咳嗽是呼吸专科门诊最常见的症状之一，其中大部分又是所谓不明原因的慢性咳嗽(unexplained chronic cough)，即常规影像学检查未发现明确病变者。在此类慢性咳嗽当中，咳嗽变异型哮喘(CVA)是一重要病因，早年Irwin报道，慢性咳嗽的病因包括哮喘和气道高反应(33％)、鼻后滴漏 (28％)、慢性支气管炎(12％)、症状性胃食管反流(10％)、病毒感染后咳嗽(25％)，其他因素包括血管紧张素转换酶抑制剂(ACEI)性咳嗽、精神性咳嗽(10％)以及多因素所致的咳嗽(约占20％) J。在我国尚缺乏CVA发病率的大样本流行病学资料，最近上海同济医院进行了一项调查，在呼吸专科门诊287例由于慢性咳嗽就诊的患者当中，无论是老年人还是中青年患者，CVA均是主要的病因(老年人 34．6％ ，中青年41．5％)，其次为上气道咳嗽综合征(UACS， 19．3％和23．5％)、ACEI相关性咳嗽(16．3％ 和1．7％)、胃食管反流性疾病(GERD，10．6％ 和3．7％) 。由于呼吸科医生以至普通内科医生逐渐熟悉了解这一疾病，在门诊病人当中CVA的比重越来越大，粗略估计CVA大约占不明原因慢性咳嗽病例1／3左右，占哮喘病例1／3左右。另一方面，尽管许多临床医生知晓CVA，但涉及其诊治仍存在不少的问题。
目的：观察古方止嗽散加味治疗喉源性咳嗽的疗效。方法：采用加味止嗽散治疗喉源性咳嗽116例，并设西药对照组113例。结果：治疗组有效率87.3%，对照组有效率68.2%，两组比较有显著差异(Plt;0.01)。治疗组不良反应例数为零；对照组不良反应例数约占10.2%。结论：加味止嗽散具有疏风宣肺、清热解毒、利咽祛痰、益气养阴、扶正祛邪、抗病毒、抗菌、抗炎和增强免疫功能等功效，为治疗喉源性咳嗽的有效方药。
Objective To systematically assess the effectiveness of traditional Chinese medicines (TCM) in treating upper airway cough syndrome (UACS) or postnasal drip syndrome (PNDS). Methods Such databases as MEDLINE (1950 to 2011), PubMed (1996 to 2011), VIP (1989 to 2011), WanFang Data (1998 to 2011), CNKI (1979 to 2011) and CBM (1978 to 2011) were searched for collecting the randomized controlled trials (RCT) or quasi-RCTs about TCM treating UACS/PNDS. The trials were screened according to the inclusive and exclusive criteria, and then after the quality assessment and data extraction were conducted, the statistical analysis was conducted by using RevMan 5.0 software. Results A total of 10 RCTs and quasi-RCTs in Chinese were identified. The results of analysis showed that: a) The integrated Chinese and western medicine was superior to western medicine alone, either for adults and children with UACS, or for adults with PNDS. However the effectiveness had to be further assessed due to lack of high-quality literatures; b) TCM alone was probably more effective than western medicine alone for adults with PNDS, but not for adults and children with UACS. No obvious adverse reaction related to TCM was reported. Conclusion The recent research outcomes show that the integrated Chinese and western medicine is superior to western medicine alone, either for adults and children with UACS, or for adults with PNDS, but no definite evidence is found to support the superiority of TCM in treating UACS/PNDS. More high-quality RCTs with large scale need to be conducted in future to verify this conclusion due to the overall low methodological quality and significantly different intervention of the included trials.
