112例误诊为支气管炎的老年慢性咳嗽病因分析

Etiological investigation of the 112 elderly patients with chronic cough misdiagnosed as bronchitis

目的探讨老年患者慢性咳嗽的误诊及病因分布。方法基层医院误诊为支气管炎的112例老年慢性咳嗽患者,采用咳嗽诊治指南制定的诊断程序,判断病因并予针对性治疗。结果最终病因明确107例(95.54%),其中单一病因为89例(79.46%),复合病因为18例(16.07%)。老年患者病因诊断前三位为胃食管返流性咳嗽、咳嗽变异型哮喘、上气道咳嗽综合征,在女性患者和男性患者中分别占26.39%,20.83%,18.06%和29.31%,22.41%,18.97%。三者占慢性咳嗽病因的67.69%,其次是ACEI诱发的咳嗽。经特异性治疗后咳嗽明显减轻或消失为103例,有效率为91.96%,其余均为部分缓解。结论老年慢性咳嗽病因复杂常被误诊,规范慢性咳嗽病因诊断程序对提高老年慢性咳嗽诊治水平有重要意义。

Objective The purpose of this study is to explore the etiology and misdiagnosis of the elderly patients with chronic cough.Methods A total of 112 the elderly patients（62 females,50 males） with chronic cough misdiagnosed as bronchitis by primary hospital were studied.Based on ＂Guideline on Diagnosis and Treatment of Chronic Cough＂ established by China Medical,the causes of chronic cough would be confirmed and given specific therapy.Results 107 of 112 patients（95.54%）were finally confirmed.Chronic cough due to a single cause was found in 89 patients（79.46%）,and due to two causes in 18 patients（16.07%）.The top three causes were gastroesophageal reflux cough（GERC）,cough variant asthma（CVA）,upper airway cough syndrome（UACS） and accounted for 67.69%,followed by the ACEI-induced cough.The three causes accounted for 26.39%,20.83%,18.06% in females and 29.31%,22.41%,18.97% in male patients,respectively.After specific therapy based on diagnosis,cough cured and alleviated in 103 patients（91.96%）;the rest are partially alleviated.Conclusions The cause of chronic cough in the elderly is complex and often misdiagnosed.It is important to improve the diagnosis and treatment of chronic cough according to standardized diagnostic protocol.