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A nagging cough can hang on for weeks or months following a respiratory illness – and there is precious little you can do about it

Some coughs can last for weeks or even months following an upper respiratory infection. The good news – albeit not very satisfying – is that most eventually…

Relentless coughing after a viral infection can be frustrating and worrisome, but in most cases, coughs resolve over time. The Good Brigade/DigitalVision via Getty Images

When was the last time you walked into a public space and didn’t hear someone coughing? After three years of flinching at the sound, it can be disarming to hear so many people coughing – and embarrassing if it’s you.

But take heart in knowing that you’re not alone. A long-lasting cough following illness from an upper respiratory infection is surprisingly common. And unfortunately, with the rise in seasonal flu, COVID-19 and respiratory syncytial virus, or RVS cases in the fall of 2022 and winter of 2023, there’s been a lot of coughing lately.

A cough is a common symptom of these sorts of respiratory infections, and coughing is a complaint that leads to an estimated 30 million office visits every year. Some 40% of those end up in a pulmonologist’s office like mine.

Given how ubiquitous persistent coughing is, you might presume that the medical profession has a long list of treatments that we know work. That, unfortunately, depends on why you are coughing. But a cough following an upper respiratory infection does usually go away, in time.

Allergies, sinus problems, medications, asthma and bronchitis are among the things that can lead to chronic cough.

How a cough works

Doctors have long wondered why the duration of cough varies so much following an upper respiratory viral or bacterial infection. The answer likely lies in differences in people, such as the presence of a condition like asthma or chronic bronchitis. I see this same variability in my office: Some patients develop a long-term cough, while others seem to kick the cough much sooner, with no clear explanation.

Coughing occurs due to a complex process that begins with an electrical impulse between the nerves within the airways, including the nose and throat. There are two types of nerves that can trigger a cough in response to external stimuli: chemical receptors and mechanical ones called mechanoreceptors. Chemical receptors respond to smells and fumes; they’re the reason people sometimes cough after breathing in spicy peppers sizzling on a hot skillet. Mechanoreceptors respond to sensations from irritants such as dust.

When these nerves are activated, the throat closes and pressure in the chest increases. This buildup of pressure leads to a burst of air and mucous into the lungs at around 500 mph – a speed nearly twice as fast as the world’s fastest cars.

Studies show that a viral infection alters how sensitive these same nerves are. When you have a viral infection, the resulting inflammatory process produces a molecule called bradykinin that drives the urge to cough. And it’s known that the virus itself can activate genetic changes that increase the sensitivity of these nerve pathways, which leads to more coughing.

But when the acute stage of infection is over and you start to feel better, the body repairs the damages caused by inflammation in your airways and lungs. Through this process, the cough reflex also abates. And the molecular processes that were making you cough and sneeze more frequently settle down and return to a normal state – at least in most cases. Unfortunately, in some people, this process takes longer than in others.

She coughed and coughed and coughed. Then a doctor discovered what was wrong.

Knowing how long is too long to cough

Doctors find it useful to break respiratory symptoms like cough into specific categories.

There are three main types of coughs: acute, sub-acute and chronic. An acute cough is what most people experience when they’re sick with an active viral infection. A sub-acute cough lingers for three or more weeks following an upper respiratory illness. And a chronic cough is one that persists longer than 12 weeks. Chronic cough is most commonly caused by asthma, postnasal drip and, perhaps surprisingly to some, reflux.

Postinfectious cough is one variety of sub-acute cough and is the lingering cough that many people have after they get over their respiratory infection. It can last for weeks or months and can progress into chronic cough.

Because postinfectious cough is so common, doctors have long worked to determine how many people have a cough that persists after their other symptoms go away. Those estimates vary among studies. One small study in Japan found that of people who have a sub-acute and chronic cough, 12% resulted from a respiratory tract infection.

When it comes to COVID-19, the best evidence to date shows that only 2.5% of the people who have gotten it have also developed a chronic cough after infection. That number may seem small, but it translates to a lot of people coughing, given that the U.S. has more than 280,000 new cases of COVID-19 per week, as of early February 2023. The actual number, though, is unclear because the studies that look at postinfectious cough are often small and only account for the people who got COVID-19 and showed up in their doctor’s office or in a telehealth visit for evaluation.

No simple fix

The American College of Chest Physicians and the European Respiratory Society have published guidelines to help clinicians navigate these uncertainties and the dearth of data available on the diagnosis and treatment of coughing. Although the U.S. guidelines were published in 2006, they still represent the best evidence available for clinicians and their patients.