Objective To investigate the causes of chronic cough in Chongqing City and assess the efficacy of specific therapy. Methods A total of 233 consecutively non-selected referred patients ( 136 females) whose cough duration more than eight weeks were studied. Their age[ median ( range) ] was 44. 5( 15-78) yrs and cough duration was 2. 6 ( 0. 2-30) yrs. They were diagnosed using a diagnostic protocol based on the Guideline on Diagnosis and Treatment of Chronic Cough established by China Medical Association and American College of Chest Physicians. The etiological diagnosis was made according to clinical manifestations, lab examinations, and response to specific therapy. The effects was assessed four weeks after the drug withdraw. Results The cause of chronic cough was confirmed in 216 patients ( 92. 7% ) . Seventeen patients( 7. 3% ) had not been definitely diagnosed. Cough due to a single cause was found in 163 patients ( 75. 45% ) , and due to multiple causes in 53 patients ( 24. 53% ) . The causes included upper airway cough syndrome ( UACS) in 127 patients( 44. 4% ) , cough variant asthma ( CVA) in 73 patients( 25. 5% ) , gastro-esophageal reflux cough ( GERC) in 26 patients( 9. 1%) , postinfectious cough and angiotensin converting enzyme ( ACE) inhibitor-induced cough in 6 patients( 2. 1% ) , atopic cough in 5 patients( 1. 7% ) , chronic bronchitis in 3 patients ( 1. 0% ) , respectively. After specific therapy based on diagnosis, cough cured in 59 patients ( 25. 3% ) , and alleviated in 114 patients ( 49. 3% ) , no response in 40 patients( 17. 1% ) . Conclusion The causes of chronic cough in different areas maybe variant. UACS, CVA and GREC are the main causes of chronic cough in Chongqing City. Specific therapy is effective in majority of patients with chronic cough.
临床上通常将以咳嗽为唯一症状或主要症状、时间超过 8周、胸部x检查无明显异常者称为不明原因慢性咳嗽，简称慢性咳嗽 。慢性咳嗽是内科门诊患者最常见的病症，与典型支气管哮喘、肺部感染、肺纤维化和支气管肺癌等疾病不同，由于缺乏典型的相关症状，胸片检查无异常，一些临床医生习惯性地给病人戴上“支气管炎或慢性支气管炎”(简称“慢支”)的帽子，给予止咳祛痰或反复使用多种抗生素治疗，当然临床疗效并不理想。我们进行的流行病学调查结果显示，72％的慢性咳嗽患者被诊断为“支气管炎、慢支或慢性咽喉炎”，而病因诊断显示其中慢性支气管炎仅占4％(该资料尚未发表)。 慢性咳嗽的病因非常复杂，但并非毫无规律可循。只要掌握正确的诊断方法，按照慢性咳嗽病因诊断程序，大部分患者实际上可以获得明确的病因诊断，根据病因进行特异性治疗能够取得良好的治疗效果。在诊断慢性咳嗽时主要应注意以下几个问题。
Objective To explore the effect of lower airway inflammation on the pathogenesis of upper airway cough syndrome( UACS) . Methods Ten cases of UACS and 10 cases of chronic rhinitis or sinusitis without cough were enrolled as group A and group B, respectively. And 10 healthy volunteers were included as controls( group C) . The cough threshold C2 and C5 to inhaled capsaicin, defined as the lowest concentration of capsaicin required to induce ≥2 and ≥5 coughs, was measured. The total and differential cell counts was determined in induced sputum, and the levels of histamine and prostaglandin E2 were analyzed in supernatant of sputum. Results Cough threshold was significantly lower in group A than group B [ C2: ( 0.65 ±0. 08) μmol / L vs ( 3.90 ±1. 37) μmol / L; C5: ( 1.59 ±0. 28) μmol / L vs ( 33.46 ±23. 71) μmol / L, P lt;0. 05] and comparable between group B and group C( P gt; 0. 05) . Group A, similar to group B( P gt; 0. 05 ) , contained more inflammatory cells, with decreased percentage of macrophages and increased percentage of neutrophils in induced sputum than group C( P lt; 0. 05) . Furthermore, the levels of histamine[ ( 9. 55 ±1. 89) ng/mL vs ( 2. 37 ±0. 25) ng/mL, P lt; 0. 05] and prostaglandin E2 [ ( 361. 71 ±39. 38) pg/mL vs ( 144. 34 ±15. 69) pg/mL, P lt; 0. 05] were higher in supernatant of induced sputum from group A than group B, while the latter was not different from group C( P gt; 0. 05) . Conclusion Increased cough sensitivity caused by airway inflammation may be important for the pathogenesis of UACS, and the activation of mast cells in mucosa of lower airway might be an important factor.