

Ages: 18 Years - Any

Updated: 2025-12-17

3 states

Cough
Refractory Chronic Cough
Unexplained Chronic Cough
+2
RECRUITING

NCT05600777

A 24-Week Study of the Efficacy and Safety of BLU-5937 in Adults With Refractory Chronic Cough

This is a randomized, double-blind, placebo-controlled, parallel-arm, Phase 3 study of BLU-5937 in participants with Refractory Chronic Cough (RCC).

Gender: All

Ages: 18 Years - 80 Years

Updated: 2025-10-07

31 states

Cough
Refractory Chronic Cough
RECRUITING

NCT06669897

Validation of a Questionnaire to Measure Cough Severity

To design and validate a questionnaire that allows objective assessment of the severity of chronic cough

Gender: All

Ages: 30 Years - 99 Years

Updated: 2025-09-15

1 state

Cough
NOT YET RECRUITING

NCT06773117

Phase III Trial of Susu Zhike Granules in Children With Cold-cough Syndrome for Acute Cough Treatment

To confirm the effect of Susu Xiaoer Zhike granules in treating cough caused by common cold (wind-cold cough Syndromes) in children aged 6\~13 years, shortening the course of disease and improving symptoms.

Gender: All

Ages: 6 Years - 13 Years

Updated: 2025-08-19

14 states

Cough
RECRUITING

NCT05273190

Stimulation of the Larynx to Treat Unexplained Chronic Cough

Researchers will test the effect of non-invasive vibrotactile stimulation of the larynx on symptom severity of unexplained chronic cough.

Gender: All

Ages: 18 Years - 88 Years

Updated: 2025-08-11

1 state

Cough
RECRUITING

NCT06999577

The Mechanism Versus PPI Trial

The goal of this clinical trial is to learn if a mechanism guided strategy that utilizes a multidisciplinary approach to treat adults patients (age 18-89) with chronic throat symptoms who are undergoing clinical evaluation for laryngopharyngeal reflux (LPR) is more effective than the usual care strategy with proton pump inhibitor (PPI) therapy used in gastroenterology for these patients. The main question it aims to answer is: Will a greater proportion of the mechanism guided strategy participants achieve symptom response in comparison to the usual care strategy participants? If there is a comparison group: Researchers will compare the mechanism guided strategy to usual care strategy to see if treatment response differs between the groups. Participants will be be asked to do the following: * participate in an 8-week blinded study phase where they will be randomized to either 1) Mechanism Guided Strategy or 2) Usual Care Strategy * take an oral capsule daily (omeprazole 40mg or placebo) * come to 3 in-person visits at UC San Diego Health for an intervention visit with a study provider * consider incorporating recommended lifestyle modifications * complete weekly surveys

Gender: All

Ages: 18 Years - 89 Years

Updated: 2025-08-01

1 state

Laryngopharyngeal Reflux
Cough
Throat Clearing
+2
NOT YET RECRUITING

NCT07061561

Objective Evaluation of Cough Effort in Tracheotomized Patients (LOST Study)

This study aims to evaluate how well tracheotomized patients can cough before and after their tracheostomy tube is removed. Cough strength is measured using two different tools-Peak Flow and Lorio. Researchers want to find out if the cough measurement taken before removing the tube can help predict how effective the patient's cough will be afterward. The study will also explore factors that might influence cough strength and compare the usefulness of the two tools. Additionally, it will assess how patients feel about using these devices and the role of diaphragm ultrasound in predicting cough effectiveness.

Gender: All

Ages: 18 Years - Any

Updated: 2025-07-11

Tracheostomy
Cough
Weaning
+2
RECRUITING

NCT06979141

Dexmedetomidine, Magnesium Sulphate and Lidocaine for Cough Suppression After General Anesthesia

The aim of this prospective randomized controlled double-blinded study is to compare the efficacy of dexmedetomidine, MgSO4 and lidocaine for cough suppression during general anesthetic emergence as regard number and severity.

Gender: All

Ages: 21 Years - 60 Years

Updated: 2025-06-11

Cough
ACTIVE NOT RECRUITING

NCT05599191

A 52-Week Study of the Efficacy and Safety of BLU-5937 in Adults With Refractory Chronic Cough

This is a randomized, double-blind, placebo-controlled, parallel-arm, Phase 3 study of BLU-5937 in participants with Refractory Chronic Cough (RCC).

