咳嗽变异性哮喘临床特征及诊断初步研究

目的 深入研究咳嗽变异性哮喘(CVA)患者的临床特征以及治疗反应对临床诊断的意义,提高对CVA的诊治水平.方法 2009年10月到2010年8月期间在第三军医大学新桥医院门诊及涪陵中心医院就诊诊断为慢性咳嗽,并且支气管激发试验阳性拟诊为CVA的患者,记录其咳嗽的临床特点、伴随症状和咽部体征.并给予沙美特罗/氟替卡松干粉...     

咳嗽变异性哮喘的临床特征及其与典型哮喘的关系

目的分析成年咳嗽变异性哮喘（CVA）患者的临床特征及其发展为哮喘的情况,探讨CVA进展为哮喘的危险因素。方法收集2002年1月至2010年1月于广州呼吸疾病研究所门诊就诊的CVA患者,记录患者的基本临床资料,包括咳嗽时相、咳嗽性质、诱发因素、伴随症状、过敏史、随访情况等。并行肺功能、支气管激发试验/PEF检测、诱导痰细胞学分类、皮肤过敏原点刺试验等检查。所有入选患者年龄≥18岁、符合我国《咳嗽的诊断与治疗指南》中CVA的诊断标准。同时给予规律吸入中等剂量的布地奈德或等效剂量的吸入激素,至少治疗8周。通过门诊及电话随访,若患者出现胸闷、喘息等典型哮喘症状或出现哮鸣音则确认其进展为哮喘,分为单纯CVA组和发展为典型哮喘组（哮喘组）;比较两组患者一般资料及实验室检查情况。结果 91例CVA患者咳嗽时相以夜间或清晨为主的发生率为74.7%,伴变应性鼻炎病史的比例为46.2%;咳嗽的主要诱发因素包括：烟雾63.5%、冷空气51.4%、上呼吸道感染47.3%、灰尘37.8%、咽喉发痒36.5%;CVA患者有74.7%诱导痰中嗜酸粒细胞（EOS）比例〉2.5%。58例患者平均随访4.2（1~8.5）年,其中8例患者（8/58,13.8%）进展为典型哮喘,单纯CVA组患者使用吸入激素时间显著长于哮喘组[12（20）周vs 6（4）周,P〈0.05],8例哮喘组患者中仅1例规律吸入激素12周以上,而其他50例单纯CVA患者中有33例规律吸入激素大于12周,两组比较差异有统计学意义（P〈0.05）。单纯CVA组各项肺功能指标、痰EOS%、外周血EOS%、皮肤过敏原点刺试验阳性率与哮喘组比较差异均无统计学意义（P〉0.05）。结论 CVA主要以夜间或清晨咳嗽为临床特征,并有近一半患者合并过敏性鼻炎,长期规范吸入激素治疗可减少CVA患者进展为典型哮喘。     

咳嗽变异性哮喘58例临床分析

咳嗽变异性哮喘（CVA）又称咳嗽性哮喘（CTA）、过敏性咳嗽，是一种潜在形式的哮喘。本病患者仅以反复夜间或清晨咳嗽为主要表现，白天就诊是错失早期诊断的原因之一，又因肺部缺乏阳性体征及家属病史介绍有误，常被贻误诊断和治疗，并增加经济负担。本文报告30例CVA患儿的误诊情况，并总结如下。     

孟鲁斯特与丙卡特罗二联治疗儿童咳嗽变异性哮喘疗效分析

目的 探讨孟鲁斯特与丙卡特罗二联治疗儿童咳嗽变异性哮喘（CVA）临床效果.方法 选取我院门诊及住院治疗CVA患儿180例,随机分为治疗组（A组）和对照组（B组）;其中B组患儿单用丙卡特罗治疗;A组患儿在B组治疗基础上,加用孟鲁斯特;比较两组患儿临床改善总有效率,结果 A组临床改善总有效率（98.9%）明显高于B组（75.6 %）,组间比较差异显著（P〈0.05）;结论孟鲁斯特与丙卡特罗二联治疗CVA可显著改善临床症状,缩短病程.     

