Department of Respiratory Medicine, Tongji Hospital, School of Medicine, Tongji University, No. 389 Xincun Road, 200065, Shanghai, China.
Lung. 2010 Jan-Feb;188(1):71-6. doi: 10.1007/s00408-009-9192-0. Epub 2009 Oct 28.
Upper-airway cough syndrome often coexists with other diseases that elicit chronic cough. However, the concomitant conditions are not always relevant to chronic cough, which complicates the cause diagnosis of chronic cough. The objective of this study was to explore the diagnosis and clinical implication of upper-airway cough syndrome with latent eosinophilic bronchitis. Eleven patients with upper-airway cough syndrome and latent eosinophilic bronchitis were retrospectively analyzed for their clinical manifestations, changes of eosinophilia in induced sputum, and cough threshold with capsaicin defined as capsaicin concentration that elicits two or more coughs (C2) and five or more coughs (C5) between pretreatment and post-treatment. All patients reported a history of allergic rhinitis, showed persistent dry cough or small amounts of viscid sputum with a time course of 2-60 months (median = 7 months), and presented with symptoms and signs of rhinitis, normal lung function, and airway responsiveness. Initial eosinophil percentage in induced sputum was 3.5-8.0%. Cough disappeared after 2-5 (3 +/- 1) weeks of only oral antihistamine. With successful treatment, cough threshold C2 increased from 1.73 +/- 1.45 to 4.43 +/- 4.50 micromol/L (t = 2.64, P = 0.025) and C5 increased from 2.79 +/- 2.16 to 10.10 +/- 8.22 micromol/L (t = 3.10, P = 0.011). However, there was no significant change of eosinophil percentage in induced sputum (4.8 +/- 1.5% vs. 4.4 +/- 1.4%, t = 0.84, P = 0.427). Upper-airway cough syndrome with latent eosinophilic bronchitis is a unique condition. The recognition of the entity may avoid unnecessary use of corticosteroids.
上气道咳嗽综合征常与引起慢性咳嗽的其他疾病共存。然而，这些伴随疾病并不总是与慢性咳嗽有关，这使得慢性咳嗽的病因诊断变得复杂。本研究旨在探讨伴有潜在嗜酸性粒细胞性支气管炎的上气道咳嗽综合征的诊断和临床意义。回顾性分析 11 例上气道咳嗽综合征伴潜在嗜酸性粒细胞性支气管炎患者的临床表现、诱导痰中嗜酸性粒细胞的变化以及辣椒素咳嗽阈值（定义为引起 2 次或 2 次以上咳嗽的辣椒素浓度 C2 和引起 5 次或 5 次以上咳嗽的辣椒素浓度 C5）的变化。所有患者均有过敏性鼻炎病史，表现为持续干咳或少量粘性痰，病程 2-60 个月（中位数为 7 个月），并伴有鼻炎症状和体征、肺功能正常和气道高反应性。诱导痰中嗜酸性粒细胞百分比为 3.5-8.0%。仅口服抗组胺药 2-5（3+/-1）周后咳嗽消失。咳嗽阈值 C2 从 1.73+/-1.45 增加到 4.43+/-4.50 μmol/L（t=2.64，P=0.025），C5 从 2.79+/-2.16 增加到 10.10+/-8.22 μmol/L（t=3.10，P=0.011），而诱导痰中嗜酸性粒细胞百分比无明显变化（4.8+/-1.5% vs. 4.4+/-1.4%，t=0.84，P=0.427）。上气道咳嗽综合征伴潜在嗜酸性粒细胞性支气管炎是一种独特的疾病。认识到这一实体可能避免不必要地使用皮质类固醇。
