吸烟者咳嗽变异性哮喘漏诊50例分析

Analysis of 50 cases of missed diagnosis of cough variant asthma in smoker

目的 提高临床医师对吸烟患者中咳嗽变异性哮喘 （CVA）的认识,以减少吸烟者CVA的漏诊误诊。方法 回顾性分析2016年10月至2017年10月就诊于广州呼吸健康研究院呼吸内科门诊确诊为CVA的50例吸烟者,包括临床表现、实验室资料、辅助检查等。结果 男49例,女1例,年龄22-78岁,平均 （52.22±13.06）岁;吸烟指数0.25-120包 · 年,平均 （25.08±24.526）包·年。23例具有气道高反应特点的咳嗽 （46%）;17例鼻炎鼻窦炎 （34%）,7例哮喘家族史 （14%）,4例药物过敏史 （8%）;X线胸片或胸部CT结果：32例表现为正常或支气管壁增厚（64%）,18例表现为肺气肿、肺大疱 （36%）;诱导痰检查24例,5例 （20 8%）嗜酸粒细胞增高,2例中性粒细胞增高 （8.3%）,两者均增多12例 （50%）;呼出气一氧化氮检查40例,其中10例（25%）增高〉50ppb。50例均行肺功能检查。结论 吸烟可能是支气管哮喘发生的风险因素之一,吸烟者以咳嗽为唯一症状就诊,不能简单诊断为气管支气管炎或咽炎,需行相关检查进一步排除是否存在CVA。

Objective To improve knowledge of cough variant asthma （CVA） in smokers, and to decrease misdiagnosis and missed diagnosis. Methods Clinical data of 50 smokers who were diagnosed with CVA in Guangzhou Institute of Respiratory Health from October 2016 to October 2017 were retrospectively analyzed, including clinical manifestations, laboratory findings, and auxiliary examinations. Results There were 49 males and one female, aging from 22 to 78 years old, mean （52.22±13.06） years old. Smoking index （SI） were from 0.25 to 120 pack-years, mean （25.08 - 24. 526） pack-years. Twenty- three patients coughed with characteristics of airway hyper reactivity （46%）, 17 cases of rhinitis sinusitis （34 % ）, seven cases （14 % ） with family history of asthma, four cases of history of allergies to drug （8 % ）. Chest radiograph or CT Scan indicated normal or bronchial wall thickening in 32 smokers （64%） and emphysema and bullae in 18 cases （36%）. For induced sputum, five patients of 24 cases （20.8%） had increased eosinophil （EOS） count, two cases （8.3%/00） had increased neutrophils （NEU） and 12 cases （50%） had increased both EOS and NEU. Fractiona exhaled nitric oxide was examined in 40 cases, of which 10 cases -50 ppb （25 %）. All patients had lung function measurement. Conclusions Smoking may be a risk factor for asthma. When cough is the only symptom in smokers, some special examinations should be done to exclude CVA, not be simply diagnosed as tracheal bronchitis or pharyngitis.