气道反应性测定在咳嗽变异性哮喘鉴别诊断中的作用

目的探讨气道反应性在咳嗽变异性哮喘鉴别诊断中的作用。方法按照慢性咳嗽解剖学诊断程序进行诊断,对肺功能正常仍不能确诊患者行支气管激发试验。结果21例咳嗽变异性哮喘、23例感染后咳嗽、3例嗜酸粒细胞性支气管炎患者气道高反应性的发生率分别为100%、26.1%和0,3组疾病气道高反应性的发病率差异有显著性,咳嗽变异性哮喘组明显高于感染后咳嗽及嗜酸粒细胞性支气管炎组;咳嗽变异性哮喘及感染后咳嗽的平均一秒钟用力呼气容积下降20%时的乙酰甲胆碱含量分别为0.74和1.86g/L,2组疾病气道反应性差异有显著性,咳嗽变异性哮喘组明显高于感染后咳嗽组。结论气道反应性测定在咳嗽变异性哮喘的鉴别诊断中具有重要意义。     

孟鲁司特钠治疗咳嗽变异性哮喘的临床观察

<正>咳嗽变异性哮喘(CVA)是一种特殊发作类型的哮喘,也是最常见的引起儿童慢性咳嗽的疾病之一。孟鲁司特钠(顺尔宁)是新一代非甾体抗炎药物,它能有效预防和抑制白三烯所导致的血管通透性增加、气道嗜酸性粒细胞(EOS)浸润及支气管痉挛,减少气道因变应原刺激引起的细胞和非细胞性     

武汉地区94例青中年慢性咳嗽临床分析

[目的]分析了解武汉地区青中年患者慢性咳嗽的病因构成并探讨有效的治疗方法.[方法]收集2013年1月至2014年12月在本院就诊的青中年慢性咳嗽患者94例,遵循我国咳嗽指南慢性咳嗽诊断流程进行相应的检查,根据检查结果和治疗后反应,确定病因诊断,分析特异性治疗的临床疗效.[结果]94例慢性咳嗽患者明确诊断咳嗽病因91例(96.8％).单一病因咳嗽者86例(91.5％),二重病因5例(5.3％).慢性咳嗽病因分布依次为:咳嗽变异性哮喘30例次(30.3％)、上气道咳嗽综合征23例次(23.2％)、嗜酸粒细胞性支气管炎14例次(14.1％)、胃食管反流性咳嗽9例次(9.1％)、变应性咳嗽5例次(5.1％)、感染后咳嗽4例次(4.0％)、支气管结核4例次(4.0％)、其他病因7例次(7.1％)、病因未明3例次(3.0％).经特异性治疗后,94例患者临床控制73例(77.7％),显效13例(13.8％),好转4例(4.3％),总有效率95.7％.[结论]武汉地区青中年患者慢性咳嗽主要病因构成为咳嗽变异性哮喘、上气道咳嗽综合征、嗜酸粒细胞性支气管炎、胃食管反流性咳嗽、变应性咳嗽.对慢性咳嗽明确诊断后,针对性治疗可取得良好的治疗效果.     

孟鲁司特治疗儿童咳嗽变异性哮喘临床观察

目的:探讨白三烯受体拮抗剂孟鲁司特治疗儿童咳嗽变异性哮喘的临床疗效.方法:回顾性分析124例咳嗽变异性哮喘患儿的临床资料.结果:显效88例,有效31例,有效率95.96%.结论:孟鲁司特治疗儿童咳嗽变异性哮喘疗效满意,不良反应少,患儿依从性良好.     

