Ternesten-Hasséus Ewa, Larsson Sven, Millqvist Eva
Department of Allergology, Institution of Internal Medicine, the Sahlgrenska Academy at University of Gothenburg, Sweden, S-413 45 Gothenburg, Sweden.
Cough. 2011 Oct 7;7:6. doi: 10.1186/1745-9974-7-6.
Chronic cough is a common condition, but some patients have no evident medical explanation for their symptoms. A group of patients has been identified, characterized by upper and lower airway symptoms triggered by chemicals and scents, and heightened cough sensitivity to inhaled capsaicin. Chronic cough is usually a prominent symptom in these patients, and it has been suggested that they suffer from sensory hyperreactivity.Our main aim was to analyse, in a group of patients with chronic cough, the presence of symptoms induced by environmental factors such as chemicals, scents, and cold air, and to measure the social and emotional influences of these symptoms in relation to quality of life. A second aim was to pilot-test a Swedish translation of a cough-specific questionnaire.
A total of 119 patients with chronic cough were asked to answer three different questionnaires: a local symptom questionnaire, the Chemical Sensitivity Scale for Sensory Hyperreactivity (CSS-SHR), and the Nottingham Health Profile (NHP). In addition, a Swedish version of the Hull Airway Reflux Questionnaire (HARQ) was developed and answered by a subgroup of patients and healthy controls.
Sixty-two patients (52%) with mean cough duration of 10.6 years answered the local symptom questionnaire, the CSS-SHR, and the NHP. Of these, 39 (63%) claimed to have cough and other symptoms induced by chemicals and scents. Compared to population-based findings, the patients scored higher on the CSS-SHR, and the CSS-SHR score was significantly higher among chemical-sensitive individuals (p < 0.001). The NHP showed that the patients had a significantly reduced quality of life, which was most pronounced among chemical-sensitive individuals. The 31 patients who answered the HARQ had significantly higher scores (p < 0.0001) than 59 healthy controls.
Among patients with chronic cough, a majority claimed that environmental factors induced coughing. Both the CSS-SHR and the HARQ score systems seem to be valuable instruments in the mapping of cough patients, supporting the novel paradigm of a cough hypersensitivity syndrome. Our results emphasize that cough is a substantial burden to the patient, influencing daily living and quality of life.
慢性咳嗽是一种常见病症，但有些患者的症状并无明显的医学解释。已识别出一组患者，其特征为化学物质和气味引发上、下呼吸道症状，且对吸入辣椒素的咳嗽敏感性增强。慢性咳嗽通常是这些患者的突出症状，有人认为他们患有感觉过敏。我们的主要目的是分析一组慢性咳嗽患者中是否存在由化学物质、气味和冷空气等环境因素诱发的症状，并衡量这些症状对生活质量的社会和情感影响。第二个目的是对一份咳嗽特异性问卷的瑞典语译本进行预测试。
共119例慢性咳嗽患者被要求回答三种不同问卷：一份局部症状问卷、感觉过敏化学敏感性量表（CSS-SHR）和诺丁汉健康量表（NHP）。此外，还编制了瑞典语版的赫尔气道反流问卷（HARQ），并由一组患者和健康对照者作答。
62例平均咳嗽病程为1年的患者回答了局部症状问卷、CSS-SHR和NHP。其中，39例（63%）称咳嗽及其他症状由化学物质和气味诱发。与基于人群的研究结果相比，患者在CSS-SHR上得分更高，且化学敏感个体的CSS-SHR得分显著更高（p<0.001）。NHP显示患者的生活质量显著降低，在化学敏感个体中最为明显。回答HARQ的31例患者得分显著高于59例健康对照者（p<0.0001）。
在慢性咳嗽患者中，大多数人称环境因素会诱发咳嗽。CSS-SHR和HARQ评分系统似乎都是描绘咳嗽患者的有价值工具，支持咳嗽过敏综合征这一新范式。我们的结果强调咳嗽给患者带来了沉重负担，影响日常生活和生活质量。
