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.
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.
Objective To investigate the etiological diagnosis of chronic cough with pharyngitis-like manifestations. Methods Patients with chronic cough and pharyngitis-like manifestations were recruited from Outpatient Department of Guangzhou Institute of Respiratory Diseases between December 2002 to March 2010. The causes of chronic cough were investigated using a well-established diagnostic protocol, including history taking and physical examination, pulmonary function tests, induced sputum cytology, 24-h esophageal pH monitoring, etc. The final diagnosis depended on clinical manifestations, examination findings, and a successful response to therapy. Results 326 patients with chronic cough and pharyngitislike manifestations were included in the study with amedian duration of 24 ( 2 ～480) months, amean age of 41 ±13 years. The causes of chronic cough were identified as follows: post nasal drip syndrome or upper airway cough syndrome in 73 cases ( 23. 31% ) , cough variant asthma in 61 cases( 18. 71% ) , eosinophilic bronchitis in 70 cases( 22. 47% ) , gastroesophageal reflux-induced cough in 54 cases ( 16. 56% ) , atopiccough in 48 cases ( 14. 72% ) , and others in 40 cases ( 12. 27% ) . There is no significant difference in percentage of common causes of chronic cough ( P gt; 0. 05) . Conclusion The proportions of upper airway syndrome and other common causes are similar in chronic cough with pharyngitis-like manifestatioins, whichsuggest pharyngitis-like manifestations are not specific for diagnosis of upper airway cough syndrome.
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.
Objective Using a simple management strategy to investigate the etiologic spectrum of chronic cough in Chengdu city and its suburbs. Methods Chronic cough patients were randomly recruited fromthe outpatient clinic of Sichuan Provincial People ’s Hospital between July 2011 to May 2012. A conception of “Chronic Airway Inflammatory Cough Syndrome, CAICS”was established including several common causes of cough such as cough variant asthma ( CVA) , eosinophilic bronchitis ( EB) , atopic cough ( AC) , and atypical chronic bronchitis. Based on CAICS, a simplified suspected diagnosis procedure of chronic cough was conducted. Patients were empirically treated. Etiology and efficiency of chronic cough was analyzed. Results A total of 148 patients of chronic cough were recruited. The mean age was ( 43. 0 ±13. 0) years old. There were 72 male and 76 female patients with mean ages of ( 39. 7 ±10. 7) and ( 45. 0 ± 14. 2) years old respectively. The males were younger than the females ( P lt; 0. 05) . There was 96. 6% ( 143/148) of patients suspectedly diagnosed and 3.4% ( 5/148) patients were undiagnosed. The suspected causes of these chronic cough patients were as follows, ie. CAICS ( 57. 5% ) , upper airway cough syndrome ( UACS, 21. 5%) , gastroesophageal reflux cough ( GERC, 9. 1% ) , and others ( 8. 4% ) . A single possible cause was found in 95 patients ( 64.1% ) , two possible causes in 41 patients ( 27. 7% ) , and three possible causes in 3 patients( 2. 0% ) . 12.2% of chronic cough patients were combined with allergic rhinitis ( AR) . Among the diseases, CVA, CAICS and UACS were disposed to coexist with AR. The overall efficiency of empiric management strategy of chronic cough was 83. 7% .Conclusions The etiological spectrum of chronic cough in Chengdu acquired by this strategy was generally consistent with previous findings in China.The three most important causes of chronic cough in Chengdu were CAICS, UACS and GERC. This strategy was simple, effective, economic and feasible. It could be a primary management for chronic cough in some hospital.
