治疗不明原因的慢性咳嗽CHEST指南和专家小组报告
2017/08/08
摘要
背景：不明原因的慢性咳嗽（UCC）会导致生活质量的严重损害，因此 UCC需要有效的评估和治疗方法。
材料与方法：对随机对照试验（RCT）进行系统综述，试图回答以下问题：与常规护理相比，针对于UCC患者的咳嗽严重程度，咳嗽频率和咳嗽相关生活质量的治疗有何好处？本文研究对象为纳入12岁以上、慢性咳嗽病史超过8周经过系统诊疗仍无法确诊病因的成年人和青少年，在系统综述的基础上，通过使用美国胸科医师学会组织方法，制定并投票提出指南。
结果:纳入了11项RCT和5项系统综述，11项RCT报告了570名慢性咳嗽患者的数据并给予了各种干预措施。其中10个RCT的研究质量很高。研究使用各种症状描述和评估来诊断UCC。虽然加巴喷丁和吗啡对提升慢性咳嗽相关生活质量均有有积极影响，但只有加巴喷丁作为推荐治疗使用。有关于吸入性皮质类固醇（ICS）的研究受到了干预偏倚的影响，而当这个偏倚得到纠正时，发现ICS对UCC无效。艾美拉唑对于没有胃食管反流特征的UCC无效。尚无非酸性胃食管反流病的研究。非药物治疗方面，多维语言病理治疗可以改善咳嗽严重程度。
结论：支持UCC诊断和治疗的证据有限， UCC仍需要进一步的研究，以建立一致的规范术语和最佳的研究方法。 提出基于言语病理学的多维语言病理治疗作为UCC的治疗方案。 本指南基于最佳现有证据提出诊断和治疗建议，并指出了未来研究发展的方向。
Treatment of Unexplained Chronic Cough CHEST Guideline and Expert Panel Report
Peter Gibson, MBBS; Gang Wang, MD, PhD; Lorcan McGarvey, MD; Anne E. Vertigan, PhD, MBA, BAppSc (SpPath); Kenneth W. Altman, MD, PhD; and Surinder S. Birring, MB ChB, MD; on behalf of the CHEST Expert Cough Panel
Abstract
BACKGROUND: Unexplained chronic cough (UCC) causes significant impairments in quality of life. Effective assessment and treatment approaches are needed for UCC.
METHODS: This systematic review of randomized controlled trials (RCTs) asked: What is the efficacy of treatment compared with usual care for cough severity, cough frequency, and cough-related quality of life in patients with UCC? Studies of adults and adolescents aged > 12 years with a chronic cough of > 8 weeks’ duration that was unexplained after systematic investigation and treatment were included and assessed for relevance and quality. Based on the systematic review, guideline suggestions were developed and voted on by using the American College of Chest Physicians organization methodology.
RESULTS: Eleven RCTs and five systematic reviews were included. The 11 RCTs reported data on 570 participants with chronic cough who received a variety of interventions. Study quality was high in 10 RCTs. The studies used an assortment of descriptors and assessments to identify UCC. Although gabapentin and morphine exhibited positive effects on cough-related quality of life, only gabapentin was supported as a treatment recommendation. Studies of inhaled corticosteroids (ICS) were affected by intervention fidelity bias; when this factor was addressed, ICS were found to be ineffective for UCC. Esomeprazole was ineffective for UCC without features of gastroesophageal acid reflux. Studies addressing nonacid gastroesophageal reflux disease were not identified. A multimodality speech pathology intervention improved cough severity.
CONCLUSIONS: The evidence supporting the diagnosis and management of UCC is limited. UCC requires further study to establish agreed terminology and the optimal methods of investigation using established criteria for intervention fidelity. Speech pathology-based cough suppression is suggested as a treatment option for UCC. This guideline presents suggestions for diagnosis and treatment based on the best available evidence and identifies gaps in our knowledge as well as areas for future research.
