Stanković Ivana, Pejcić Tatjana, Rancić Milan, Milenković Branislava
Klinika za plućne bolesti i tuberkulozu, Knez Selo, Nis.
Med Pregl. 2010 Mar-Apr;63(3-4):170-4. doi: 10.2298/mpns1004170s.
Classic asthma is characterized by cough, wheezing and dyspnea. Cough, however, may be the sole presenting symptom of asthma and this type of asthma is known as cough-variant asthma. The therapeutic approach to cough variant asthma is similar to that of the typical form of asthma. A diagnosis of cough-variant asthma is made when a chronic cough is associated with airway hyperresponsiveness and a favorable response to asthma therapy in the absence of other discernible cause. The aims of this study were to analyse the influence of inhaled corticosteroids on cough and bronchial hyperresponsiveness.
The study included 55 patients with cough as the sole presenting symptom. 40 patients (Group A) were treated with inhaled corticosteroids and beta2 agonists for eight weeks while 15 patients (Group B) were treated only with oral beta2 agonists. The nonspecific bronchoprovocative test with histamine was performed on all the patients before the treatment and after the examination and there was established the provocative dose of histamine causing the 20% fall in FEVI (PD20).
At the end of the study in Group A we found a statistically significant decrease of PD20 0.98 +/- 0.86 vs. 1.58 +/- 1.06 (p < 0.005), while in Group B there were no significant changes. In 90% of the patients treated with inhaled corticosteroids the cough was completely relieved while in 80% of the patients treated with only beta2 agonists the cough has remained unchanged.
Inhaled corticosteroids are choice drugs for the treatment of cough-variant asthma because they relieve cough and decrease bronchial hyperresponsiveness, thus ultimately reducing the risk of classic asthma.
典型哮喘的特征为咳嗽、喘息和呼吸困难。然而，咳嗽可能是哮喘的唯一表现症状，这种类型的哮喘被称为咳嗽变异性哮喘。咳嗽变异性哮喘的治疗方法与典型哮喘相似。当慢性咳嗽伴有气道高反应性且在无其他可识别病因的情况下对哮喘治疗有良好反应时，可诊断为咳嗽变异性哮喘。本研究的目的是分析吸入性糖皮质激素对咳嗽和支气管高反应性的影响。
该研究纳入了55例以咳嗽为唯一表现症状的患者。40例患者（A组）接受吸入性糖皮质激素和β2激动剂治疗8周，而15例患者（B组）仅接受口服β2激动剂治疗。在治疗前和检查后对所有患者进行组胺非特异性支气管激发试验，并确定导致第一秒用力呼气容积（FEV1）下降20%的组胺激发剂量（PD20）。
在研究结束时，A组的PD20有统计学显著下降，从1.58±1.06降至0.98±0.86（p<0.005），而B组无显著变化。在接受吸入性糖皮质激素治疗的患者中，90%的咳嗽完全缓解，而在仅接受β2激动剂治疗的患者中，80%的咳嗽无变化。
吸入性糖皮质激素是治疗咳嗽变异性哮喘的首选药物，因为它们能缓解咳嗽并降低支气管高反应性，从而最终降低典型哮喘的风险。
