哮喘联盟

   摘要
   背景：本研究观察慢性非特异性单纯咳嗽(NIC)儿童，对症状自愈和最终发展为哮喘的儿童进行临床比较，并探讨最终发展为哮喘的儿童对口服皮质类固醇激素（ICS）应答时间的差异。
   方法：根据儿童父母的意愿，慢性NIC患儿可选择接受等待-复查过程或吸入布地奈德400μg/d 2周治疗。采用有效咳嗽评分对患者应答情况进行监测。对于部分应答的病例治疗延长为8周。对所有儿童每3周进行一次随访。
   结果：109例儿童（平均年龄（四分位数）为5（3.5-9）岁；咳嗽时间，8-16周）接受了为期平均21(± 5)个月的随访。71%的儿童咳嗽没有复发（自愈），但是28%的儿童咳嗽复发且ICS治疗有效（哮喘）。气源性致敏源(相对风险, 2.86; 95% CI, 1.17-6.99)和慢性咳嗽既往史(相对风险, 2.68; 95% CI, 1.10-6.49)可增加哮喘发生风险。受试者咳嗽持续时间、咳嗽评分、哮喘家族史和血清嗜酸性粒细胞增多症对最终诊断无影响。在最终发展为哮喘的儿童中，2周应答或8周应答的儿童在研究参数方面无显著差异。
   结论：在多数儿童中，慢性NIC不会复发。对ICS试验早期应答可能造成误诊,但对有特异敏感性、慢性咳嗽史或两者兼有的儿童应该优选该试验。

 

（刘国梁 审校）
Chest. 2014 Jun 1;145(6):1279-85. doi: 10.1378/chest.13-2348.

 

Children with chronic nonspecific isolated cough.
 

Yilmaz O, Bakirtas A, Ertoy Karagol HI, Topal E, Turktas I.
 

ABSTRACT
BACKGROUND: This study observed children with chronic nonspecific isolated cough (NIC) to investigate clinical differences between children whose symptoms resolved spontaneously and those who eventually developed asthma and then explored the differences among the children who eventually developed asthma in terms of their time of response to a trial of inhaled corticosteroid (ICS).
METHODS: Children with chronic NIC were managed either with a wait-and-review approach or with a 2-week trial with 400 μg/d inhaled budesonide according to the preference of their parents. Responses were monitored with a validated cough score. Treatment was prolonged to 8 weeks in the case of partial responders. All children were followed up at 3-month intervals.
RESULTS: A total of 109 children (median [interquartile range] age, 5 [3.5-9] years; cough duration, [8-16] weeks]) were followed for a mean (± SD) time of 21(± 5) months. Cough did not recur in 71% (spontaneous resolution) but relapsed in 28% of the children who later responded to ICS treatment again (asthma). Aeroallergen sensitization (relative risk, 2.86; 95% CI, 1.17-6.99) and previous history of chronic cough (relative risk, 2.68; 95% CI, 1.10-6.49) increased the risk of asthma. Cough duration, the cough score, the family history of asthma, and serum eosinophilia were not found discriminative for the final diagnosis. There were no differences among children who eventually developed asthma and responded to either the 2-week or 8-week trial in terms of the study parameters.
CONCLUSIONS: Chronic NIC does not recur in the majority of children. Initial response to the ICS trial may be misleading but the trial may be preferred for children who have atopic sensitization, a previous history of chronic cough, or both .
 

Chest. 2014 Jun 1;145(6):1279-85. doi: 10.1378/chest.13-2348.