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.

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.

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 completely disappears with antireflux therapy.

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.

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

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.

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。

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。

慢性咳嗽与中枢神经因子调节剂的利用

慢性咳嗽是一种常见的疾病,但会给患者带来巨大的身体、精神和社会负担。虽然慢性咳嗽通常与基础疾病,如哮喘、胃食管反流病、嗜酸性粒细胞性支气管炎等相关,但是部分患者咳嗽极难控制,并且难以明确咳嗽病因,其中许多患者表现出咳嗽高敏感性的临床特征,这为慢性咳嗽的治疗研究提供了新的方向。随着对慢性咳嗽病理生理学机制的深入研究,慢性咳嗽的治疗方法发展到新阶段。本文总结并讨论了中枢神经因子调节剂用于治疗慢性咳嗽的机制以及临床证据,这些药物可能在未来有较好的临床应用前景。

儿童迁延性细菌性支气管炎诊疗现状

迁延性细菌性支气管炎(PBB)是由细菌引起的支气管内膜持续感染性疾病。PBB是国内外儿童慢性咳嗽的主要病因。目前已有多个国家将其纳入慢性咳嗽指南并加以完善及更新。PBB的诊断包括基于临床和基于微生物学的诊断标准。现国际上推荐阿莫西林-克拉维酸钾作为治疗PBB的首选药物,当患儿对青霉素过敏或对阿莫西林-克拉维酸钾耐药时,可选择头孢类或大环内酯类抗生素。尽管2周合适抗生素治疗后咳嗽缓解是诊断PBB的关键部分,但目前最佳的抗生素疗程暂未统一。PBB的预后整体较好,但频繁复发和反复使用抗生素的情况比较常见。同时,若PBB反复发作及合并流感嗜血杆菌感染则有进展为支气管扩张的风险。目前国内对于PBB的认识起步相对较晚,在诊断及治疗方面仍有不足。因此本文主要介绍PBB的诊断及治疗现状,指出目前这一领域存在的问题,使PBB的诊治更加规范。

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。

儿童慢性咳嗽病因及误诊原因分析

目的分析儿童慢性咳嗽的病因,以及儿童慢性咳嗽误诊的相关原因。方法选取2018年1月—2022年1月收治的曾误诊慢性咳嗽患儿53例,分析其病例资料。结果53例中男32例,女21例;年龄7~12岁;病程4~28个月;有过敏性鼻炎、鼻窦炎史15例,有家族哮喘史12例。53例以不同程度咳嗽为主诉就诊,夜间刺激性咳嗽31例,日间发作性咳嗽20例,日间及夜间均咳嗽2例;伴剑突下不适、胸骨后烧灼感、反酸、嗳气12例;有鼻后滴流感或日常有频繁清喉动作15例。误诊慢性支气管炎31例、慢性咽炎22例,予镇咳、化痰、抗感染等治疗,症状未见明显改善。后26例行肺功能、支气管激发试验及诱导痰检查确诊咳嗽变异性哮喘;15例鼻后滴流感或日常有频繁清喉动作,有过敏性鼻炎、鼻窦炎史,鼻咽镜见咽后壁有黏液附着,确诊上气道咳嗽综合征;12例咳嗽伴胸骨后烧灼感、反酸、嗳气,胃镜发现反流性食管炎表现,确诊胃食管反流性咳嗽。误诊时间3~20个月。53例确诊后予相应治疗预后良好。结论儿童慢性咳嗽的病因复杂,临床医师应熟知儿童慢性咳嗽的多系统表现、病因及诊断流程,注意详细询问病史及用药史,仔细查体,注意咳嗽的性质、咳嗽的昼夜规律、咳嗽诱发因素,认真病因诊断,及时行相关特异性检查,以及早明确诊断并治疗,改善患儿生活质量。

慢性咳嗽疑似咳嗽变异型哮喘成人患者的支气管舒张反应试验的预测价值

目的 探讨支气管舒张反应(BDR)试验预测慢性咳嗽且BDR试验阴性患者咳嗽变异性哮喘(CVA)的价值。方法 选取140例慢性咳嗽、BDR试验阴性患者为研究对象,患者均接受4周的吸入性糖皮质激素(ICS)和长效β2-激动剂治疗,并对治疗前后的肺功能进行检测。采用受试者工作特征(ROC)曲线评估患者第1秒用力呼吸容积占预计值百分比(FEV_(1)%)、呼出气一氧化氮(FeNO)、用力呼气25%~75%肺活量的瞬间流量(FEF_(25%~75%))和用力呼气25%~75%肺活量的瞬间流量占预计值的百分比(FEF%_(25%~75%))的单独诊断及联合诊断的预测价值。结果 治疗后,CVA阴性者98例,CVA阳性者42例。在联合评估指标组合中,对CVA的诊断排名前3位的指标组合分别是FEF%_(25%~75%)+△FEV_(1)%、FEF25%~75%+FeNO和△FEV_(1)+△FEV_(1)%。联合预测的维恩图结果显示,FeNO≥41.50×10^(-9)mol/L、△FEV_(1)%≥5.90%、FEF%25%~75%≤61.99%的CVA阳性诊断患者存在重叠。结论 治疗后,患者FeNO≥41.50×10^(-9)mol/L、△FEV_(1)%≥5.90%、FEF%25%~75%≤61.99%可用于预测CVA和对哮喘治疗的反应。

