A systemaic review and meta-analysis of traditional Chinese medicine in the treatment of chronic cough

Objective: To systematically evaluate the safety and efficacy of traditional Chinese medicine (TCM) in the treatment of chronic cough. Methods: Databases CNKI, WanFang Data, VIP, CBM, PubMed, Web of Science, Cochrane Library from inception to February 2021 were electronically searched by two researchers, to collect randomized controlled trials (RCTs) of traditional Chinese medicine in the treatment of chronic cough, UACS/PNDS, CVA, EB, AC, GERD and other types of cough. Revman 5.3 software was used to analyze and summarize the collected literature, and the methodological quality of the included studies was evaluated by the bias risk assessment scale of Cochrance Collaboration Network. Results: A total of 26 articles involving 2 820 patients, with 1 420 in the experimental group and 1 400 in the control group were included. The results of meta-analysis showed that compared to the control group which was treated with western medicine alone, TCM significantly improved the clinical effective rate [RR=1.20, 95% CI(1.16,1.25), P<0.000 01], alleviated cough syndrome score [SMD=-0.83, 95% CI(-1.21,-0.44)], and enhenced the score of quality of life [MD=-2.18, 95%CI(1.63,2.74), P<0.000 01];at the same time, the experimental group was better than the control group in improving lung function and reducing the time of cough relief. In terms of safety, a total of 24 patients in 5 literatures had adverse reactions, but the symptoms were mild and could be relieved quickly. In addition, there was no significant difference in adverse reactions between the control group and the experimental group, showing good safety. Conclusion: TCM treatment can significantly improve the cure rate of cough, reduce cough score, improve systemic symptoms, relieve psychological anxiety, improve lung function, and improve cough symptoms rapidly, with good safety.

Investigation of the active components and mechanism of Sanao Decoction in treating chronic cough by network pharmacology and molecular docking

Objective To investigate the active components and mechanism of Sanao Decoction(三拗汤,SAD)in treating chronic cough based on network pharmacology and molecular docking.Methods Active components and their targets were obtained from the Traditional Chinese Medicine Systems and Pharmacology Database and Analysis Platform(TCMSP),Bioinformatics Analysis Tool for Molecular mech ANism of Traditional Chinese Medicine(BATMAN-TCM)database,and the literature.The component-target regulatory network and protein-protein interaction(PPI)network were constructed by Cytoscape 3.7.2,and a bioinformatics analysis was performed to identify the significant pathways and their relevant targets.Molecular docking of the core active components and relevant targets was performed.Results A total of 98 active components of SAD and the corresponding 113 drug targets were identified.The component-target regulatory network and PPI network were successfully established.Results of the bioinformatics analysis indicated that 2281 Gene Ontology(GO)terms were enriched in chronic cough,including 2062 terms were in biological processes,77 in cellular components,and 142 in molecular functions,and top 20 significant pathways in Kyoto Encyclopedia of Genes and Genomes(KEGG)analysis.Molecular docking study demonstrated that quercetin,luteolin,kaempferol,and naringenin were in good agreement with the corresponding targets.Conclusion The active compounds of SAD,such as quercetin,luteolin,kaempferol,and naringenin,may act on AKT1,MAPK1,RELA,EGFR,and Bcl-2 and regulate the PI3 K-Akt signaling pathway,AGE-RAGE signaling pathway,and fluid shear stress and atherosclerosis pathway to exert the effects of anti-inflammatory,anti-airway remodeling,anti-oxidant stress effects,and repair airway damage,thus treating chronic cough.

Diagnosis and Treatment of Chronic Cough due toGastroesophageal Reflux Disease

Gastroesophageal reflux disease is one of most common causes of chronic cough. Medical history offers few clues as to the cause of cough induced by this disease. 24-h esophageal ph monitoring is considered as the most sensitive and specific test for the diagnosis. When it is unavailable or unsuitable, upper gastrointestinal endoscopy and barium esophagography can be used as an alternative examination. Combined multichannel intraluminal impedance and pH testing is promising because of its ability to detect non-acid reflux as well as acid reflux. Empiric therapy trial is a simple and cheap way to identify suspected patients. Drug therapy is effective in most of the patients, in which proton pump inhibitors is the most powerful. Antireflux surgery is the last choice,used only when intensive drug therapy fails. The definitive diagnosis of cough due to gastroesophageal reflux disease can be established only after cough improves or cc.npletely disappears with antireflux therapy.