互动式护理干预在儿童呼出气一氧化氮检测中的应用

<正>慢性咳嗽是儿科常见病和多发病,其常见原因有感染相关性咳嗽、咳嗽变异性哮喘(cough variant asthma,CVA)、鼻-鼻窦炎、胃食管反流和嗜酸性粒细胞性支气管炎等,其中咳嗽变异性哮喘占到24%~29%[1]。咳嗽变异性哮喘以持续气道炎性反应与气道高反应为特点,以慢性咳嗽为主要症状,往往被误诊为上呼吸道感染或急慢性支气管炎而滥用抗生素,引起     

孟鲁司特钠对支原体肺炎诱发哮喘患儿诱导痰中细胞因子的影响

肺炎支原体(MP)感染与哮喘的诱发和加重关系密切,其感染发病率在哮喘患儿呈逐年增加趋势。对于白三烯受体拮抗剂鲁司特钠治疗支气管哮喘以及咳嗽变异性哮喘的研究较多,但是对于支原体肺炎诱发的支气管哮喘,使用鲁司特钠与丙卡特罗联合治疗的报道尚少[1,2]。本研究旨在观察孟鲁司特     

孟鲁司特钠联合氯雷他定治疗小儿咳嗽变异性哮喘的疗效观察

咳嗽变异性哮喘(cough variant asthma,CVA)又称隐匿性哮喘或过敏性咳嗽,是小儿慢性咳嗽的常见病因之一,临床以顽固性咳嗽、反复发作为特征.我们应用白三烯受体拮抗药孟鲁司特钠联合氯雷他定口服治疗CVA 30例,并以博利康尼片与酮替酚治疗为对照,观察其疗效及预防复发作用.     

门诊慢性咳嗽100例分析

目的：探讨慢性咳嗽的诊治方法。方法：依据慢性咳嗽解剖学诊断流程及痰细胞分类检查,对100例慢性咳嗽的病因进行分析,并给予特异性治疗。结果：100例患者中确诊94例,其中咳嗽变异性哮喘31例,鼻后滴流综合征26例,感染后咳嗽14例,嗜酸粒细胞性支气管炎12例,胃食管反流性咳嗽7例,药源性咳嗽4例。结论：慢性咳嗽的解剖学诊断流程和诱导痰细胞分类是诊断慢性咳嗽的重要手段,针对病因的特异性治疗效果良好。     

呼出气一氧化氮测定在慢性咳嗽病因诊断中的价值

慢性咳嗽是临床常见症状,病因较多,其中常见的病因有支气管哮喘、上气道咳嗽综合征(UACS)、胃食管反流性咳嗽(GERC)、变应性咳嗽(AC)、嗜酸细胞性支气管炎(EB)、慢性支气管炎等。在慢性咳嗽病因的鉴别诊断中,支气管激发试验、诱导痰嗜酸细胞检测常用于鉴别哮喘性咳嗽和非哮喘性咳嗽。支气管激发试验操作复杂且具有一定的风险性,诱导痰嗜酸细胞检测特异性不强,痰中细嗜酸细胞增多不但见于哮喘,而且     

儿童慢性咳嗽118例分析

目的探讨儿童慢性咳嗽的病因分布、诊断方法和治疗措施。方法回顾性总结分析潍坊市寒亭区人民医院符合慢性咳嗽诊断标准的118例患儿的诊断和治疗。结果 118例中上气道咳嗽症46例、咳嗽变异性哮喘32例、肺炎支原体感染27例、感染后咳嗽9例、心因性咳嗽2例、支气管异物1例、嗜酸粒细胞性支气管炎1例。确诊后针对病因进行治疗。107例(91%)咳嗽明显缓解或消失,其余9例(7.6%)部分缓解,2例(1.7%)效果不明显。结论慢性咳嗽是儿科常见的临床症状,病因多样,针对病因给予治疗可取得较好的疗效。     

