Irwin Richard S
Division of Pulmonary, Allergy, and Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA.
Otolaryngol Clin North Am. 2010 Feb;43(1):167-80, xi-xii. doi: 10.1016/j.otc.2009.11.009.
Unexplained cough is a diagnosis of exclusion that should not be made until a thorough validated diagnostic evaluation is performed, specific and appropriate validated treatments have been tried and failed, and uncommon causes have been ruled out. When chronic cough remains troublesome after the initial work up, determine that a protocol has been used that has been shown to lead to successful results. If such a protocol has been used, next consider whether or not pitfalls in management have been avoided. If they have been, the frequency of truly unexplained chronic cough usually should not exceed 10%. While patients with truly unexplained coughs have an overly sensitive cough reflex, the mere presence of an overly sensitive cough reflex does not by itself explain why they do not get better, because most patients with chronic cough, even those who respond to treatment and get better, have demonstrable heightened cough sensitivity. Management options include referral to a cough clinic with interdisciplinary expertise, speech therapy, and self-limited trials of drugs, preferentially with those shown to be effective in randomized, double-blind placebo-controlled trials in patients with unexplained chronic cough.
不明原因咳嗽是一种排除性诊断，在进行全面有效的诊断评估、尝试了特定且合适的有效治疗但失败且排除了罕见病因之前，不应做出该诊断。当初始检查后慢性咳嗽仍然困扰患者时，要确定是否使用了已被证明能带来成功结果的方案。如果已经使用了这样的方案，接下来要考虑是否避免了管理中的陷阱。如果已经避免，真正不明原因的慢性咳嗽发生率通常不应超过10%。虽然真正不明原因咳嗽的患者咳嗽反射过度敏感，但仅仅存在过度敏感的咳嗽反射本身并不能解释他们为何没有好转，因为大多数慢性咳嗽患者，即使是那些对治疗有反应并好转的患者，也有可证实的咳嗽敏感性增强。管理选项包括转诊至具有多学科专业知识的咳嗽诊所、言语治疗以及药物的自限性试验，优先选择那些在不明原因慢性咳嗽患者的随机、双盲安慰剂对照试验中显示有效的药物。