Analysis of Zhang Hongxing's Clinical Experience in Treating Chronic Cough

Director Zhang Hongxing is a famous traditional Chinese medicine(TCM)doctor in Shandong province and a teacher in the Famous TCM Expert Studio in Dezhou city.He has rich clinical experience and considerable experience in the treatment of common clinical chronic coughs.Director Zhang Hongxing believes that chronic cough belongs to the category of"wind cough"and"long-term cough"according to TCM.TCM diagnosis should start from the four aspects of "wind evil residing in lung","liver"?"spleen and stomach",and"yang deficiency".Starting from viewing the human body as an organic whole,distinguish between deficiency or excess in cold and heat,and clinical treatment for cough should focus on dispelling"wind",regulating the functions of liver,spleen,and stomach,and supplementing the body's yang.Formulate treatment based on different categorization,and modify prescription according to the symptoms,and the treatment effects are remarkable.

Refractory chronic cough due to gastroesophageal reflux: Definition, mechanism and management

Refractory chronic cough due to gastroesophageal reflux is a trouble some condition unresponsive to thestandard medical anti-reflux therapy. Its underlying mechanisms may include incomplete acid suppression, non-acid reflux, transient lower esophageal sphincter relaxations and esophageal hypersensitivity. The diagnosis of this disorder depends on both the findings of multi-channel intraluminal impedance-pH monitoring and the subsequent intensified anti-reflux therapy. The strategies of pharmacological treatment for refractory chronic cough due to reflux include the optimization of proton pump inhibitors and add-on therapies with histamine H2 receptor antagonists, baclofen and gabapentin. However, the further study is needed to satisfy its management.

Pulmonary Hypoplasia: A Rare Cause of Chronic Cough in TB Endemic Area

Pulmonary hypoplasia is a rare disease characterized by a defect of lung development more often unilateral. The diagnosis requires several exams to eliminate other causes of pulmonary retraction. We report two cases at the department of pneumophtisiology of the University Teaching Hospital of Point G. The first case is a young adult who was complaining of a chronic cough. Etiological investigation required several exams including spirometry and Computed tomographic scan (CT scan). After elimination of all suspected causes of pulmonary opacity, the diagnosis of pulmonary hypoplasia was retained. The second case is a 2-year-old girl who was born with congenital cardiopathy whose respiratory complications were increasing during her childhood and respiratory explorations discovered pulmonary agenesis. Pulmonary hypoplasia is rare in our medical practice, but attention must be drawn to a retractile pulmonary opacity in young age after elimination of all infectious causes in TB endemic area.

Should We Measure the FEV1 or the Specific Resistance of the Airways? An Evaluation in Patients with Either COPD, Chronic Dyspnea or Chronic Cough

Background: The purpose of this study was to evaluate the relative contribution of measuring the forced expiratory volume in one second (FEV1) or the specific resistance of the airways (sRaw) in adults referred for chronic obstructive pulmonary disease (COPD), chronic dyspnea or chronic cough. Methods: This was a prospective study of 321 subjects referred for lung function testing, in a setting of routine clinical management, for suspicion of COPD (or follow-up of known COPD), chronic dyspnea or chronic cough. The proportions of FEV1 values below the normal range and of sRaw values above the normal range were compared using a Chi-square exact test of Fisher. Results: In the COPD and chronic dyspnea groups, sRaw was as frequently abnormal as FEV1. In the chronic cough group, sRaw was increased in 56.5% of subjects, while FEV1 was decreased in solely 34.8% (p = 0.059). Conclusions: This study suggests that sRaw may be a better tool than FEV1 to detect bronchial obstruction in patients presenting with chronic cough.

Living near a Major Road in Beijing： Association with Lower Lung Function, Airway Acidification, and Chronic Cough

Background： The effects of near-road pollution on lung function in China have not been well studied. We aimed to investigate the effects of long-term exposure to traffic-related air pollution on lung function, airway inflammation, and respiratory symptoms. Methods： We enrolled 1003 residents aged 57.96 ± 8.99 years living in the Shichahai Community in Beijing. Distances between home addresses and the nearest major roads were measured to calculate home-road distance. We used the distance categories 1, 2, and 3, representing 〈100 m, 100-200 m, and 〉200 m, respectively, as the dose indicator for traffic-related air pollution exposure. Lung function, exhaled breath condensate （EBC） pH, and interleukin 6 levels were measured. As a follow-up, 398 participants had a second lung function assessment about 3 years later, and lung function decline was also examined as an outcome. We used regression analysis to assess the impacts of home-road distance on lung function and respiratory symptoms. As the EBC biomarker data were not normally distributed, we performed correlation analysis between home-road distance categories and EBC biomarkers. Results： Participants living a shorter distance from major roads had lower percentage of predicted value of forced expiratory volume in 1 s （FEV1% -1.54, 95% confidence interval [CI]： -0.20 to -2.89）. The odds ratio for chronic cough was 2.54 （95% CI： 1.57-4.10） for category 1 and 1.97 （95% CI： 1.16-3.37） for category 2, compared with category 3. EBC pH was positively correlated with road distance （rank correlation coefficient of Spearman [rs] = 0.176, P 〈 0.001 ）. Conclusions： Long-term exposure to traffic-related air pollution in people who live near major roads in Beijing is associated with lower lung function, airway acidification, and a higher prevalence of chronic cough. EBC pH is a potential useful biomarker for evaluating air pollution exposure.

