儿童咳嗽变异型哮喘误诊为呼吸系统感染原因分析

Causes of Misdiagnosis of Cough Variant Asthma in Children as Upper Respiratory Tract Infection

目的探讨儿童咳嗽变异型哮喘(cough variant asthma, CVA)的临床特点、误诊原因及防范措施。方法对曾误诊为呼吸系统感染的儿童CVA 23例的临床资料进行回顾性分析并复习相关文献。结果本组误诊率23.96%。23例均以慢性咳嗽就诊,呈反复或持续咳嗽,时轻时重,以清晨明显,皆伴少量白色黏液样痰。咽部充血14例;双肺呼吸音增粗10例,可闻及干湿性啰音6例,可闻及哮鸣音2例。胸部X线检查示肺纹理增粗12例。血白细胞升高6例,中性粒细胞升高7例。初步诊断为上呼吸道感染5例、慢性支气管炎12例、支气管肺炎6例。误诊时间1~12(8.57±2.36)个月。23例按呼吸系统感染给予对症治疗后,病情均无明显改善或加重。后进一步行支气管舒张及激发试验、肺功能检查、皮肤变应原试验,结合病史和家族史等,确诊为CVA,给予相应治疗后病情稳定。随访1年,21例咳嗽症状消失,2例仍有咳嗽症状,但发作频率降低。结论 CVA临床表现缺乏特异性,易误诊。临床接诊长期反复慢性咳嗽患者时,应考虑到CVA,要详细询问病史、开阔诊断思维、综合全面分析病情,并及时行支气管舒张及激发试验、肺功能检查、皮肤变应原试验等特异性检查,以减少或避免CVA误诊误治。

Objective To explore the clinical characteristics, misdiagnosis causes and preventive measures of cough variant asthma(CVA) in children. Methods The clinical data of 23 children with CVA who were misdiagnosed as respiratory system infection were analyzed retrospectively and relevant literature was reviewed. Results The misdiagnosis rate was 23.96%. All 23 cases presented with chronic cough, which was repeated or persistent, mild and severe, and obvious in the morning, with a small amount of white mucoid sputum. There were 14 cases of pharyngeal hyperemia, 10 cases of thickened breath sounds, 6 cases of dry and wet rales, and 2 cases of wheezing sounds. Chest X-ray examination showed thickened lung texture in 12 cases, and an increase in the number of leukocytes in 6 cases and neutrophils in 7 cases. Based on initial diagnosis, there were 5 cases of upper respiratory tract infection, 12 cases of chronic bronchitis and 6 cases of bronchopneumonia. The duration of misdiagnosis was 1-12(8.57±2.36) months. No significant improvement or aggravation was found in 23 patients after symptomatic treatment of the respiratory system infection. CVA was diagnosed by the bronchodilation and bronchial provocation test, pulmonary function test, skin allergen test combined with their medical history and family history. After the corresponding treatment, the condition was stable. At 1-year follow-up, 21 cases had no cough symptoms, while 2 cases still had cough symptoms, but frequency of attack was reduced. Conclusion Due to lack of specificity in clinical manifestations, CVA is more likely to be misdiagnosed. In order to reduce or avoid misdiagnosis and mistreatment of CVA, physicians should take into account the possibility of CVA in the treatment of patients with long-term recurrent chronic cough, inquire the history of CVA in detail, broaden the diagnostic thinking, analyze the condition comprehensively, and carry out timely specific examinations such as bronchodilation and bronchial provocation test, pulmonary function test and skin allergen test.