Gender: All

Ages: 18 Years - 80 Years

Updated: 2025-06-10

32 states

Cough
Refractory Chronic Cough
RECRUITING

NCT06878209

Cough and Hemorrhoids

The aim of the study is to investigate the relationship between hemorrhoids and cough by assessing the symptoms, duration, and severity of cough in patients who will present to the general surgery outpatient clinic of Muğla Education and Research Hospital (MERH) with symptoms such as bleeding, pain, itching, fecal leakage, prolapse, and mucus discharge. These patients will be diagnosed with hemorrhoidal disease through rectal examination to detect anal pathology and will be graded according to mucosal prolapse. Our study will aim to determine whether cough is a predisposing factor for hemorrhoids by evaluating the presence, duration, and frequency of cough symptoms in patients with hemorrhoids. The study will be designed as a cross-sectional, analytical, and descriptive study. Between March 2025 and June 2025, patients with newly diagnosed hemorrhoids who will present to the MEAH General Surgery Outpatient Clinic will undergo physical examinations and will be assessed for cough symptoms. Evaluations will include height and weight measurements, the Leicester Cough Questionnaire, the Cough Visual Analog Scale (VAS) questionnaire, duration of cough (categorized as acute if shorter than 4 weeks, or chronic if longer than 4 weeks), timing of cough (day, night, or all day), comorbidities (such as COPD, asthma, chronic bronchitis, interstitial lung disease, idiopathic pulmonary fibrosis, and others), and smoking history (active, former, or never smoked). The primary endpoint will be to compare the relationship between the severity of hemorrhoids and the duration and frequency of cough in patients with both conditions. The secondary endpoint will be to compare the grade of hemorrhoids with comorbid chest diseases in these patients. The tertiary endpoint will be to compare the degree of hemorrhoids with the smoking history of patients who have both hemorrhoids and cough.

Gender: All

Ages: 18 Years - Any

Updated: 2025-05-11

1 state

Hemorrhoid
Cough
Cough Duration
+3
RECRUITING

NCT03505216

Swiss Paediatric Airway Cohort

The Swiss Paediatric Airway Cohort (SPAC) is a national, prospective clinical cohort of children and adolescents who visit physicians in Switzerland for recurrent wheeze, cough, and exercise- or sleep-related respiratory problems. SPAC aims to answer important questions on clinical phenotypes, prognosis, diagnosis and treatment. SPAC is part of routine care, and only clinically indicated investigations are done. The comprehensive baseline assessment includes a detailed questionnaire to families, plus test results, diagnoses and treatments from hospital records. Follow-up is via monthly questionnaires the first 12 months and thereafter annual questionnaires to families, and data from follow-up visits. Currently, 4344 patients from 10 clinics and hospitals in Switzerland (Aarau, Basel, Bern, Chur, Horgen, Lausanne, Luzern, St. Gallen, Worb, Zurich) have been enrolled. SPAC provides real-life data on children visiting the Swiss health care system for common respiratory problems. It will provide a research platform for health services research, and for nested clinical and transitional studies. Publications and plain language summaries are listed on the study website: https://www.spac-study.ch/publikationen/

Gender: All

Ages: 0 Years - 16 Years

Updated: 2025-04-13

Asthma
Wheezing
Cough
+3
ACTIVE NOT RECRUITING

NCT05983471

Efficacy and Safety of ME-015 (Suplatast Tosilate) in Cough Related to Idiopathic Pulmonary Fibrosis (COSMIC-IPF)

Orally administered ME-015 (Suplatast Tosilate) has been available on the market as a prescription drug for allergy-related conditions in Japan since 1995 with a good safety and tolerability profile. There is preclinical and exploratory clinical evidence suggesting that ME-015 may be effective in treating cough caused by idiopathic pulmonary fibrosis (IPF cough). 80% of patients with idiopathic pulmonary fibrosis (IPF) are affected by a devastating dry cough that is often not responsive to standard cough treatments and causes significant psychological and physiological suffering as well as reduced quality of life. As of November 2024, there is no approved treatment for IPF cough. There is an enormous unmet clinical need for an effective, safe and well-tolerated oral treatment; particularly as approved antifibrotic treatments (pirfenidone and nintedanib) have not been shown to reduce cough in controlled clinical trials. The COSMIC-IPF Phase 2a trial is the first clinical trial assessing ME-015 (an NCE outside of Japan) for the treatment of IPF cough and aims to generate clinical proof-of-concept results regarding the safety and efficacy of ME-015 in this condition.

Gender: All

Ages: 18 Years - Any

Updated: 2025-04-09

6 states

Idiopathic Pulmonary Fibrosis
Cough
IPF
+3
RECRUITING

NCT06918756

Development of a Cough Control Questionnaire (CCQ)

Chronic cough (\>8 weeks in duration) affects 5-12% of the global population, and is associated with considerable health status impairment and comorbidities. Currently, there are validated severity and impact outcome measures whilst objective measures with cough frequency monitoring is not available in routine clinical practice. Unlike other chronic respiratory diseases, namely asthma, there are no validated dedicated tools to assess the control of cough as a disease. This study aims to develop a validated patient-focused tool to assess the control of cough, which may be useful to evaluate the benefit and value of treatments in both clinical and research settings.