咳嗽变异性哮喘68例临床分析

咳嗽变异性哮喘（CVA）又称隐匿性哮喘,是支气管哮喘的特殊类型,占咳嗽病因的14%~33%[1],主要表现为慢性刺激性、夜间为主的干咳.以持续气道炎症与气道高反应性为特点,常被误诊为呼吸道感染而使用多种抗生素及镇咳药,久治无效.为提高对CVA的认识,现将近年来本院收治的68例CVA患者情况报告如下.     

诱导痰技术诊断咳嗽变异性哮喘的临床价值

咳嗽变异性哮喘（CVA）是指以咳嗽为主要临床症状的哮喘,目前对其研究多集中在临床表现、肺功能情况和非特异性气道反应及治疗方案等方面。2002年6月-2004年2月,我们采用诱导痰技术对42例可疑CVA患者的痰液进行分析,以探讨其在CVA诊断中的作用。     

咳嗽变异性哮喘60例诊治体会

咳嗽变异性哮喘（CVA）是支气管哮喘的一种特殊类型,临床表现为反复持续的咳嗽,多数为干咳或伴少量白色泡沫样痰,夜间或晨起加重,临床上常无喘息症状,易被漏诊或误诊。现将我院2007年1月～2008年7月收治的60例CVA患者的诊治情况报告如下。     

沙美特罗替卡松联合苏黄止咳胶囊治疗咳嗽变异性哮喘疗效观察

目的观察沙美特罗替卡松（舒利迭）联合苏黄止咳胶囊对咳嗽变异性哮喘（CVA）的治疗效果。方法将50例临床诊断为CVA的患者随机分为两组。A：23例,舒利迭（50／250ug）吸入,每日2次。B：27例,舒利迭（50／250Ixg）吸入,每日2次,同时口服苏黄止咳胶囊3粒／次,每日3次。2周后比较两组患者的咳嗽症状积分和咳嗽敏感性,4周后比较两周患者的复发率。结果2周后,与A组比较,B组的咳嗽症状积分（P〉0．05）无显著差异,而咳嗽敏感性（P（0．05）降低,4周后,B组总复发率较A组下降。结论舒利迭联合苏黄止咳胶囊治疗能降低CVA患者的咳嗽敏感性,减少复发率。     

布地奈德/福莫特罗对咳嗽变异性哮喘患者FeNO及血浆hs-CRP影响的研究

目的 探讨布地奈德/福莫特罗治疗对咳嗽变异性哮喘（CVA）患者呼气一氧化氮（FeNO）及血浆超敏C反应蛋白（hs-CRP）水平的影响,比较FeNO和hs-CRP两种方法在反映CVA患者气道炎症方面的价值.方法 将25例CVA患者作为实验CVA组,24例健康体检者为对照组.所有研究对象均进行肺功能和支气管激发试验.所有CVA患者接受布地奈德/福莫特罗干粉吸入治疗4周（160 μg/4.5 μg,每12小时1次）,比较治疗前后咳嗽症状总积分、FeNO和血浆hs-CRP水平变化,并进行相关性分析.结果 （1）CVA患者治疗前FeNO和hs-CRP水平明显高于正常对照组（P均＜0.01）.FeNO水平与咳嗽症状总积分明显相关（r=0.602,P＜0.01）.（2）布地奈德/福莫特罗吸入治疗4周后患者咳嗽症状总积分、FeNO和hs-CRP较治疗前均明显下降（P＜0.01或P＜0.05）.（3）治疗后咳嗽缓解患者的基线FeNO水平明显高于未缓解者,且FeNO下降的比例与咳嗽总积分下降比例明显相关（r =0.466,P＜0.05）,而hs-CRP下降比例与咳嗽总积分下降比例无明显相关.结论 布地奈德/福莫特罗吸入治疗4周可以有效改善CVA患者症状,同时降低FeNO和血浆hs-CRP水平.相比血浆hs-CRP水平,监测FeNO在评价CVA患者气道炎症及激素治疗反应方面更有优势.     

