对有或无呼吸道疾病的成人咳嗽进行药物和非药物干预：系统文献综述
2010/07/07
摘要
对有和无呼吸道疾患的成人咳嗽患者的管理尚未得到优化，基本都是基于临床意见，而非循证结果。本文对文献进行系统综述，旨在对所有试验进行全面评价。在这些试验中，将有和无呼吸道疾病（恶性肿瘤除外）患者的咳嗽症状作为主要或次要研究指标。共计找到1177个试验，75个试验满足本研究的纳入标准。大部分患者存在哮喘和慢性阻塞性肺疾病（COPD）。在不到1/4的试验中，将咳嗽作为主要研究指标。对咳嗽的检测方法也是多种多样，主要采用未经校验的量表或总体症状评分。阳性结果总体来说与使用糖皮质激素、白三烯受体拮抗剂、肥大细胞稳定剂、异丙托溴铵、奈替克新、碘化甘油和利多卡因有关。口头心理辅导及通过SMS信息监测症状（同时根据情况调整治疗）有助于改善咳嗽。虽然已有止咳药（如可待因）的疗效早在20世纪60年代就有报道，但尚缺乏证据，而近期诸多研究显示，这些药物在COPD患者中无效。许多研究存在相互矛盾的结果。因此有必要通过高质量的研究设计并且将咳嗽作为研究主要指标，来改善咳嗽治疗及其循证证据。
（陈欣 审校）
Molassiotis A, et al. Respir Med. 2010 Apr 10. [Epub ahead of print]
Pharmacological and non-pharmacological interventions for cough in adults with respiratory and non-respiratory diseases: A systematic review of the literature.
Molassiotis A, Bryan G, Caress A, Bailey C, Smith J.
School of Nursing, Midwifery & Social Work, University of Manchester, University Place, Manchester M13 9PL, UK.
Abstract
The management of cough in adults with respiratory and non-respiratory illnesses is suboptimal and based mostly on clinical opinions rather than evidence. A systematic review was carried out assessing all trials in adult patients with respiratory and non-respiratory diseases (excluding cancer) that had chronic cough as primary or secondary outcome. A total of 1177 trials were retrieved and 75 met the criteria for inclusion in the review. The vast majority were in patients with asthma and chronic obstructive pulmonary disease (COPD). Cough was the primary outcome in less than one-quarter of the studies. The measurement of cough was variable, mostly using unvalidated scales or being part of an overall ’symptoms’ score. Positive results were overall seen with the use of corticosteroids, leukotriene receptor antagonists, mast cell stabilizers, ipratropium bromide, neltenexine, iodinised glycerol and lidocaine. Speech pathology training and symptom monitoring through SMS messages (accompanied by treatment adjustments) have also shown promise. Evidence for established anti-tussive agents such as codeine was scarce, with positive studies from the 1960s, whilst more recent studies showed no effect in patients with COPD. Many studies had conflicting results. It is imperative that the management of cough and its evidence base be improved, using higher quality research designs and with cough being the primary outcome of trials.