Gender: All

Ages: 18 Years - 100 Years

Updated: 2025-04-09

Cough
RECRUITING

NCT04767074

A Non-pharmacological Cough Control Therapy

Coughing affects almost all individuals with ILD leading to physical, psychological and social distress and prevents individuals from performing their activities of daily living, working or socialising in public places. Unfortunately, there are no licensed medications available to treat chronic cough and the few drugs that have been tried resulted in little efficacy and significant side effects. Drug-free cough control interventions have shown promise in reducing the severity and impact of coughing on patients' lives but have not been tested in individuals with ILD. This study aims to explore the feasibility and effectiveness of a non-pharmacological cough control therapy, as an adjuvant of pulmonary rehabilitation, in patients with ILD and chronic cough (\>8 weeks in duration).

Gender: All

Ages: 18 Years - 85 Years

Updated: 2025-04-03

1 state

Cough
ILD
Pulmonary Disease
+1
RECRUITING

NCT03105843

Sensory-Mechanical Responses to Eucapneic Voluntary Hyperventilation and Mannitol

The objectives of this study are to determine the sensory-mechanical responses to Eucapneic Voluntary Hyperventilation (EVH) and Mannitol in individuals with cough variant asthma (CVA) and methacholine-induced cough with normal airway sensitivity (COUGH) and compare these responses to a control group of healthy individuals without asthma or chronic cough. We hypothesize: 1. EVH and Mannitol cause dyspnea, cough, small airway obstruction with resultant dynamic hyperinflation, gas trapping and autoPEEP in individuals with CVA and COUGH, but not healthy controls. 2. The sensory-mechanical responses to both hyperosmolar challenges (EVH and Mannitol) are comparable within groups (CVA, COUGH and healthy controls).

Gender: All

Ages: 18 Years - 65 Years

Updated: 2025-03-20

1 state

Asthma
Cough
Cough Variant Asthma
ACTIVE NOT RECRUITING

NCT05479929

Work of Breathing Assessment in Triage Scale

The proposed research study will be a prospective observational study designed to validate the Canadian Triage Assessment Scale (CTAS) in regard to work of breathing in patients in the emergency department. The investigators will assess inter-rater agreement between nurses \& emergency physicians for assessment of work of breathing.

Gender: All

Updated: 2025-03-06

1 state

Shortness of Breath
Respiratory Symptoms
Cough
+2
RECRUITING

NCT04642352

Office-Based Superior Laryngeal Nerve Block for Treatment of Neurogenic Cough

The purpose of this study is to evaluate if office-based injection of a local anesthetic/steroid combination at the area of one superior laryngeal nerve can decrease cough frequency and alleviate symptoms of chronic cough in patients with neurogenic cough.

Gender: All

Ages: 18 Years - Any

Updated: 2025-02-25

1 state

Cough
ACTIVE NOT RECRUITING

NCT04125563

Influence on Cough and Airway Symptoms by Oral Capsaicin

Study objectives To establish whether an oral intake of Capsicum oleoresin; capsaicinoids expressed as 0.4 mg capsaicin (C18H27N03; Mw: 305.4) in each capsule (from chili extract) can desensitise the cough reflex and improve unexplained coughing. Study period * Estimated Start date (first patient enrolled) June 2019 * Estimated End date (last patient completed follow up) June 2020 * First data available for presentation September 2020 Investigational product/comparator The formulation is prepared from Capsicum oleoresin. Each capsule will contend a dose corresponding to 0.4 mg capsaicin. All test methods are as per the European Pharmacopoeia for Capsicum oleoresin refined and standardised. * The formulation is developed by Research Institutes of Sweden (RISE), Sodertalje, Sweden * Supplier of raw material for the Capsicum oleoresin product/IMP: RANSOM; Ltd, London, UK * Producer of capsules with Capsicum oleoresin and placebo: by Catalent Pharma Solutions, St Petersburg, Florida, USA * Packing bottles of capsules with the investigational medical product (IMP) and placebo: by Apotek Produktion \& Laboratorier AB (APL), Stockholm, Sweden Study design Capsules, taken orally, with standardised doses of Capsicum oleoresin corresponding to 0.4 mg pure capsaicin (from chili extract) in each capsule in comparison to matched capsules with placebo (sorbitol and colorant), all capsules looking the same. Four weeks of active treatment is compared to four weeks of placebo. In between there is a wash out period of two weeks. The time frame is 24 hours + 10 weeks. During the first 24 hours the patients carry a cough recorder (Leicester Cough Monitor - LCM) and then start with 4 weeks of active treatment or placebo. This is followed by 2 weeks of wash out and then the patients start with another 4 weeks of active treatment or placebo. After this the study ends. Collaboration Professor Alyn Morice MD, PhD, chief physician at Hull York Medical School, University of Hull, UK. Professor Surinder Birring MD, Senior Lecturer, specialist in respiratory medicine, Imperial College, London, UK. Associate professor Alastair Ross,PhD, Chalmers University of Technology, Gothenburg, Sweden. Study center and number of subjects planned All clinical trials take place at the asthma and allergy clinic, Sahlgrenska University Hospital, Gothenburg, Sweden from where 60 patients with chronic idiopathic cough (CIC) are recruited.

Gender: All

Ages: 18 Years - 75 Years

Updated: 2024-11-25

1 state

Cough