信必可治疗CVA的疗效及对细胞因子和小气道功能的影响

目的探讨信必可辅助治疗咳嗽变异性哮喘(CVA)患者的临床效果及对患者细胞因子、小气道功能的影响作用。方法选取本院呼吸内科2015年4月-2015年12月收治的98例CVA患者进行回顾性分析,其中50例患者采用常规治疗措施(常规组),48例患者加用信必可进行辅助治疗(信必可组),观察治疗效果差异。结果治疗前,信必可组和常规组的日间、夜间咳嗽症状积分、细胞因子、EOS计数、小气道功能指标差异无统计学意义(P0.05);治疗后,信必可组患者的日间、夜间咳嗽症状积分、血清hs-CRP、IL-4、TNF-α及EOS计数显著的低于同期常规组患者(P0.05);信必可组FEF25%、FEF50%、FEF75%测定值显著的高于同期常规组患者(P0.05)。结论信必可辅助治疗CVA患者能够更加显著的改善患者的咳嗽情况,降低炎症反应水平,改善气道功能。     

咳嗽变异性哮喘临床分析

目的探讨咳嗽变异性哮喘(CVA)的临床特征及诊治措施,以提高其诊断率,减少误诊误治。方法回顾性分析54例CVA患者的临床资料及治疗方法。结果本组病例均以慢性咳嗽为主要症状,临床表现不典型,误诊率高,确诊后经吸入糖皮质激素和β2-受体激动剂治疗有显效。结论 CVA是一种特殊类型的哮喘,临床表现不典型,极易被误诊,应提高对该病的认识,尽可能早期诊断,并给予规律治疗。     

咳嗽变异型哮喘31例临床分析

目的 探讨咳嗽变异型哮喘(cough variation asthma,CVA)的诊治特点.方法 对诊断明确的31例患者进行回顾性分析.结果 CVA主要症状为慢性咳嗽,80.6％表现为夜间刺激性咳嗽(25例),83.9％有季节性加重(26例),其中,84.6％表现为夏秋季节加重(22例);12.9％合并胃食管反流性咳嗽(GERC)(4例),70.9％合并变应性鼻炎(22例),12.9％合并鼻窦炎(4例).其主要治疗方法同哮喘,58.1％患者(18例)咳嗽症状在治疗10天后有部分改善,但完全缓解则需吸入糖皮质激素60天以上.结论 了解CVA的临床特点可以提高诊断和治疗效率.     

Prevalence and clinical features of cough variant asthma in a general internal medicine outpatient clinic in Japan

OBJECTIVE: The aims of the present study were to examine the prevalence and clinical features of cough variant asthma (CVA) among patients with chronic and persistent cough at an outpatient clinic in Japan, and the efficacy of treatment with an inhaled corticosteroid. METHODOLOGY: This prospective study was conducted at a general internal medicine outpatient clinic in Japan over a 12-month period. CVA was diagnosed as chronic cough without wheezing or any apparent cause, that had persisted for more than 8 weeks, with a normal CXR and spirometry but with bronchial hyperresponsiveness to methacholine, and relief of cough after bronchodilator treatment. We also examined the effects of inhaled beclomethasone propionate on symptoms and differences in PEF between early morning and evening. RESULTS: Of 55 patients suffering from chronic cough, 23 satisfied the criteria for CVA. Their cough occurred more frequently at night and early in the morning. Early morning PEF was significantly lower than evening PEF with a mean variability of 11.5 +/- 4.1%. Treatment with beclomethasone propionate improved coughing and significantly increased early morning PEF, reducing variability to less than 10%. CONCLUSIONS: These findings suggest that CVA is most common among patients with chronic cough not due to any apparent cause. The efficacy of inhaled corticosteroid suggests that early intervention is effective in the treatment of CVA.     

