慢性咳嗽的发病率、发病机制及病因
2008/08/13
英国学者、英国国立心肺研究院著名教授 Kian Fan Chung 及 Ian D Pavord 合著了关于慢性咳嗽发病率、发病机制及病因分析的综述，欧美社区咳嗽发病率为9％～33％，呼吸门诊中以慢性咳嗽就诊的患者占10％～38％。慢性咳嗽的环境因素包括吸烟、被动吸烟、环境污染，病因包括哮喘、嗜酸粒细胞性支气管炎、胃食管反流、鼻后滴流综合症、鼻副鼻窦炎、慢性阻塞性肺疾病、肺间质纤维化、支气管扩张，少数病例病因不明，称为特发性慢性咳嗽。
（蔡闯 广州医学院第一附属医院 广州呼吸疾病研究所 510120 摘译）
（Lancet. 2008; 371: 1364–1374）
Prevalence, pathogenesis, and causes of chronic cough
Chung KF, Pavord ID
Abstract 摘要
Cough is a reflex action of the respiratory tract that is used to clear the upper airways. Chronic cough lasting for more than 8 weeks is common in the community. The causes include cigarette smoking, exposure to cigarette smoke, and exposure to environmental pollution, especially particulates. Diseases causing chronic cough include asthma, eosinophilic bronchitis, gastro-oesophageal reflux disease, postnasal drip syndrome or rhinosinusitis, chronic obstructive pulmonary disease, pulmonary fibrosis, and bronchiectasis. Doctors should always work towards a clear diagnosis, considering common and rare illnesses. In some patients, no cause is identified, leading to the diagnosis of idiopathic cough. Chronic cough is often associated with an increased response to tussive agents such as capsaicin. Plastic changes in intrinsic and synaptic excitability in the brainstem, spine, or airway nerves can enhance the cough reflex, and can persist in the absence of the initiating cough event. Structural and inflammatory airway mucosal changes in non-asthmatic chronic cough could represent the cause or the traumatic response to repetitive coughing. Effective control of cough requires not only controlling the disease causing the cough but also desensitisation of cough pathways.
