- 期刊
The Incidence of Cough-variant Asthma in Patients with Chronic Cough of Unknown Origin
咳嗽變異型氣喘在不明原因慢性咳嗽中的發生率
摘要
前言：咳嗽是一個惱人的症狀並常促使患者尋求醫療協助。有時候醫師會把慢性咳嗽的患者當做氣喘治療，雖然氣喘發生率逐年增加，雖然治療不足會造成不可逆的呼吸道氣流阻塞及呼吸道重塑，但過度使用治療氣喘藥物也是有害的。使用不必要的支氣管擴張劑，像β-agonist與theophylline類藥物，會引起手抖、心悸及頭痛。過度使用類固醇也會導致局部或全身性的副作用。 方法：我們選擇44個慢性咳嗽超過八週的病人，胸部X光片正常、無抽菸史、無使用ACEI類降高血壓藥物、胸部理學檢查呈現乾淨呼吸聲。檢查痰液中嗜伊紅性白血球的數量與支氣管激發試驗。 結果：10(22.7%)個受試者診斷為氣喘，3(68%)個受試者診斷為嗜伊紅性支氣管炎。總共只有13(29.5%)個受試者會因使用類固醇藥物而受益。 結論：只靠慢性咳嗽就診斷氣喘，似乎不太可靠。因此當我們沒有進一步的證據時，應該更謹慎且保守的用類固醇藥物來治療慢性咳嗽。
並列摘要
Background: Cough is a noisy and troublesome symptom which leads sufferers to search for medical help. In some circumstances, doctors treat chronic cough patients as asthmatics, due to the clinical picture or audible wheezing. Although the incidence of asthma has been increasing in recent years, under-treatment may allow the development of irreversible airflow limitation as a result of airway remodeling. It is well known that asthma should not be over-treated. Unnecessary administration of a bronchodilator, such as 2 agonist and theophylline, may cause hand tremor, palpitation and headache. Excess exposure to corticosteroids also may lead to some local or systemic side effects. Methods: In this study, we included 44 patients who had suffered from chronic cough for more than 8 weeks. All patients demonstrated chronic cough, initially negative chest X ray findings, no smoking history, no ACEI consumption history, and clear breathing sounds during physical examination. Sputum special stain for eosinophil count and a bronchial provocation test were performed in selected patients. Results: Ten (22.7%) of the participants were asthmatics, and 3 (6.8%) were patients with eosinophilic bronchitis. Only 29.5% of the participants benefited from corticosteroid treatment. Conclusion: Chronic cough is an unreliable symptom for diagnosing asthma, and may lead to over-treatment. Treatment with corticosteroid or 2 agonist in patients with chronic cough should be more conservative, unless sufficient evidence of asthma has been obtained.