常见慢性咳嗽病因及其诊断探讨

目的 探讨常见慢性咳嗽的病因及疾病表现的临床意义,为经验性治疗提供依据.方法 按慢性咳嗽的病因诊断流程对160例患者的病因构成进行分析,比较常见病因慢性咳嗽患者的咳嗽时相、性质、诱发因素及相关伴随症状,统计方法采用U检验,计算P值.结果 共入选160例2009年1月至12月宜昌市中心人民医院呼吸科门诊慢性咳嗽患者,其中常见病因分布依次为咳嗽变异性哮喘(CVA) 72例占45.00％、上气道咳嗽综合征(UACS) 54例占33.75％、嗜酸性粒细胞性支气管炎(EB) 14例占8.75％、胃食管反流性咳嗽(GERC)9例占5.63％,其他病因共11例、占6.87％.不同病因组临床表现有差异.CVA患者夜间咳嗽构成比为52.8(38/72),明显高于其他病因;UACS患者以白天咳嗽为主,70.2％伴有鼻后滴流症状,且绝大部分伴有鼻炎相关症状或有鼻炎病史,高于其他各组;GERC患者饮食相关咳嗽占66.7％,77.8％伴有反流症状明显高于其他病因组;上述症状差异均有统计学意义.但EB患者临床症状无特异性.结论 各种病因的慢性咳嗽具有一定的临床特征,慢性咳嗽病因构成及咳嗽时相、部分伴随症状对病因诊断具有一定的参考价值.     

Therapeutic modulation of allergic airways disease with leukotriene receptor antagonists

Although asthma is one of the most common chronic respiratory conditions, it often remains unrecognized and undertreated, while patients are often reluctant to comply with regular inhaled anti-inflammatory and bronchodilator therapy. Allergic rhinitis co-exists with asthma in as many as 40% of patients, and can be regarded as a continuum of the same inflammatory disease process. Corticosteroids are the 'gold standard' first-line treatment for both conditions, and have a significant impact upon underlying inflammation, symptoms and long-term outcome. Cysteinyl leukotrienes are potent airway inflammatory mediators, suggesting that treatment antagonizing their effects could play a role in disease management. In recent years, leukotriene receptor antagonists have provided a further therapeutic option in the management of allergic airways disease. These drugs are orally active, can be administered once daily, and provide a systemic approach to the management of patients with asthma and allergic rhinitis. We review the pharmacology of leukotriene receptor antagonists, their potential role in clinical practice in patients with allergic airways disease, and likely areas for further research.     

Eosinophilic airway diseases presenting with isolated cough except for asthma]

Cough variant asthma (CVA), atopic cough (AC) and eosinophilic bronchitis without asthma (EB) are eosinophilic airway diseases presenting with isolated chronic cough. Among them, bronchodilators are effective only in CVA. Bronchial responsiveness, diurnal variation of pulmonary function and bronchomotor tone are mildly increased to intermediate levels between mild asthma and normal in CVA, but not in AC or EB. Cough sensitivity is heightened in atopic cough and probably in EB, but not in CVA. Bronchoalveolar lavage eosinophilia is present in CVA and EB, but absent in AC. As asthma onset has been recognized in nearly 30% patients with CVA, but not in AC, long-term inhaled corticosteroid therapy is recommended only in CVA.     

慢性咳嗽患者的呼吸道嗜酸性粒细胞性炎性反应特征

目的探讨慢性咳嗽患者的呼吸道嗜酸性粒细胞炎性反应特征。方法使用诱导痰嗜酸性粒细胞计数检查123例慢性咳嗽患者的呼吸道嗜酸性粒细胞性炎性反应情况,其中咳嗽变异型哮喘(CVA)44例、嗜酸性粒细胞性支气管炎(EB)27例、上气道咳嗽综合征(UACS)26例、变应性咳嗽(AC)17例和胃食管反流相关性咳嗽(GERC)9例。收集56例典型哮喘(CA)患者和25例健康者的诱导痰嗜酸性粒细胞计数结果进行统计学比较。结果慢性咳嗽患者呼吸道嗜酸性粒细胞炎性反应的阳性率为0.487 8(60/123),其中,CVA组和EB组分别为0.750 0(33/44)和1.000 0(27/27),其他病因组均为0.000 0。CVA组与EB组之间的差异具有统计学意义(P=0.005),CVA组与CA组[0.821 4(46/56)]之间的差异无统计学意义(P=0.507),EB组与CA组之间差异具有统计学意义(P=0.019),CVA组、EB组分别与UACS组、AC组、GERC组、健康对照组比较,差异具有统计学意义(P值均为0.000)。呼吸道嗜酸性粒细胞炎性反应患者的诱导痰嗜酸性粒细胞比值,EB组低于CVA组(Z=-2.551,P=0.011)和CA组(Z=-3.190,P=0.001),CVA组与CA组之间差异无统计学意义(Z=-0.801,P=0.423)。结论嗜酸性粒细胞性炎性反应是慢性咳嗽患者的一种主要的呼吸道炎性反应类型,主要见于CVA和EB患者。CVA和EB的呼吸道嗜酸性粒细胞性炎性反应程度不同。     

