Objective To investigate the clinical characteristics of upper airway cough syndrome ( UACS) and the relationship of UACS with upper airway diseases, cough variant asthma ( CVA) , and gastroesophageal reflux disease ( GERD) . Methods 92 subjects with chronic cough and throat symptoms and signs were included in the study. The medical records were collected fromall subjects, and 49 subjects suspected for CVA undertook bronchial provocation test. Then the efficacy was evaluated and etiology were analyzed based on the efficacy of targeted treatment. Results Bronchial provocation test yielded positive results in 14 subjects suspected of CVA, accounting for 15. 2% of all cases ( 14/92) . 18. 5% ( 17 /92) of patients had a history of chronic gastritis or combined symptoms of GERD, of whom anti-gastroesophagealreflux treatment was effective. The patients with rhinitis, sinusitis history and/ or symptoms accounted for 33. 7% of cases ( 31 cases) . 51. 1% ( 47/92) of patients had only signs and symptoms of chronic pharyngitis. Conclusions UACS is not only due to the rhinitis and/ or sinusitis but also chronic pharyngitis. Chronic pharyngitis may be secondary to chronic rhinitis/ sinusitis with post nasal drip and gastroesophageal reflux, also may be an independent cause of chronic cough.
目的：观察卡介菌多糖核酸注射液在小儿咳嗽变异性哮喘治疗应用的疗效。方法：将本科40例咳嗽变异性哮喘患儿，随机分为治疗组和对照组(各20例)。治疗组给予BCG-PSN+必可酮气雾剂，对照组：给予单用必可酮气雾剂吸入，连续吸入6周，观察疗效，并进行统计学处理。结果：治疗组总有效率为95%，对照组总有效率为70%，统计学处理总有效率有显著差异(Plt;0.01)。结论：卡介菌多糖核酸(polysaccharide nucleic acidfraction of BCG，BCG-PSN)能有效地控制咳嗽变异性哮喘(CVA)的呼吸道的反复感染，提高免疫功能；与必可酮配合，能有效地控制CVA的复发。
ObjectiveTo investigate the diagnostic value of bronchial provocation test in patients with chronic cough. MethodsA total of 550 chronic cough patients were selected in the 452nd Military Hospital from March 2011 to February 2012. These patients all underwent the basic lung function test and the bronchial provocation test (BPT) to acetylcholine so as to assess the bronchial hyper-reactivity by inhaling methacholine. The diagnostic value of BPT was then evaluated. ResultsAll included patients had normal lung function. There were 267 patients (48.5%) who showed positive results in BPT, of whom, 236 BPT-positive patients were finally diagnosed as cough variant asthma. After regular treatment, the cough symptoms were well controlled. ConclusionCough variant asthma is one of the main causes of chronic cough. The BPT is an important method of aiding the diagnosis of cough variant asthma which helps early diagnosis of it.
ObjectiveTo systematically review the clinical effect and safety of traditional Chinese medicine (TCM) in the treatment of cough variant asthma (CVA). MethodsWe searched MEDLINE (Ovid), PubMed, EMbase, The Cochrane Library, VIP, WanFang Data, CNKI and CBM databases to collect randomized controlled trials (RCTs) about TCM for CVA from inception to May 2014. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by RevMan 5.2 software. ResultsA total of 17 RCTs were included. The results of qualitative analysis showed that:in improving cough symptom, three of four RCTs showed that TCM was superior to western medicine alone. In improving airway hyper responsiveness and overall treatment effect, the difference between TCM and western medicine alone remained uncertain. No serious adverse reactions related to TCM was reported in 17 RCTs. ConclusionBased on the current evidence, some trials suggest the TCM is superior to western medicine alone in improving cough symptom, however in the improvement of airway hyper responsiveness and overall efficacy, the difference between TCM and western medicine alone remains uncertain. Due to the variety of TCM and western medicine as well as limited methodological quality and different intervention of the included studies, more high-quality RCTs with large scale are needed to verify the above conclusion.