Discrepancy between presumptive and definite causes of chronic cough

Background The current diagnostic algorithms for chronic cough require the establishment of the primary presumptive causes followed by the confirmation of diagnosis with the specific therapies. The aim of the study was to investigate the discrepancy between presumptive and definite causes and its clinical implication. Methods A total of 109 patients with chronic cough underwent laboratory investigations to identify the cause of cough; including sinus computerized tomography （if needed）, histamine bronchial provocation, induced sputum cytology and 24-hour esophageal pH or multi-channel intraluminal impedance combined with pH monitoring. The presumptive causes were confirmed by treating them sequentially. The difference between presumptive and definite causes of chronic cough was compared. Results Single cause was more frequent in the definite diagnosis than in the presumptive diagnosis （78.9% vs. 54.1%, X2=15.01, m=-0.0001）. In contrast, multiple causes were significantly fewer in definite diagnosis than in the presumptive diagnosis （15.6% vs. 37.6%, X2=13.53, P=-0.0002）. There was a discrepancy between definite and presumptive causes in 30 patients （27.5%）. Compared with the presumptive causes, definite upper airway cough syndrome （24.8% vs. 11.9%, X^2=6.0, P=0.01） and gastroesophageal reflux disease （6.4% vs. 0, X2=7.23, P=0.007） was more frequent as a single cause of chronic cough while cough variant asthma plus gastroesophageal reflux disease （3.7% vs. 11.9%, X2=5.17, P=0.02） and upper airway cough syndrome plus nonasthmatic eosinophilic bronchitis （0 vs. 9.2%, X2=10.48, P=0.001） were fewer as multiple causes of chronic cough. Conclusions A discrepancy was common between presumptive and definite causes of chronic cough. To treat presumptive causes sequentially may be a suitable solution for avoidance of erroneous multiple causes and possible over-treatment.

Sixty-eight Cases of Child Chronic Cough Treated by Moxibustion

Objective: To observe the therapeutic effects of moxibustion for chronic cough in children. Methods: 68 child cases of chronic cough were treated by moxibustion. Results: 54 cases were cured, 13 cases improved, and one case failed. The cure rate was 79.2%, with a total effective rate of 98.5%. Conclusion: The moxibustion therapy has definite therapeutic effect for children chronic cough.

Validation of the Chinese version of Hull airway reflux questionnaire and its application in the evaluation of chronic cough

Objective To validate the effectiveness,repeatability and treatment responsiveness of the Chinese version of Hull airway reflux questionnaire(HARQ),and to determine its clinical value.Methods A standard Chinese version of HARQ was developed by an established translation procedure and its repeatability was assessed in a preliminary study involving 55 untreated patients

从“阳化气,阴成形”探讨慢性咳嗽之因机证治

慢性咳嗽是以咳嗽为主症或唯一症状、病程持续8周以上的呼吸系统疾病。慢性咳嗽病因复杂,病程较长,病势缠绵,且极易复发。西医诊断该病过程繁琐,治疗手段有限,而中医药以整体观念和辨证论治思想为指导,在缓解临床症状、预防疾病复发方面具有独特优势。该文以“阳化气,阴成形”为抓手,分析阴阳在慢性咳嗽因机证治全周期的重要意义,认为慢性咳嗽之病机关键为“阳化气,阴成形”功能失衡,以肺之气血失和、阴阳虚损为本,阳化而气行不畅、周流有碍,阴变而凝结停滞、壅塞肺络为标。治疗上,需要补肺、脾、肾阴阳之不足,泄气滞、水湿、痰饮、瘀血、热毒之有余,以恢复“阳化气,阴成形”之平衡。具体用药方面,主张以偏纠偏,以药物气味之偏性纠正人体阴阳之偏颇。另附典型医案二例,加以验证说明,以期为中医药防治慢性咳嗽提供新的诊疗思路和方法。