Leukotriene receptor antagonists in the treatment of allergic rhinitis.

OBJECTIVE: To review the literature examining the clinical use of leukotriene receptor antagonists in the treatment of allergic rhinitis. DATA SOURCES: Biomedical literature accessed through MEDLINE (1990-November 2000) and Current Contents (week 35 of 1999 to week 48 of 2000). Key terms included leukotriene antagonists, montelukast, zafirlukast, and rhinitis (allergic). DATA SYNTHESIS: Preliminary evidence on the clinical use of either montelukast or zafirlukast as monotherapy is equivocal, with one study noting benefit and another noting lack of benefit in symptom amelioration. A third study suggests that these agents may have a role in further modifying allergic rhinitis symptoms when used in combination with standard treatments. CONCLUSIONS: Future large-scale studies should assess the efficacy of these agents in the treatment of allergic rhinitis, in particular, to identify subsets of patients likely to derive the most benefit. Available data suggest it is reasonable and safe to add these agents to standard therapy if symptomatology remains unresolved.     

Caring for patients with allergic rhinitis

PURPOSE: Allergic rhinitis (AR) affects up to 40 million Americans, with an estimated cost of $2.7 billion per annum. This review discusses several therapeutic options that reduce the symptoms of AR, including allergen avoidance, antihistamines, intranasal corticosteroids (INS), leukotriene receptor antagonists, and immunotherapy. DATA SOURCES: The articles included in this review were retrieved by a search of Medline literature on the subjects of AR, antihistamines, INS, leukotriene antagonists, and immunotherapy, as well as current published guidelines for the treatment of AR. CONCLUSIONS: Allergen avoidance is recommended for all patients prior to pharmacologic therapy. Oral and nasal H(1)-antihistamines are recommended to alleviate the mild and intermittent symptoms of AR, and INS are recommended as the first-line treatment choice for mild persistent and more moderate-to-severe persistent AR. IMPLICATIONS FOR PRACTICE: There are a number of different types of therapy for the management of AR; with so many options available, successful tailoring of treatment to suit individual requirements is realistically achievable.     

A multicenter study on the efficacy and safety of So-Cheong-Ryong-Tang for perennial allergic rhinitis

BackgroundSo-Cheong-Ryong-Tang (SCRT), also known as Xiao-Qing-Long-Tang or Sho-seiryo-to, is a mixed herbal formula that is used to treat allergic rhinitis, bronchitis, allergic asthma, and common cold in traditional Korean medicine.ObjectiveTo assess the efficacy and safety of the SCRT for the treatment of allergic rhinitis. Methods: We conducted a double-blind, randomized, placebo-controlled, parallel-group, multicenter study of Korean adults with perennial allergic rhinitis. The trial consisted of a 4-week oral administration of SCRT or placebo, with two visits at 2-week intervals, and an 8-week follow-up period, with two visits at 4-week intervals. The primary outcome was a change in the total nasal symptoms score. The secondary outcomes included changes in the Rhinoconjunctivitis Quality of Life Questionnaire score, total serum immunoglobulin E (IgE), cytokines levels, and nasal endoscopy index.ResultsSCRT improved nasal symptoms and quality of life in patients with PAR after 4 weeks medication, and these effects did not last 8 weeks after the end of medication. The level of serum IgE, eosinophil counts, and cytokines did not alter after medication. Nasal endoscopy index did not show significant difference. No serious AEs and safety assessment changes were observed in this trial.ConclusionSCRT is an effective and safe medication for patients with chronic, perennial, and moderate to severe AR. A clinical study with a >4-week period of medication use, and more participants for immune material test is needed to investigate the long-term efficacy of SCRT in relieving the symptoms of nasal obstruction and identifying the underlying mechanisms of action and indications for traditional Korean medicine.     

