哮喘联盟

   摘要
   背景和目的：慢性咳嗽是一种常见的症状，但是对其进行病因学诊断却具有一定的难度。慢性咳嗽的临床诊断方案需要有专科医师的协助，而后者却无法轻易获得。本试验研究是否可以采用一种临床算法来对慢性咳嗽患者进行成功治疗。
   方法：112名连续就诊的慢性咳嗽患者入选本项前瞻性研究。对其病史、体检结果、胸片、肺量检测和沙丁胺醇雾化吸入后的支气管可逆性进行评价。做出临床诊断后，患者接受为期8周的适当治疗。是否需要进一步治疗取决于治疗反应和可能的鉴别诊断。在临床治疗失败后进行分析，排除特定的病理因素。临床组包括基于临床评价进行治疗且未进行任何后续检查的患者。检查组包括需要进行进一步检查的患者。
   结果：临床组共有81名（72%）患者。74名患者（66%）治疗有效后出院。31名（28%）患者在使用临床方案诊断失败后转入检查组。最常见的咳嗽原因为胃食管反流、哮喘和慢性鼻炎。51名（45.5%）患者在初步诊断后治疗有效，而23名（20.5%）患者在对咳嗽常见病因进行序贯治疗后有效。数字反应性评分显示，咳嗽严重程度评分平均改善3.6（0--10, p < 0.0001）。
   结论：根据临床症状并针对咳嗽的常见原因进行治疗，可成功治疗大部分的慢性咳嗽患者。

（林江涛 审校）
Cough. 2013 Jan 24;9(1):2. [Epub ahead of print]

 

Management of patients with chronic cough using a clinical protocol: a prospective observational study.
 
Ojoo JC, Everett CF, Mulrennan SA, Faruqi S, Kastelik JA, Morice AH.

Abstract 
BACKGROUND AND AIMS: Chronic cough is a common symptom the aetiology of which can be challenging to diagnose. Diagnostic protocols for chronic cough have required the use of specialist investigations which are not always easily available. We wanted to determine whether patients with chronic cough can be successfully managed using a clinical algorithm.
METHODS: 112 consecutive patients with chronic cough were prospectively recruited into this study. They were assessed by history, physical examination, chest radiograph, spirometry and reversibility to nebulised salbutamol. A clinical diagnosis was made and the patient had an 8-week trial of appropriate therapy. Further therapeutic trials were carried out depending on response to treatment and the possible differential diagnoses. Investigations were carried out in cases of failed clinical trials and to exclude specific pathology. The "clinical arm" comprised patients managed on the basis of clinical assessment and without any investigations. The "investigative arm" comprised those who needed further investigations.
RESULTS: 81(72%) were managed in the clinical arm. Of these 74 (66%) were discharged following response to therapy. 31 (28%) patients were converted to the investigative arm after failure of diagnosis in the clinical protocol. The commonest causes of cough were gastroesophageal reflux, asthma and chronic rhinitis. 51 (45.5%) patients responded to therapy based on diagnosis at initial assessment while a further 23 (20.5%) patients responded to sequential clinical trials for the commonest causes of cough. Cough severity score improved by a mean of 3.6 points on a numeric response score (from 0--10, p < 0.0001).
CONCLUSION: It is possible to manage a majority of chronic cough patients successfully using a protocol based on presenting symptoms and therapeutic trials for the common causes of cough.
 

Cough. 2013 Jan 24;9(1):2. [Epub ahead of print]