Eosinophilic airway disorders associated with chronic cough

Chronic cough is a major clinical problem. The causes of chronic cough can be categorized into eosinophilic and noneosinophilic disorders, the former being comprised of asthma, cough variant asthma (CVA), atopic cough (AC) and non-asthmatic eosinophilic bronchitis (NAEB).Cough is one of the major symptoms of asthma. Cough in asthma can be classified into three categories; 1) CVA: asthma presenting solely with coughing, 2) cough-predominant asthma: asthma predominantly presenting with coughing but also with dyspnea and/or wheezing, and 3) cough remaining after treatment with inhaled corticosteroid (ICS) and β2-agonists in patients with classical asthma, despite control of other symptoms. There may be two subtypes in the last category; one is cough responsive to anti-mediator drugs such as leukotriene receptor antagonists and histamine H1 receptor antagonists, and the other is cough due to co-morbid conditions such as gastroesophageal reflux.CVA is one of the commonest causes of chronic isolated cough. It shares a number of pathophysiological features with classical asthma with wheezing such as atopy, airway hyperresponsiveness (AHR), eosinophilic airway inflammation and various features of airway remodeling. One third of adult patients may develop wheezing and progress to classical asthma. As established in classical asthma, ICS is considered the first-line treatment, which improves cough and may also reduce the risk of progression to classical asthma.AC proposed by Fujimura et al. presents with bronchodilator-resistant dry cough associated with an atopic constitution. It involves eosinophilic tracheobronchitis and cough hypersensitivity and responds to ICS treatment, while lacking in AHR and variable airflow obstruction. These features are shared by non-asthmatic eosinophilic bronchitis (NAEB). However, atopic cough does not involve bronchoalveolar eosinophilia, has no evidence of airway remodeling, and rarely progresses to classical asthma, unlike CVA and NAEB. Histamine H1 antagonists are effective in atopic cough, but their efficacy in NAEB is unknown. AHR of NAEB may improve with ICS within the normal range. Taken together, NAEB significantly overlaps with atopic cough, but might also include milder cases of CVA with very modest AHR. The similarity and difference of these related entities presenting with chronic cough and characterized by airway eosinophilia will be discussed.     

咳嗽变异型哮喘42例分析

目的探讨咳嗽变异型哮喘的诊断和治疗情况。方法回顾性研究42例咳嗽变异型哮喘患者的的临床特点，诊疗方法和治疗效果。结果主要症状为慢性干咳，支气管扩张剂与糖皮质激素能有效治疗，39例患者在治疗在治疗1周内症状缓解。结论该病易误诊，正确的诊断和激素治疗有利于预后。     

Effects of regular treatment with combination of salmeterol/fluticasone propionate and salmeterol alone in cough variant asthma

Objective: Cough variant asthma (CVA) is an important cause of chronic cough, and pathophysiological features of the disease appear to be similar to typical asthma. Because CVA is recognized as a precursor of asthma, early intervention with long-term anti-inflammatory agents may be recommended. However, the role of combination therapy with inhaled corticosteroid and β₂-agonist in the treatment of CVA has not been elucidated. To evaluate the effectiveness of the combination therapy, we investigated the clinical impact of regular treatment with salmeterol/fliticasone propionate combination (SFC) and inhaled salmeterol (SAL) alone in patients with CVA. Methods: The study was a randomized, controlled, parallel-group multi-center trial. Forty-three CVA patients were assigned to SFC (50/100?µg once daily) or SAL (50?µg twice daily) for 12 weeks. Then, these medications were stopped for the next 24 weeks. Main outcome measures were cough symptoms, pulmonary function and airway inflammation. Results: Treatment with each of SFC and SAL significantly decreased cough scores and increased FEV₁ and PEF, where the efficacy was more pronounced with SFC than SAL. SFC also decreased sputum eosinophil counts and eosinophil cationic protein contents, whereas SAL had no effect. After discontinuation of the treatment, cough scores increased, pulmonary function and eosinophilic airway inflammation were aggravated and returned to the baseline levels. Conclusions: Maintenance therapy with SFC provides further improvements in cough symptoms, pulmonary function and airway inflammation, and discontinuation of the therapy causes worsening of the disease, indicating that stopping or interrupting anti-inflammatory therapy may not be advisable in patients with CVA.     

