哮喘联盟

    目的/假设：慢性持续咳嗽患者喉部症状逐渐受到关注，这些症状可能源于感觉性高反应性，这也是该疾病的特征。除了咳嗽，慢性持续咳嗽患者感觉性活化对运动功能的影响研究较少。慢性咳嗽言语治疗有效，表明喉部功能异常与慢性持续咳嗽有关。本试验通过反常声带运动（PVCM）和胸腔外气道高反应性研究慢性咳嗽患者咳嗽反射敏感性与喉功能异常之间的关系。
    研究设计：对慢性咳嗽患者和健康志愿者进行横断面的病例－对照研究。
    方法：对25名慢性持续咳嗽患者和11名健康志愿者进行咳嗽特异性生活质量问卷调查，并检测高渗盐溶液激发的胸腔外气道高反应性、辣椒素咳嗽反射超敏反应和纤维支气管镜来评价PVCM。
    结果：慢性持续咳嗽患者多数出现喉部功能异常。56%的慢性咳嗽患者出现PVCM，伴随有咳嗽反射超敏反应和生活质量下降。有PVCM的患者吸气流量下降以及有明显的胸腔外气道高反应性。
    结论：慢性咳嗽患者喉部功能异常较为普遍，表现为反常的声带运动和胸腔外气道高反应性。慢性咳嗽患者喉部功能异常导致生活质量下降。喉部超敏反应可能是言语治疗有效的一个原因。

（苏楠 审校）
Ryan NM, Gibson PG. Laryngoscope. 2009 Feb 9. [Epub ahead of print]

Characterization of laryngeal dysfunction in chronic persistent cough.

OBJECTIVES/HYPOTHESIS: Laryngeal symptoms are increasingly recognized to occur in chronic persistent cough and may result from the sensory hyperresponsiveness that characterizes this condition. Apart from cough, the motor consequences of sensory activation have not been well described in chronic persistent cough. The efficacy of speech pathology treatment for chronic cough suggests that laryngeal dysfunction may be relevant in chronic persistent cough. This study investigated the relationship between cough reflex sensitivity and laryngeal dysfunction, which was assessed as paradoxical vocal cord movement (PVCM) and extrathoracic airway hyperresponsiveness, in patients with chronic cough.

STUDY DESIGN: Cross-sectional case-control comparison of subjects with chronic cough and healthy controls.
METHODS: Adults with chronic persistent cough (n = 25) and healthy controls (n = 11) were assessed by cough-specific quality of life questionnaire, extrathoracic airway hyperresponsiveness to hypertonic saline provocation, capsaicin cough reflex hypersensitivity, and fibreoptic laryngoscopy to assess PVCM.
RESULTS: Laryngeal dysfunction was present in many patients with chronic persistent cough. PVCM was present in 56% of subjects with chronic cough and accompanied by cough reflex hypersensitivity and impaired quality of life. Inspiratory airflows were reduced in cough with PVCM, and there was significant extrathoracic airway hyperresponsiveness.
CONCLUSIONS: Laryngeal dysfunction is common in chronic cough, where it is manifest as paradoxical vocal cord movement and extrathoracic airway hyperresponsiveness. Laryngeal dysfunction in chronic cough is associated with reduced quality of life. Laryngeal hypersensitivity may be a common mechanism that can be effectively treated by speech language therapy.