肺科专家和执业呼吸病教育专家对慢性咳嗽患者进行的处理对患者生活质量的影响：随机试验
2009/06/24
背景：在加拿大，执业呼吸病教育专家（CRE）主要教育、评估并帮助患者处理哮喘和慢性阻塞性肺病（COPD）。本试验研究CRE是否能协助肺科专家（MD）一起处理患者慢性咳嗽。
方法：本项随机对照研究是为期8周的前瞻性、平行试验，在某所大学第三附属医学中心，研究采用基于协议算法的CRE是否能帮助慢性哮喘患者进行评价和处理。患者随机分为CRE管理组和MD管理组。对患者进行筛查，排除危重病引发咳嗽的患者。主要检测咳嗽特异性生活质量（CQLQ）。
结果：对198名患者进行随机分组，8周后共151人完成本研究，患者平均年龄为49.8±13.4岁，其中70％为女性，中位咳嗽时间为16个月。8周后，CRE管理组患者的总体CQLQ显著提高（从58.1±14.9到50.0±15.8, P= 0.0003）。CQLQ的6个部分中有4个部分得到了改善，但躯体和情感部分未见改善。CRE管理组患者的生活质量改善程度与MD管理组相似（初始总体CQLQ评分: CRE vs MD, P = 0.261, 8周后CQLQ 评分: CRE vs MD, P = 0.42）。对CRE和MD管理组患者的数据进行组合分析，结果显示，咳嗽消失的患者（从56.3±13.6至41.5±13.6, P < 0.0001）或咳嗽改善但未消失的患者（从60.9±14.2到50.5±13.9, P < 0.0001），CQLQ得到改善，而那些咳嗽未见改善的患者的CQLQ也未见改善（从58.1±13.3到58.6±12.7, P = NS）。
结论：CRE能安全、有效、经济地协助处理那些经过适当筛选的慢性咳嗽患者。CRE的引入，将缩短这些患者等待专家咨询的时间。
（刘国梁 审校）
Field SK, et al. Chest. 2009 Apr 6. [Epub ahead of print]
Effect of the Management of Chronic Cough Patients by Pulmonologists and Certified Respiratory Educators on Quality of Life: A Randomized Trial.
Background： The role of certified respiratory educators (CRE) is to educate, assess, and help manage asthma and COPD patients in Canada. This study was undertaken to see whether CREs could assist pulmonologists (MD) to manage patients with chronic cough.
Methods： An 8 week prospective, parallel-design, randomized, controlled trial to determine whether CREs using a protocol-driven algorithmic approach could assist in the management of patients referred to a university tertiary care medical center for assessment and treatment of chronic cough. Patients were randomly assigned to the CRE-led or to the MD arm for management of their chronic cough. Patients were screened to exclude those whose cough was due to life-threatening conditions. The primary outcome was cough-specific quality of life (CQLQ).
Results： 198 patients were randomized and 8 week results were available on 151 patients, 49.8+/-13.4 years, 70% female, with a median cough duration of 16 months. At 8 weeks, total CQLQ improved in the CRE-led patients (58.1 +/-14.9 to 50.0+/-15.8, p = .0003). CQLQ scores improved in 4 of 6 domains but not in the physical or emotional domains. Improvements in CRE-led patients were similar to improvements in MD-managed patients (initial total CQLQ score: CRE vs MD, p = 0.261, CQLQ score at 8 weeks: CRE vs MD, p = 0.42). In a composite analysis of both the CRE and MD patient data, CQLQ improved in patients whose cough resolved (56.3+/-13.6 to 41.5+/-13.6, p < 0.0001) and in those whose cough improved but did not disappear (60.9+/-14.2 to 50.5+/-13.9, p < 0.0001) but did not improve in those whose cough did not improve (58.1+/-13.3 to 58.6+/-12.7, p = NS)
Conclusions： CREs can help to safely, economically, and effectively manage properly screened patients with chronic cough. The use of CREs may shorten wait times for specialist consultation for these patients.
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咳嗽对8～14岁患儿生活质量的影响超过其他哮喘症状
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成人支气管扩张患者的不同表型：儿童和成人排痰性咳嗽的发作