沙美特罗替卡松粉剂吸入治疗儿童咳嗽变异性哮喘的临床观察

目的观察沙美特罗替卡松粉剂吸入治疗咳嗽变异性哮喘(CVA)的临床疗效及安全性。方法将92例CVA患者随机分为两组各46例,治疗组予舒利迭(每吸内含50μg沙美特罗和100μg丙酸氟替卡松),1吸/次,早晚各1次;对照组予普米克气雾剂(每喷内含布地奈德200μg),1喷/次,早晚各1次。咳嗽明显缓解后改为1吸/d,疗程维持3个月。结果治疗组显效率为86.96%,总有效率为95.65%,对照组显效率为63.04%,总有效率为78.26%,两组疗效比较差异均有统计学意义(P<0.05);治疗组在咳嗽缓解和咳嗽消失时间上明显优于对照组(P<0.01);治疗组在临床改善咳嗽、夜间呼吸症状及日常活动与运动行为不受限方面均优于对照组(P<0.05);两组均未发生明显药物不良反应及肝肾损害。结论沙美特罗替卡松吸入治疗CVA临床疗效确切,能迅速缓解和减轻症状、恢复正常呼吸功能,使用安全,具有协同增效作用。     

布地奈德气雾剂联合孟鲁司特治疗咳嗽变异型哮喘的疗效观察

目的研究布地奈德联合孟鲁司特治疗咳嗽变异型哮喘的疗效。方法回顾性分析我院近年来60例确诊为咳嗽变异型哮喘患者,分为观察组与对照组,各30例。观察组采用布地奈德气雾剂联合孟鲁司特咀嚼,对照组采用地塞米松联合氨茶碱注射液静脉滴注治疗。比较两组治疗前后的有效率。结果观察组有效率与对照组比较,差异无统计学意义(P>0.05)。结论布地奈德联合孟鲁司特治疗咳嗽变异型哮喘与地塞米松联合氨茶碱注射液疗效相当,且治疗更便捷、安全,适宜在临床推广应用。     

Clinical significance of fractional exhaled nitric oxide and periostin as potential markers to assess therapeutic efficacy in patients with cough variant asthma

BackgroundIn Japan, cough variant asthma (CVA) is the most common etiology of chronic cough. Contrary to substantial progress in understanding the roles of various factors in classic asthma, little is known regarding the pathogenesis and development of CVA. Furthermore, few studies have explored valuable biomarkers for evaluating the therapeutic efficacy of patients with CVA.MethodsWe conducted a single-center, prospective study to investigate the clinical significance of various clinical factors as potential “therapeutic” markers for CVA.ResultsFrom December 2019 to September 2020, we enrolled 20 patients with CVA and 10 age-matched healthy control subjects. Fractional exhaled nitric oxide (FeNO) values were significantly higher in patients with CVA than those in healthy controls. All patients with CVA commenced treatment at the initial visit, which markedly alleviated symptoms 12 weeks after treatment. FeNO values and serum periostin levels were significantly decreased following treatment, and altered FeNO values correlated with improved visual analogue scale scores of symptoms. Moreover, changes in both FeNO values and serum periostin levels were significantly correlated with increased values of some pulmonary function tests while also correlating with each other.ConclusionsOur observations indicate the usefulness of FeNO and periostin as potential “therapeutic” markers for CVA. To the best of our knowledge, this is the first report demonstrating the clinical significance of these factors as potential biomarkers to assess therapeutic efficacy in patients with CVA.