Chomette-Ballereau S, Bertoletti L, Glas N, Frappé P, Costes F, Vergnon J-M
Service de pneumologie et d'oncologie thoracique, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
Rev Pneumol Clin. 2012 Jun;68(3):171-9. doi: 10.1016/j.pneumo.2011.07.003. Epub 2011 Oct 19.
Chronic cough represents a persistent dilemma, for general practitioner (GP), inducing a lot of medical investigations. Few data are available about French GP practice and their expectancy from cough specialists. We studied management in primary care and impressions of GP of patients with chronic cough. Thirty-four patients were studied. They were mostly women, mean age was above 50 years-old, and the waste majority of patients were non-smokers. Halftime, the symptom was persistent (more than 6 months), had promoted numerous medical consultations (more than five). Drugs were prescribed since the first visit for the majority of patients, principally cough-sedation drugs, steroids and bronchodilatators. A chest radiography was realized in almost all patients. Advices were asked (with a decreasing frequency) to physicians specialized in: ear-nose-throat or respiratory, gastroenterology, allergy, or cardiology. The majority of patients were satisfied of their GP, despite persistent symptoms. From the point of the GP, chronic cough remains a relentless dilemma. Their main purpose, when they addressed their patient to a specialized physician, was to obtain an etiologic diagnosis. When they were asked "which tool will be more adequate for you in the next future?", the preferred response was "a simple etiologic algorithm". Despite persistent symptoms, inducing furthers medical consultations, the main ask from GP was to promote a simple etiologic algorithm.
慢性咳嗽一直是个难题,给全科医生(GP)带来诸多困扰,引发了大量医学检查。关于法国全科医生的诊疗实践以及他们对咳嗽专科医生的期望,相关数据较少。我们研究了基层医疗中慢性咳嗽患者的管理情况以及全科医生的看法。共研究了34名患者。他们大多为女性,平均年龄超过50岁,绝大多数患者不吸烟。半数情况下,症状持续(超过6个月),促使患者进行了多次医疗咨询(超过5次)。大多数患者从首次就诊起就开始用药,主要是止咳镇静药、类固醇和支气管扩张剂。几乎所有患者都进行了胸部X光检查。还向以下专科医生咨询建议(频率逐渐降低):耳鼻喉科或呼吸科、胃肠病学、过敏科或心脏病学。尽管症状持续,大多数患者对他们的全科医生感到满意。从全科医生的角度来看,慢性咳嗽仍然是一个棘手的难题。当他们将患者转诊给专科医生时,主要目的是获得病因诊断。当被问及“未来哪种工具对你来说更合适?”时,首选回答是“一个简单的病因诊断算法”。尽管症状持续导致进一步的医疗咨询,但全科医生的主要诉求是推广一种简单的病因诊断算法。