Cough variant asthma is a special type of asthma, of which the only or main symptom is cough, and it is the main cause of chronic cough. Early diagnosis and treatment can prevent cough variant asthma developing into typical asthma. This article summarizes the progress in pathogenesis, diagnosis and assessment, treatment, and prognosis of cough variant asthma, aiming to improve the prevention and treatment of this disease, and increase the patients’ quality of life.
ObjectiveTo evaluates the values of fractional exhaled nitric oxide (FENO) in the treatment of chronic cough prospectively.MethodsSubjects with chronic cough were recruited from the outpatient clinic of China-Japan Friendship Hospital. All the patients accepted FENO tests, sputum cell counts, pulmonary function tests, bronchial provocation tests, serum IgE, cough symptom scores and Leicester Cough Questionnaire before and after treatment of 4 weeks.ResultsThere were 29 patients with cough variant asthma (CVA), 19 patients with eosinophilic bronchitis (EB) and 39 patients with other causes. The baseline FENO level of the subjects whose coughs were relieved after inhaled corticosteroids (ICS) therapy of 4 weeks was (63±42) ppb, significantly higher than those with bad-response [(28±13) ppb, P<0.01]. The proportion of FENO decrease after ICS therapy was not only significantly related to the proportion of eosinophilic decrease (r=0.54, P<0.01), but also significantly related to the proportion of decrease of cough symptom scores (r=0.48, P<0.01). To distinguish the good responders from bad responders, the optimal baseline FENO cutoff value was 36 ppb, with sensitivity of 82%, specificity of 93%, positive predictive value of 94%, negative predictive value of 87%, accuracy of 83%.ConclusionsThere is a good relationship between the FENO decreasing levels after ICS therapy and the reliefs of cough symptoms in the CVA and EB patients. Chronic cough patients with FENO value more than 36 ppb are indicated to respond to ICS therapy.
Objective To reveal the differences in gene expression levels between Th2-driven classical asthma (CA) and Th2-driven cough variant asthma (CVA) in order to investigate the pathogenesis of asthma further. Methods Clinical data were collected from asthmatic patients in the Department of Respiratory and Critical Care of Sichuan Provincial People's Hospital from June 1, 2018, to December 31, 2019. The healthy control (HC) group was healthy adults from the physical examination center. Gene expression of peripheral blood mononuclear cells (PBMCs) in the CA group, CVA group, and HC group was determined by full-length transcriptome sequencing. Differential genes were screened by GO, KEGG analysis, and protein-protein interaction (PPI) network analysis. The results of interaction network analysis were visualized by Cytoscape. Finally, the candidate genes were verified by real-time quantitative polymerase chain reaction (RT-PCR). ResultsA total of 31 patients with asthma were included in the study, including 20 patients in the CA group and 11 patients in the CVA group. According to serum total IgE > 60 IU/mL and fractional exhaled nitric oxide (FeNO) > 40 ppb as the screening condition, 9 cases of Th2-driven CA and 5 cases of Th2-driven CVA were screened for analysis. Gene expression analysis showed 300 differentially expressed genes between the Th2-driven CA group and the Th2-driven CVA group, among which 155 genes were up-regulated, and 145 were down-regulated. GO enrichment analysis showed that differential genes were mainly enriched in drug response, nitrogen compound biosynthesis, cytoplasmic matrix, protein binding, ATP binding, etc. KEGG pathway analysis showed that differential genes were mainly concentrated in 2-oxy-carboxylic acid metabolism and cytotoxic signaling pathways mediated by natural killer cells. PPI analysis revealed extensive protein interactions between different genes. Ten candidate genes were screened for RT-PCR verification and finally found that CLU, GZMB, PPBP, PRF1, PTGS1, and TMSB4X were significantly differentially expressed between the Th2-driven CA group and the Th2-driven CVA group. Conclusions Asthma's occurrence results from the interaction of many genes and pathways. CLU, GZMB, PPBP, PRF1, PTGS1, and TMSB4X genes may be essential in developing Th2-driven CVA to Th2-driven CA.