About half of patients recover from their cough without any treatment. For those who don’t, the limited data available suggests that inhalers, steroids, narcotics and certain over-the-counter medications may provide relief for some people.

In adults, the evidence for the efficacy of various treatments is mixed and limited. In my practice, I often prescribe a non-narcotic cough suppressant called benzonatate, sold under the brand name Tessalon Perles. It works by numbing the nerves in the lungs and airways, calming the cough reflex. Data for treatments in children is equally lacking, and studies have shown that over-the-counter cough suppressants and antihistamines were no more effective than the placebo.

Home remedies can also play an important role for some patients. Many people swear by honey, and there is some limited supporting evidence behind its benefits. One trial showed that honey was more effective at soothing a cough than the placebo over a three-day period.

When in doubt, ask a doctor

Being worried about a persistent cough is understandable – a quick Google search can present plenty of reasons to worry. Though not a very satisfying answer, most coughs really will eventually resolve on their own. However, if you lose weight rapidly, cough up blood, have night sweats or produce lots of sputum, you should talk to your primary care provider. In rare cases, sub-acute and chronic cough can be a sign of lung cancer or various forms of chronic pulmonary disease.

If you are simply nervous about it and want more information and advice, that is reason enough to check in with your doctor. After all, a cough is the reason behind millions of office visits every year.

Kyle B. Enfield receives funding from the National Heart and Lung Institute, Society of Critical Care Medicine - CureID, and the USDA. He is a member of the Society of Critical Care Medicine, the American Thoracic Society, the Society for Health Care Epidemiology of America, and the Wilderness Medicine Society. He is a volunteer with the Boy Scouts of America.

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Four burning questions about the future of the $16.5B Novo-Catalent deal

To build or to buy? That’s a classic question for pharma boardrooms, and Novo Nordisk is going with both.
Beyond spending billions of dollars to expand…



To build or to buy? That’s a classic question for pharma boardrooms, and Novo Nordisk is going with both.

Beyond spending billions of dollars to expand its own production capacity for its weight loss drugs, the Danish drugmaker said Monday it will pay $11 billion to acquire three manufacturing plants from Catalent. It’s part of a broader $16.5 billion deal with Novo Holdings, the investment arm of the pharma’s parent group, which agreed to acquire the contract manufacturer and take it private.

It’s a big deal for all parties, with potential ripple effects across the biotech ecosystem. Here’s a look at some of the most pressing questions to watch after Monday’s announcement.

Why did Novo do this?

Novo Holdings isn’t the most obvious buyer for Catalent, particularly after last year’s on-and-off M&A interest from the serial acquirer Danaher. But the deal could benefit both Novo Holdings and Novo Nordisk.

Novo Nordisk’s biggest challenge has been simply making enough of the weight loss drug Wegovy and diabetes therapy Ozempic. On last week’s earnings call, Novo Nordisk CEO Lars Fruergaard Jørgensen said the company isn’t constrained by capital in its efforts to boost manufacturing. Rather, the main challenge is the limited amount of capabilities out there, he said.

“Most pharmaceutical companies in the world would be shopping among the same manufacturers,” he said. “There’s not an unlimited amount of machinery and people to build it.”

While Novo was already one of Catalent’s major customers, the manufacturer has been hamstrung by its own balance sheet. With roughly $5 billion in debt on its books, it’s had to juggle paying down debt with sufficiently investing in its facilities. That’s been particularly challenging in keeping pace with soaring demand for GLP-1 drugs.

Novo, on the other hand, has the balance sheet to funnel as much money as needed into the plants in Italy, Belgium, and Indiana. It’s also struggled to make enough of its popular GLP-1 drugs to meet their soaring demand, with documented shortages of both Ozempic and Wegovy.

The impact won’t be immediate. The parties expect the deal to close near the end of 2024. Novo Nordisk said it expects the three new sites to “gradually increase Novo Nordisk’s filling capacity from 2026 and onwards.”

As for the rest of Catalent — nearly 50 other sites employing thousands of workers — Novo Holdings will take control. The group previously acquired Altasciences in 2021 and Ritedose in 2022, so the Catalent deal builds on a core investing interest in biopharma services, Novo Holdings CEO Kasim Kutay told Endpoints News.

Kasim Kutay

When asked about possible site closures or layoffs, Kutay said the team hasn’t thought about that.

“That’s not our track record. Our track record is to invest in quality businesses and help them grow,” he said. “There’s always stuff to do with any asset you own, but we haven’t bought this company to do some of the stuff you’re talking about.”

