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 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.
ObjectiveTo investigate the clinical efficacy of CoughAssist for cleaning airway secretions in neuromuscular disease patients with respiratory insufficiency. MethodsForty-six cases of neuromuscular disease with respiratory insufficiency were recruited in the study,with Guillain-Barre syndrome in 24 cases,myasthenia gravis in 18 cases,and multiple myositis in 4 patients.Thirty-four patients underwent intubation and mechanical ventilation,and 12 patients underwent tracheotomy.They were randomly divided into group A using CoughAssist and group B using suction tube to clear airway secretions after mechanical vibration.The frequency of suction within 24 hours,oxygenation index,pulmonary static compliance,incidence of lung infections,lung auscultation and chest radiograph were recorded and compared between two groups. ResultsCoughAssist could more effectively clean respiratory secretions with higher oxygenation index and pulmonary static compliance in group A.Lung auscultation and chest radiograph significantly improved,and the incidence of lung infection significantly decreased in group A compared with group B.Furthermore,CoughAssist reduced nursing workload with lower frequency of suction within 24 hours. ConclusionCoughAssist can effectively clean up airway secretions,improve oxygenation,while reducing pulmonary infection and nursing workload for neuromuscular disease patients with respiratory insufficiency,so it is aworthy tool in clincal practice.
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.
ObjectivesTo assess the quality of clinical practice guidelines (CPGs) for diagnosis and management of cough in China, and to provide methodological experiences for updating and developing the evidence-based guideline in this field in future. MethodsWe searched CBM, WanFang Data, VIP and CNKI databases, and Chinese clinical guidelines' website to identify and select CPGs related to cough in China. Four reviewers independently evaluated the quality of eligible guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) Ⅱ instrument. ResultsSix guidelines were included. The mean scores for six AGREE Ⅱ domains were low:scope and purpose 61.1%, stakeholder involvement 26.6%, rigor of development 16.7%, clarity and presentation 58.3%, applicability 11.1%, and editorial independence 0.0%. ConclusionThe quality of guidelines for cough in China is low. More efforts are urgently needed to develop high quality Chinese guidelines using methodologically rigorous development frameworks and strengthen guideline reporting.
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.