咳嗽变异性哮喘33例临床分析

Clinical analysis of 33 cases of cough variant asthma

目的分析咳嗽变异性哮喘的临床资料,提高对本病的诊治水平。方法回顾性分析33例咳嗽变异性哮喘的临床特点、治疗及疗效。结果33例中25例被误诊为其他疾病,14例有支气管哮喘家族史,24例有个人过敏史,31例有明确的诱因。临床表现以干咳为主24例,伴少量痰液9例,咳嗽症状明显于夜间或清晨加重20例,伴胸闷憋气不适7例,伴流涕、打喷嚏15例,以咳嗽为唯一症状23例。肺部听诊、胸部X线检查均无明显异常。支气管扩张试验均为阳性。所有患者用抗生素和化痰止咳药物治疗无效,吸入糖皮质激素、β2受体激动剂、茶碱、M受体拮抗剂及H1受体阻断剂治疗后症状消失29例,症状缓解4例。结论咳嗽变异性哮喘临床表现缺乏特异性,易造成误诊,应根据该病的临床特点与其他引起咳嗽的疾病相鉴别诊断,治疗原则同典型的支气管哮喘。

Objective To analyze the clinical data of cough variant asthma（CVA） and improve the diagnosis and treatment of the disease. Methods Clinical characteristics, treatments and curative effects of 33 cases of CVA were analyzed retrospectively. Results Twenty-five of thirty-three cases were misdiagnosed as some other diseases, fourteen cases were characterized by family history of bronchial asthma, twenty-four cases were characterized by individual hypersensitivity history and 31 cases had definite remote causes. Clinical manifestation： nonproductive cough（ 24 cases）, complicated with slight productive cough（9 cases）, symptoms of cough obviously aggravated at night or early in the morning（20 cases）, accompanied by chest distress（7 cases）, accompanied by a running nose or sneezing （15 cam）, cough was the single symptom（ 23 cases）. Chest auscultations and chest X-ray examinations didn＇t show the apparent abnormalities in all the cases. Brinchial provocation test were positive in all the cases. Antibiotics, apophlegmatisant and cough remedy were ineffective to all the cases. Symptoms disappeared in 29 cases and relaxed in 4 cases after the treatments with inhaled glucocorticosteroids, β2 receptor agonists, theophylline, M receptor antagonist and H1 receptor blocking agents. Conclusion The CVA is easily misdiagnosed because it＇ s nonspecific clinical manifestations. Clinical doctors should make differential diagnosis with some other diseases that can also lead to cough according to its clinical features. Therapeutic principle is the same as typical bronchial asthma.