What does it mean for Catalent’s customers? 

Until the deal closes, Catalent will operate as a standalone business. After it closes, Novo Nordisk said it will honor its customer obligations at the three sites, a spokesperson said. But they didn’t answer a question about what happens when those contracts expire.

The wrinkle is the long-term future of the three plants that Novo Nordisk is paying for. Those sites don’t exclusively pump out Wegovy, but that could be the logical long-term aim for the Danish drugmaker.

The ideal scenario is that pricing and timelines remain the same for customers, said Nicole Paulk, CEO of the gene therapy startup Siren Biotechnology.

Nicole Paulk

“The name of the group that you’re going to send your check to is now going to be Novo Holdings instead of Catalent, but otherwise everything remains the same,” Paulk told Endpoints. “That’s the best-case scenario.”

In a worst case, Paulk said she feared the new owners could wind up closing sites or laying off Catalent groups. That could create some uncertainty for customers looking for a long-term manufacturing partner.

Are shareholders and regulators happy? 

The pandemic was a wild ride for Catalent’s stock, with shares surging from about $40 to $140 and then crashing back to earth. The $63.50 share price for the takeover is a happy ending depending on the investor.

On that point, the investing giant Elliott Investment Management is satisfied. Marc Steinberg, a partner at Elliott, called the agreement “an outstanding outcome” that “clearly maximizes value for Catalent stockholders” in a statement.

Elliott helped kick off a strategic review last August that culminated in the sale agreement. Compared to Catalent’s stock price before that review started, the deal pays a nearly 40% premium.

Alessandro Maselli

But this is hardly a victory lap for CEO Alessandro Maselli, who took over in July 2022 when Catalent’s stock price was north of $100. Novo’s takeover is a tacit acknowledgment that Maselli could never fully right the ship, as operational problems plagued the company throughout 2023 while it was limited by its debt.

Additional regulatory filings in the next few weeks could give insight into just how competitive the sale process was. William Blair analysts said they don’t expect a competing bidder “given the organic investments already being pursued at other leading CDMOs and the breadth and scale of Catalent’s operations.”

The Blair analysts also noted the companies likely “expect to spend some time educating relevant government agencies” about the deal, given the lengthy closing timeline. Given Novo Nordisk’s ascent — it’s now one of Europe’s most valuable companies — paired with the limited number of large contract manufacturers, antitrust regulators could be interested in taking a close look.

Are Catalent’s problems finally a thing of the past?

Catalent ran into a mix of financial and operational problems over the past year that played no small part in attracting the interest of an activist like Elliott.

Now with a deal in place, how quickly can Novo rectify those problems? Some of the challenges were driven by the demands of being a publicly traded company, like failing to meet investors’ revenue expectations or even filing earnings reports on time.

But Catalent also struggled with its business at times, with a range of manufacturing delays, inspection reports and occasionally writing down acquisitions that didn’t pan out. Novo’s deep pockets will go a long way to a turnaround, but only the future will tell if all these issues are fixed.

Kutay said his team is excited by the opportunity and was satisfied with the due diligence it did on the company.

“We believe we’re buying a strong company with a good management team and good prospects,” Kutay said. “If that wasn’t the case, I don’t think we’d be here.”

Amber Tong and Reynald Castañeda contributed reporting.

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Petrina Kamya, Ph.D., Head of AI Platforms at Insilico Medicine, presents at BIO CEO & Investor Conference

Petrina Kamya, PhD, Head of AI Platforms and President of Insilico Medicine Canada, will present at the BIO CEO & Investor Conference happening Feb….



Petrina Kamya, PhD, Head of AI Platforms and President of Insilico Medicine Canada, will present at the BIO CEO & Investor Conference happening Feb. 26-27 at the New York Marriott Marquis in New York City. Dr. Kamya will speak as part of the panel “AI within Biopharma: Separating Value from Hype,” on Feb. 27, 1pm ET along with Michael Nally, CEO of Generate: Biomedicines and Liz Schwarzbach, PhD, CBO of BigHat Biosciences.

Credit: Insilico Medicine

Petrina Kamya, PhD, Head of AI Platforms and President of Insilico Medicine Canada, will present at the BIO CEO & Investor Conference happening Feb. 26-27 at the New York Marriott Marquis in New York City. Dr. Kamya will speak as part of the panel “AI within Biopharma: Separating Value from Hype,” on Feb. 27, 1pm ET along with Michael Nally, CEO of Generate: Biomedicines and Liz Schwarzbach, PhD, CBO of BigHat Biosciences.