参芪补肺汤联合孟鲁司特钠片治疗非小细胞肺癌术后慢性咳嗽的临床研究

目的观察参芪补肺汤联合孟鲁司特钠片治疗非小细胞肺癌(NSCLC)术后慢性咳嗽的临床疗效。方法将100例NSCLC术后慢性咳嗽患者按照随机数字表法分为2组,对照组50例予孟鲁司特钠片治疗,治疗组50例在对照组治疗基础上联合参芪补肺汤治疗。2组均治疗4周。比较2组治疗前后咳嗽症状、莱彻斯特咳嗽生命质量问卷(LCQ-MC)评分、肺功能指标[用力肺活量(FVC)、第1 s用力呼气容积(FEV_(1))、FEV_(1)/FVC、呼气峰流量(PEF)]、炎症指标[白细胞介素8(IL-8)、肿瘤坏死因子α(TNF-α)、降钙素原(PCT)、白细胞介素6(IL-6)]、中医证候评分,并统计2组不良反应发生率、复发率和疗效。结果治疗组总有效率98.00%(49/50),对照组总有效率82.00%(41/50),治疗组临床疗效优于对照组(P<0.05)。2组治疗后日间与夜间咳嗽症状评分均较本组治疗降低(P<0.05),且治疗组治疗后均低于对照组(P<0.05),2组治疗后LCQ-MC评分均升高(P<0.05),且治疗组治疗后高于对照组(P<0.05)。2组治疗后FVC、FEV_(1)、FEV_(1)/FVC、PEF均较本组治疗前升高(P<0.05),且治疗组治疗后均高于对照组(P<0.05)。2组治疗后IL-8、TNF-α、PCT、IL-6均较本组治疗降低(P<0.05),且治疗组治疗后均低于对照组(P<0.05)。2组治疗后中医证候各项评分均较本组治疗前降低(P<0.05),且治疗组治疗后均低于对照组(P<0.05)。治疗组不良反应发生率4.00%(2/50),对照组不良反应发生率18.00%(9/50),治疗组不良反应发生率低于对照组(P<0.05)。治疗组复发率4.08%(2/49),对照组24.39%(10/41),治疗组复发率低于对照组(P<0.05)。结论参芪补肺汤联合孟鲁司特钠片治疗NSCLC术后慢性咳嗽患者疗效显著,能够有效缓解咳嗽症状,改善患者肺功能,提升LCQ-MC评分,且不良反应发生率与复发率降低,具有临床应用价值。

推拿联合闪罐改善儿童肺炎支原体肺炎后慢性咳嗽临床观察

目的 观察小儿推拿联合闪罐改善儿童肺炎支原体肺炎(MPP)后慢性咳嗽的治疗效果。方法 选取72例MPP后慢性咳嗽患儿,随机分为试验组36例和对照组36例。试验组采用小儿推拿联合闪罐交替进行治疗,对照组予孟鲁司特钠咀嚼片口服。比较2组患儿治疗前后咳嗽视觉模拟(VAS)评分、简易咳嗽程度(CET)评分、临床疗效。结果 治疗后,2组患儿咳嗽VAS评分、CET评分均降低(P<0.05),试验组各评分改善程度优于对照组(P<0.05);试验组总有效率高于对照组(P<0.05)。结论 小儿推拿联合闪罐能够减轻MPP后患儿咳嗽严重程度,实现对患儿气道高反应性的良性调节,降低咳嗽对患儿日常生活及心理的影响,相对单纯口服孟鲁司特钠具备一定优势,值得在临床上进一步推广应用。

经方治疗慢性咳嗽的研究进展

慢性咳嗽患者在呼吸科门诊中占比越来越高,西医治疗具有一定疗效,但同时会伴有不良反应发生。众多研究及临床经验均证实,中医治疗慢性咳嗽展现出其独特优势,尤其是传统经方的治疗效果已得到临床认可。本文旨在对经方治疗慢性咳嗽的研究进展进行综述,以期为慢性咳嗽的临床治疗提供参考和帮助。

金水六君煎治疗慢性支气管炎迁延期规律探析

金水六君煎出自《景岳全书》,主治肺肾虚寒、水泛为痰,或年迈阴虚、气血不足、外受风寒、咳嗽呕恶、多痰喘急等症。文章通过分析金水六君煎方药组成,结合景岳的“治形”思想以及对痰的认识,总结金水六君煎在慢性支气管炎迁延期运用的规律及要点。肺肾两虚、痰浊内生是其主要病机特点,补肺益肾、祛痰化浊是其主要治则。临证运用金水六君煎加减治疗慢性支气管炎迁延期肺肾两虚兼痰浊恋肺证,效果显著,安全性高,值得临床推广应用。