背景：不明原因的慢性咳嗽（UCC）会导致生活质量的严重损害，因此 UCC需要有效的评估和治疗方法。
材料与方法：对随机对照试验（RCT）进行系统综述，试图回答以下问题：与常规护理相比，针对于UCC患者的咳嗽严重程度，咳嗽频率和咳嗽相关生活质量的治疗有何好处？本文研究对象为纳入12岁以上、慢性咳嗽病史超过8周经过系统诊疗仍无法确诊病因的成年人和青少年，在系统综述的基础上，通过使用美国胸科医师学会组织方法，制定并投票提出指南。
结果:纳入了11项RCT和5项系统综述，11项RCT报告了570名慢性咳嗽患者的数据并给予了各种干预措施。其中10个RCT的研究质量很高。研究使用各种症状描述和评估来诊断UCC。虽然加巴喷丁和吗啡对提升慢性咳嗽相关生活质量均有有积极影响，但只有加巴喷丁作为推荐治疗使用。有关于吸入性皮质类固醇（ICS）的研究受到了干预偏倚的影响，而当这个偏倚得到纠正时，发现ICS对UCC无效。艾美拉唑对于没有胃食管反流特征的UCC无效。尚无非酸性胃食管反流病的研究。非药物治疗方面，多维语言病理治疗可以改善咳嗽严重程度。
结论：支持UCC诊断和治疗的证据有限， UCC仍需要进一步的研究，以建立一致的规范术语和最佳的研究方法。 提出基于言语病理学的多维语言病理治疗作为UCC的治疗方案。 本指南基于最佳现有证据提出诊断和治疗建议，并指出了未来研究发展的方向。
(中日友好医院呼吸与危重症医学科 王圆方 摘译 林江涛 审校)
(Gibson P, Wang G, Mcgarvey L, et al. Treatment of Unexplained Chronic Cough: CHEST Guideline and Expert Panel Report[J]. Chest, 2016, 149(1):27-44.)
(Gibson P, Wang G, Mcgarvey L, et al. Treatment of Unexplained Chronic Cough: CHEST Guideline and Expert Panel Report[J]. Chest, 2016, 149(1):27-44.)
Treatment of Unexplained Chronic Cough CHEST Guideline and Expert Panel Report
Peter Gibson, MBBS; Gang Wang, MD, PhD; Lorcan McGarvey, MD; Anne E. Vertigan, PhD, MBA, BAppSc (SpPath); Kenneth W. Altman, MD, PhD; and Surinder S. Birring, MB ChB, MD; on behalf of the CHEST Expert Cough Panel
Abstract
BACKGROUND: Unexplained chronic cough (UCC) causes significant impairments in quality of life. Effective assessment and treatment approaches are needed for UCC.
METHODS: This systematic review of randomized controlled trials (RCTs) asked: What is the efficacy of treatment compared with usual care for cough severity, cough frequency, and cough-related quality of life in patients with UCC? Studies of adults and adolescents aged > 12 years with a chronic cough of > 8 weeks’ duration that was unexplained after systematic investigation and treatment were included and assessed for relevance and quality. Based on the systematic review, guideline suggestions were developed and voted on by using the American College of Chest Physicians organization methodology.
RESULTS: Eleven RCTs and five systematic reviews were included. The 11 RCTs reported data on 570 participants with chronic cough who received a variety of interventions. Study quality was high in 10 RCTs. The studies used an assortment of descriptors and assessments to identify UCC. Although gabapentin and morphine exhibited positive effects on cough-related quality of life, only gabapentin was supported as a treatment recommendation. Studies of inhaled corticosteroids (ICS) were affected by intervention fidelity bias; when this factor was addressed, ICS were found to be ineffective for UCC. Esomeprazole was ineffective for UCC without features of gastroesophageal acid reflux. Studies addressing nonacid gastroesophageal reflux disease were not identified. A multimodality speech pathology intervention improved cough severity.
CONCLUSIONS: The evidence supporting the diagnosis and management of UCC is limited. UCC requires further study to establish agreed terminology and the optimal methods of investigation using established criteria for intervention fidelity. Speech pathology-based cough suppression is suggested as a treatment option for UCC. This guideline presents suggestions for diagnosis and treatment based on the best available evidence and identifies gaps in our knowledge as well as areas for future research.
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