咳嗽变异性哮喘临床特征及诊断初步研究

Preliminary study of clinical features and diagnosis of cough variant asthma

目的深入研究咳嗽变异性哮喘（CVA）患者的临床特征以及治疗反应对临床诊断的意义，提高对CVA的诊治水平。方法2009年lO月到2010年8月期间在第三军医大学新桥医院门诊及涪陵中心医院就诊诊断为慢性咳嗽，并且支气管激发试验阳性拟诊为CVA的患者，记录其咳嗽的临床特点、伴随症状和咽部体征。并给予沙美特罗／N替卡松干粉剂50／100μg，2次／d吸人，1～2周后门诊或电话随访，评价疗效和确定诊断。结果共46例患者入选本试验，41例完成随访研究。CVA患者大多数有夜间咳嗽（87．9％）和咽部瘙痒等症状（87．9％），近半数患者咳嗽剧烈，干咳患者仅占39．0％，45．5％合并鼻炎或鼻窦炎。治疗有效率为80．5%33／41）。治疗无效组与有效组患者的临床特征比较，显示两组患者夜间咳嗽情况和咽部阳性症状的比例无明显差异，但治疗无效组患者伴随的胃病或反流症状，清喉和咽部体征有明显高于有效组患者的趋势。结论夜间咳嗽和咽部瘙痒等是大多数CVA具有的症状特点，气道反应性测定和抗哮喘治疗反应是确诊CVA的主要依据。对抗哮喘治疗无效的患者，还需要深入研究影响疗效的原因，不宜简单地排除CVA诊断。

Objective To investigate the clinical features and the response to treatment for clinical diagnosis of cough variant asthma （CVA） for the raising the level of clinical treatment. Methods We selected the CVA cases from the chronic cough cases with bronchial provocation test positive from respiratory medicine clinic in our hospital and Fuling central hospital from October 2009 to August 2010. The clinical features of cough and symptoms and throat symptoms from the suspected CVA cases were recorded, and then the eases were treated with Salmeterol/fluticasone dry powder （50/100 μg, twice a day） for 1 2 weeks. After 1-2 weeks, the results of treatments and clear diagnosis were evaluated through telephone or clinic follow-up. In addition to its study,the anti-asthma or cough drugs were disable during the treatment. It was statistics effect when cough improved 1/2 or more effective for the treatment. Results 46 patients were selected into this study, and 41 patients completed the follow-up study. Most of CVA patients were with nocturnal cough （87.9 %） and throat itching and other symptoms （87.9%）. Nearly half of CVA patients were with severe cough, and only 39.0%of patients were with dry cough, and 45.5%of patients were combined with rhinitis or sinusitis. Therapeutic efficacy was 80.5 % （33/ 41）. The clinical features of effective treatments patients and ineffective treatments patients showed that positive symptoms of cough and throat had no significant difference between two groups of patients, butConclusions Nighttime cough and throat itching symptoms are the majority features CVA. Determination of airway reactivity and anti-asthma treatment response are the main basis for diagnosis of CVA. The reasons of efficacy treatment should be in-depth study in the patients with ineffective treatment against asthma, not simply rule out the diagnosis of CVA.