The session will look at how the latest artificial intelligence (AI) tools – including generative AI and large language models – are currently being used to advance the discovery and design of new drugs, and which technologies are still in development. 

The BIO CEO & Investor Conference brings together over 1,000 attendees and more than 700 companies across industry and institutional investment to discuss the future investment landscape of biotechnology. Sessions focus on topics such as therapeutic advancements, market outlook, and policy priorities.

Insilico Medicine is a leading, clinical stage AI-driven drug discovery company that has raised over $400m in investments since it was founded in 2014. Dr. Kamya leads the development of the Company’s end-to-end generative AI platform, Pharma.AI from Insilico’s AI R&D Center in Montreal. Using modern machine learning techniques in the context of chemistry and biology, the platform has driven the discovery and design of 30+ new therapies, with five in clinical stages – for cancer, fibrosis, inflammatory bowel disease (IBD), and COVID-19. The Company’s lead drug, for the chronic, rare lung condition idiopathic pulmonary fibrosis, is the first AI-designed drug for an AI-discovered target to reach Phase II clinical trials with patients. Nine of the top 20 pharmaceutical companies have used Insilico’s AI platform to advance their programs, and the Company has a number of major strategic licensing deals around its AI-designed therapeutic assets, including with Sanofi, Exelixis and Menarini. 


About Insilico Medicine

Insilico Medicine, a global clinical stage biotechnology company powered by generative AI, is connecting biology, chemistry, and clinical trials analysis using next-generation AI systems. The company has developed AI platforms that utilize deep generative models, reinforcement learning, transformers, and other modern machine learning techniques for novel target discovery and the generation of novel molecular structures with desired properties. Insilico Medicine is developing breakthrough solutions to discover and develop innovative drugs for cancer, fibrosis, immunity, central nervous system diseases, infectious diseases, autoimmune diseases, and aging-related diseases. 

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Another country is getting ready to launch a visa for digital nomads

Early reports are saying Japan will soon have a digital nomad visa for high-earning foreigners.



Over the last decade, the explosion of remote work that came as a result of improved technology and the pandemic has allowed an increasing number of people to become digital nomads. 

When looked at more broadly as anyone not required to come into a fixed office but instead moves between different locations such as the home and the coffee shop, the latest estimate shows that there were more than 35 million such workers in the world by the end of 2023 while over half of those come from the United States.

Related: There is a new list of cities that are best for digital nomads

While remote work has also allowed many to move to cheaper places and travel around the world while still bringing in income, working outside of one's home country requires either dual citizenship or work authorization — the global shift toward remote work has pushed many countries to launch specific digital nomad visas to boost their economies and bring in new residents.

Japan is a very popular destination for U.S. tourists. 


This popular vacation destination will soon have a nomad visa

Spain, Portugal, Indonesia, Malaysia, Costa Rica, Brazil, Latvia and Malta are some of the countries currently offering specific visas for foreigners who want to live there while bringing in income from abroad.

More Travel:

With the exception of a few, Asian countries generally have stricter immigration laws and were much slower to launch these types of visas that some of the countries with weaker economies had as far back as 2015. As first reported by the Japan Times, the country's Immigration Services Agency ended up making the leap toward a visa for those who can earn more than ¥10 million ($68,300 USD) with income from another country.

The Japanese government has not yet worked out the specifics of how long the visa will be valid for or how much it will cost — public comment on the proposal is being accepted throughout next week. 

That said, early reports say the visa will be shorter than the typical digital nomad option that allows foreigners to live in a country for several years. The visa will reportedly be valid for six months or slightly longer but still no more than a year — along with the ability to work, this allows some to stay beyond the 90-day tourist period typically afforded to those from countries with visa-free agreements.

'Not be given a residence card of residence certificate'

While one will be able to reapply for the visa after the time runs out, this can only be done by exiting the country and being away for six months before coming back again — becoming a permanent resident on the pathway to citizenship is an entirely different process with much more strict requirements.

"Those living in Japan with the digital nomad visa will not be given a residence card or a residence certificate, which provide access to certain government benefits," reports the news outlet. "The visa cannot be renewed and must be reapplied for, with this only possible six months after leaving the countr

The visa will reportedly start in March and also allow holders to bring their spouses and families with them. To start using the visa, holders will also need to purchase private health insurance from their home country while taxes on any money one earns will also need to be paid through one's home country.

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