Abouzgheib Wissam, Pratter Melvin R, Bartter Thaddeus
Division of Pulmonary and Critical Care Medicine, Cooper University Hospital, Camden, New Jersey, USA.
Curr Opin Pulm Med. 2007 Jan;13(1):44-8. doi: 10.1097/MCP.0b013e328011391c.
The intention of this article is to discuss and place into perspective recent articles on cough and asthma.
Asthma continues to be a major diagnosis in most studies of cough. The first prospective study of sub-acute cough demonstrated an asthma incidence lower than that for chronic cough, a logical finding; upper airway cough syndrome often causes cough in the postinfectious state. The first prospective study of cough in infants suggested asthma to be a minor cause of cough in infants, but methodological flaws make the conclusions uncertain. Efforts to separate cough-variant asthma from classic asthma continue. One group has demonstrated that the maximal bronchoconstrictor response in cough-variant asthma is blunted when compared with classic asthma, a possible explanation for the absence of wheeze and dyspnea in cough-variant asthma. Another look at airway resistance showed a less rapid rate of rise in resistance in cough-variant asthma with increasing methacholine dosing than in classic asthma. On the biochemical front, a group has demonstrated differences in vascular endothelial growth factor, which may be the underpinnings of differences between cough-variant asthma and classic asthma.
Recent data suggest that cough-variant asthma is part of a continuum in the expression of asthma symptoms and in the asthmatic inflammatory response.
本文旨在讨论近期关于咳嗽与哮喘的文章并对其进行综合分析。
在大多数咳嗽研究中，哮喘仍是主要诊断结果。首项关于亚急性咳嗽的前瞻性研究表明，哮喘发病率低于慢性咳嗽，这是符合逻辑的发现；上气道咳嗽综合征常在感染后状态引发咳嗽。首项关于婴儿咳嗽的前瞻性研究表明，哮喘是婴儿咳嗽的次要原因，但方法学缺陷使结论不确定。区分咳嗽变异性哮喘与典型哮喘的工作仍在继续。一组研究表明，与典型哮喘相比，咳嗽变异性哮喘的最大支气管收缩反应减弱，这可能是咳嗽变异性哮喘无喘息和呼吸困难症状的原因。另一项关于气道阻力的研究显示，随着乙酰甲胆碱剂量增加，咳嗽变异性哮喘的阻力上升速度比典型哮喘慢。在生化方面，一组研究表明血管内皮生长因子存在差异，这可能是咳嗽变异性哮喘与典型哮喘差异的基础。
近期数据表明，咳嗽变异性哮喘是哮喘症状表达及哮喘炎症反应连续统一体的一部分。