肺部切除术后慢性咳嗽预测模型的建立与验证

背景与目的肺部切除术后慢性咳嗽是最常见的并发症之一,严重影响患者术后生活质量,目前国内尚无关于肺部切除术后慢性咳嗽预测模型。因此,本研究旨在探讨肺部切除术后慢性咳嗽相关危险因素,构建预测模型并进行验证。方法回顾性分析2021年1月至2023年6月于中国科学技术大学附属第一医院接受肺部切除术的499例患者的临床资料和术后咳嗽情况,按7:3随机分配原则分为训练集(n=348)和验证集(n=151),根据训练集患者术后是否慢性咳嗽分为咳嗽组和非咳嗽组。使用中文版莱斯特咳嗽问卷(The Mandarin-Chinese version of Leicester cough questionnare,LCQ-MC)评估术前、术后咳嗽的严重程度及其对患者生活质量的影响,采用咳嗽视觉模拟量表(visual analog scale,VAS)和自拟的数字评分法(numerical rating scale,NRS)评估术后慢性咳嗽,采用单因素和多因素Logistic回归分析独立危险因素和模型构建,受试者工作特征(receiver operator characteristic,ROC)曲线评估模型区分度,校准曲线评估模型的一致性,绘制决策曲线分析(decision curve analysis,DCA)评估模型的临床应用价值。结果多因素Logistic分析筛选出术前用力呼气第1秒呼气量与用力肺活量比(forced expiratory volume in the first second/forced vital capacity,FEV_(1)/FVC)、手术方式、行上纵隔淋巴结清扫、行隆突下淋巴结清扫、术后胸腔闭式引流时间是术后慢性咳嗽的独立危险因素,基于多因素分析结果构建列线图预测模型。ROC曲线下面积为0.954(95%CI:0.930-0.978),最大约登指数所对应的临界值为0.171,此时敏感度为94.7%,特异度为86.6%。Bootstrap法抽样1000次,校准曲线图预测的肺部切除术后慢性咳嗽与实际发生风险高度一致。DCA显示当预测模型概率的预概率为0.1-0.9之间,患者表现为正的净收益。结论肺部切除术后慢性咳嗽严重影响患者生活质量。列线图的可视化展现形式有助于准确预测肺部切除术后慢性咳嗽,为临床决策提供支持。

儿童慢性咳嗽中医诊疗指南

遵循循证医学原则,按照标准化文件的结构和起草规则,在文献研究的基础上,根据小儿慢性咳嗽的特点以及需要形成共识的问题,基于德尔菲法和专家论证会、公开征求意见等步骤制定《儿童慢性咳嗽中医诊疗指南》,内容包括适用范围、术语及定义、病因与诊断、辅助检查、治疗、预防与调护等内容。旨在厘清中医药在诊治儿童慢性咳嗽的最佳治疗方案,为提高儿童慢性咳嗽中医药临床诊疗水平给予指导性意见。

标准化分级药学监护服务在慢性气道疾病住院患者中的多维价值分析

目的 为构建慢性气道疾病住院患者科学、合理的药学服务新模式提供参考。方法 选取2023年10月-2024年3月在河北省人民医院呼吸科住院并接受药学监护(PC)服务的慢性阻塞性肺疾病及哮喘急性加重的患者250例,采用随机数字表法将其分成对照组(125例)和观察组(125例)。对照组患者住院期间全程给予一般药学服务,观察组患者住院期间全程给予标准化分级PC服务。比较不同PC服务模式在患者临床价值指标、人文价值指标及质量管理指标间的差异。结果 在临床价值评价指标中,观察组患者的疾病治疗目标达成率、吸入装置正确使用得分、药品不良反应发生率、解决药物相关问题数量均显著优于对照组(P<0.05)。在人文价值评价指标中,观察组的患者用药依从性得分、药师干预成功率、患者满意度均显著高于对照组(P<0.05)。在质量管理评价指标中,观察组患者的药品费用占比、静脉用药占比、抗菌药物使用率、抗菌药物使用强度均显著优于对照组(P<0.05);观察组药事服务例数也多于对照组,但两组间各项药事服务例数占比的差异无统计学意义(P>0.05)。结论 标准化分级PC服务可帮助药师识别更需要关注和管理的高危患者,提高药师工作效率,提升患者就医体验,是值得推广的新型药学服务模式。