Objective Chronic cough is often present as increasing cough reaction to various physical and chemical stimulating factors. This study is aimed to investigate the difference of cough sensitivity and its mechanisms which are not clear among different causes of chronic cough. Methods Patients with chronic cough were recruited from cough clinic of Guangzhou Institute of Respiratory Diseases between 2005 to 2010. Using a modified diagnostic algorithm of chronic cough, common causes were identified. Capsaicin cough provocation test was also performed in these patients to assess the cough threshold. The relations between cough reflex sensitivity and duration of cough, cough severity, pulmonary function, induced sputum cell counts were then investigated. Results Through the diagnostic algorithm of chronic cough, the current study evaluated 133 adult patients, including 24 cases with upper airway cough syndrome (UACS) , 26 patients with cough variant asthma (CVA) , 31 cases with eosinophilic bronchitis (EB) , 30 patients with atopic cough (AC) , 22 cases with gastroesophageal reflux induced cough (GERC) . There were 30 healthy volunteers recruited as normal control. The cough threshold of LgC5 in AC, CVA, EB, GERC and UACS was 1.70 ±0.70, 2.12 ±0.67, 2.13 ±0.69, 1.69 ±0.73, 2.16 ±0.66, respectively. The LgC5 of the normal group ( 2.63 ±0.39) was higher than those in chronic cough groups( All P lt; 0.05) . The LgC5 of AC and GERC were lower than CVA, EB and UACS ( all Plt;0.05) . Duration and daytime score of cough showed positive correlations with LgC5( r =-0. 280, -0. 168, all P lt;0.05) . Pulmonary function and differential cell count of induced sputumwere not associated with LgC5 ( all Pgt;0.05) . Conclusions Different cause of chronic cough exhbit high cough reflex sensitivity to different extent. The difference of cough sensitivity may reflect the different pathogenesis among different causes, and may be related to the type of nerve fiber dominating the cough reflex.
Objective To investigate the changes of small airway function，airway resistance and responsiveness of extrathoracic airway in chronic cough patients before and after bronchial provocation test (BPT)．Methods 68 chronic cough patients were requested to conduct lung function test and BPT．The airw ay resistance were measured via forced oscillationary technology before and after BPT．Results BPT revealed airway hyperresponsiveness in 52％subjects．MEF50 and R0 before BPT were significantly different between the patients with or without airway hyperresponsiveness．Post BPT changes in MEF50(MEF50％) were correlated positively to the changes in FEV1(FEVl％)，and negatively to the changes in R0[Ro-d]． Extrathoracic airway hyperresponsivenes(EAHR)was f0und in13 patients，in which 6 patients were not revealed by routine BPT．Conclusion There is small airway function abnormalities in chronic cough patients．Extrathoracic airway responsiveness test is a valuable supplementary index to routine BPT．
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 efficacy and safety of Yangyinqingfei decoction for chronic cough and chronic obstructive pulmonary disease (COPD) patients.MethodsWe electronically searched databases including PubMed, Web of Science, CBM, CNKI, VIP and WanFang Data for randomized controlled trials (RCTs) of Yangyinqingfei decoction for chronic cough and COPD patients from inception to August 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, RevMan 5.3 software was used for meta-analysis.ResultsTwenty-four RCTs involving 2 268 patients with COPD and chronic cough were included. The results of meta-analysis showed that compared with the control group, Yangyinqingfei decoction combined with the conventional medicine could significantly improve clinical effective rate (RR=1.21, 95%CI 1.16 to 1.27, P<0.000 01) and lung function (SMD=0.76, 95%CI 0.59 to 0.94, P<0.000 01) in patients with COPD. Yangyinqingfei decoction combined with the conventional medicine group was superior to the control group (RR=1.41, 95%CI 1.22 to 1.64, P<0.000 01) in clinical efficacy for adults patients with chronic cough. In terms of safety, seven cases occurred adverse reactions in the Yangyinqingfei decoction group, while 13 were found in the control group, the types and degree of adverse reactions in both groups were almost the same.ConclusionThe combination of Yangyinqingfei plus conventional medicine may significantly improve the clinical efficacy for chronic cough and COPD with reliable safety. However, due to the limited quality and quantity of included studies, the above conclusions are needed to verify by more high quality studies.
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.