Gahbauer Mary, Keane Patricia
Pathophysiology, Otterbein College, Columbus, Ohio 43081, USA.
J Am Acad Nurse Pract. 2009 Aug;21(8):409-16. doi: 10.1111/j.1745-7599.2009.00432.x.
To illustrate decision points encountered when using evidence-based guidelines for diagnosis and management of chronic cough by means of a composite case study based on primary care practice.
The American College of Chest Physicians (ACCP) Evidence-Based Clinical Practice Guidelines for Diagnosis and Management of Cough, and review of the scientific literature on cough and related topics.
The ACCP guidelines offer a systematic approach that uses trials of empirical therapies to diagnose and resolve the very common, often perplexing complaint of chronic cough. The major diagnoses reached are upper airway cough syndrome, cough-variant asthma, gastroesophageal reflux disease, and nonasthmatic eosinophilic bronchitis.
Cough is the most common reason that patients seek an office visit. Many coughs resolve spontaneously, but coughs that persist significantly impair the quality of life. Use of the ACCP guidelines allows a stepwise empirical approach to the problem of unexplained chronic cough. This approach greatly increases the percentage of chronic coughs that are accurately diagnosed and effectively treated, and avoids unnecessary diagnostic testing.
通过一个基于初级保健实践的综合案例研究，阐述在使用循证指南诊断和管理慢性咳嗽时遇到的决策要点。
美国胸科医师学会（ACCP）咳嗽诊断和管理的循证临床实践指南，以及关于咳嗽及相关主题的科学文献综述。
ACCP指南提供了一种系统方法，利用经验性治疗试验来诊断和解决慢性咳嗽这一非常常见且常常令人困惑的主诉。主要诊断包括上气道咳嗽综合征、咳嗽变异性哮喘、胃食管反流病和非哮喘性嗜酸性粒细胞性支气管炎。
咳嗽是患者寻求门诊就诊的最常见原因。许多咳嗽会自行缓解，但持续的咳嗽会严重影响生活质量。使用ACCP指南可以对不明原因的慢性咳嗽问题采取逐步的经验性方法。这种方法大大提高了准确诊断和有效治疗的慢性咳嗽的比例，并避免了不必要的诊断测试。