胃食管反流性咳嗽50例分析

目的：探讨胃食管反流性咳嗽的治疗方法。方法：对2004年1月-2007年1月收治的50例胃食管反流性咳嗽患者的临床表现、治疗方法及治疗效果进行回顾性分析。结果：50例患者中,31例咳嗽伴反酸及胸骨后烧灼感。通过对患者进行宣教,给予抑酸剂、质子泵抑制剂或H2受体拮抗剂及促胃动力药等治疗,23例患者口服药物7～14d时症状缓解,21d左右症状消失;17例患者口服药物15～21d时症状缓解,4周时症状消失;10例症状较重者服药4周时症状明显减轻,总疗程≥2个月。结论：患者通过改变饮食及睡眠习惯,应用抑酸剂及抗反流药物,积极治疗消化性溃疡等原发病,胃食管反流性咳嗽可取得满意疗效。     

老年患者慢性咳嗽病因构成及咳嗽严重程度分析

目的探讨老年与非老年组患者慢性咳嗽病因构成及咳嗽严重程度。方法 58例老年和82例非老年不明原因慢性咳嗽患者,按照慢性咳嗽的解剖学诊断程序,根据病史、体格检查、实验室检查及相关辅助检查明确病因,咳嗽积分评价咳嗽严重程度。结果老年组常见病因依次为：咳嗽变异性哮喘（CVA）23例,上气道咳嗽综合征（UACS）16例,胃食管反流性咳嗽（GERC）8例;非老年组常见病因依次为：CVA 31例,UACS 26例,GERC 10例。两组主要病因构成比较差异无统计学意义（P〉0.05）。两组患者各病因间的日间咳嗽积分比较差异无统计学意义（P〉0.05）,CVA的夜间积分明显高于其他病因（P均〈0.01）。结论与非老年组类似,CVA、UACS、GERC也是老年不明原因慢性咳嗽的常见病因,不同病因慢性咳嗽的日间咳嗽程度类似,但CAV夜间咳嗽程度显著高于其他病因的咳嗽。     

儿童慢性上气道咳嗽综合征病因及诊断方法探讨

目的探讨儿童慢性上气道咳嗽综合征（UACS）的病因及诊断方法。方法对135例诊断为UACS患儿的病因、临床特点及对治疗反应进行分析。结果135例UACS患儿中3例失访,132例慢性上气道咳嗽综合征患儿病因明确（97.78%）,其中慢性鼻炎67例（49.63%）,鼻窦炎42例（31.11%）,变应性鼻炎22例（16.30%）,腺样体肥大7例（5.19%）,解剖结构异常所致鼻炎1例（0.74%）。主要临床特点是咳嗽135例（100%）,抠鼻孔102例（75.56%）,清喉94例（69.63%）、流涕89例（65.93%）,鼻塞或打鼾78例（57.78%）,打喷嚏71例（52.59%）、咽痒68例（50.37%）、咽部感分泌物下流或异物感63例（46.67%）,张口呼吸45例（33.33%）。治疗12周症状基本消失128例（94.81%）,显效3例（2.22%）,总有效率97.04%（131/135）。结论儿童UACS最常见的三个病因是慢性鼻炎、鼻窦炎及变应性鼻炎,咳嗽是其主要症状,通过详细询问咳嗽特点及其伴随症状,尤其是鼻部症状、检查鼻咽部,97.78%都能明确诊断,经特异积极治疗,绝大部分疗效好。