高原地区儿童慢性咳嗽病因构成及临床特征分析

目的:分析高原地区儿童慢性咳嗽病因构成及临床特征。方法:选取2020年1月—2022年12月青海省妇女儿童医院收治的慢性咳嗽患儿262例为观察组,再选择本院同期呼吸道感染患儿50例为对照组,比较对照组与观察组临床资料,比较观察组不同年龄、性别、季节、咳嗽性质、咳嗽时相儿童慢性咳嗽病因构成。结果:262例患儿中,咳嗽变异性哮喘(CVA)60例(22.90%),上气道咳嗽综合征(UACS)55例(20.99%),感染后咳嗽(PIC)77例(29.39%),过敏性咳嗽(AC)27例(10.31%),胃食管反流性咳嗽(GERC)24例(9.16%),心因性咳嗽(PC)6例(2.29%),抽动秽语综合征(TS)13例(4.96%)。A组以UACS、PIC、CVA为主;B组以PIC、UACS及CVA为主;C组以CVA、GERC及PIC为主。三组各病因比较,差异均有统计学意义(P<0.05)。262例患儿中,男童138例(52.67%),女童124例(47.33%),两组各病因比较,差异均无统计学意义(P>0.05)。262例患儿中,春季63例(24.05%),夏季55例(20.99%),秋季43例(16.41%),冬季101例(38.55%),春季以UACS、PIC为主,夏季以CVA、UACS为主,秋季以PIC为主,冬季以CVA、UACS、PIC为主。262例患儿中,干咳135例(51.53%),湿咳为127例(48.47%),干咳以UACS、PIC为主,湿咳以CVA为主。262例患儿中,晨咳以CVA为主,日咳以PIC为主,夜间咳嗽以CVA、UACS为主。结论:儿童慢性咳嗽的原因复杂,高原地区儿童慢性咳嗽病因前三位依次为CVA、UACS、PIC,不同年龄、季节、咳嗽性质、咳嗽时相的慢性咳嗽病因都不同。

阿奇霉素序贯疗法联合小儿推拿对儿童肺炎支原体感染后慢性咳嗽疗效观察

目的 探究阿奇霉素序贯疗法(AST)联合小儿推拿(IM)对儿童肺炎支原体感染后慢性咳嗽-痰热闭肺证(CCAMP-PHCLS)的临床疗效,以期为CCAMP的临床诊治提供新方案。方法 回顾性收集2022年3月至2023年3月广州中医药大学第二附属医院诊治的CCAMP-PHCLS患儿临床资料。根据治疗方案,将患儿分为AST组(AST治疗)和AST+IM组(AST+IM治疗)。比较两组患儿咳嗽症状积分和炎性因子[白细胞介素-6(IL-6)、降钙素原(PCT)和C-反应蛋白(CRP)]变化、临床症状/体征消退时间、血清MP抗体(MP-IgM)转阴情况、治疗总有效率和不良反应发生率。结果 共纳入98例CCAMP-PHCLS患儿,每组各49例。治疗前,两组在日间咳嗽症状积分、夜间咳嗽症状积分、血清IL-6含量、血清PCT含量和血清CRP含量上差异无统计学意义(P> 0.05);治疗后,两组日间咳嗽症状积分、夜间咳嗽症状积分、血清IL-6含量、血清PCT含量和血清CRP含量均较治疗前显著下降(P <0.05),且AST+IM组显著低于AST组(P <0.05)。临床特征方面,AST+IM组患儿咳嗽消退时间、发热消退时间和肺部啰音消退时间均短于AST组(P <0.05),MP-IgM转阴率高于AST组(P <0.05)。临床疗效和安全性方面,AST+IM组患儿治疗总有效率显著高于AST组(P <0.05),总不良反应发生显著低于AST组(P <0.05)。结论 AST联合IM对CCAMP患儿疗效显著,且安全性高。其潜在的可能机制是IM通过多途径、多系统介导炎性因子的产生,改善气道炎症,从而缓解临床症状和体征。