Department of Respiratory Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China.
Chin Med J (Engl). 2011 Dec;124(24):4138-43.
The current diagnostic algorithms for chronic cough require the establishment of the primary presumptive causes followed by the confirmation of diagnosis with the specific therapies. The aim of the study was to investigate the discrepancy between presumptive and definite causes and its clinical implication.
A total of 109 patients with chronic cough underwent laboratory investigations to identify the cause of cough; including sinus computerized tomography (if needed), histamine bronchial provocation, induced sputum cytology and 24-hour esophageal pH or multi-channel intraluminal impedance combined with pH monitoring. The presumptive causes were confirmed by treating them sequentially. The difference between presumptive and definite causes of chronic cough was compared.
Single cause was more frequent in the definite diagnosis than in the presumptive diagnosis (78.9% vs. 54.1%, χ(2) = 15.01, P = 0.0001). In contrast, multiple causes were significantly fewer in definite diagnosis than in the presumptive diagnosis (15.6% vs. 37.6%, χ(2) = 13.53, P = 0.0002). There was a discrepancy between definite and presumptive causes in 30 patients (27.5%). Compared with the presumptive causes, definite upper airway cough syndrome (24.8% vs. 11.9%, χ(2) = 6.0, P = 0.01) and gastroesophageal reflux disease (6.4% vs. 0, χ(2) = 7.23, P = 0.007) was more frequent as a single cause of chronic cough while cough variant asthma plus gastroesophageal reflux disease (3.7% vs. 11.9%, χ(2) = 5.17, P = 0.02) and upper airway cough syndrome plus nonasthmatic eosinophilic bronchitis (0 vs. 9.2%, χ(2) = 10.48, P = 0.001) were fewer as multiple causes of chronic cough.
A discrepancy was common between presumptive and definite causes of chronic cough. To treat presumptive causes sequentially may be a suitable solution for avoidance of erroneous multiple causes and possible over-treatment.
目前慢性咳嗽的诊断算法需要先确定主要疑似病因，然后再用特定疗法来确诊。本研究旨在探讨疑似病因和确诊病因之间的差异及其临床意义。
共 109 例慢性咳嗽患者接受了实验室检查以确定咳嗽的病因；包括鼻窦计算机断层扫描（如有需要）、组胺支气管激发试验、诱导痰细胞学检查和 24 小时食管 pH 或多通道腔内阻抗联合 pH 监测。通过序贯治疗来确定疑似病因。比较慢性咳嗽的疑似和确诊病因之间的差异。
单一病因在确诊诊断中比在疑似诊断中更为常见（78.9%比 54.1%，χ²=15.01，P=0.0001）。相反，在确诊诊断中，多病因明显少于疑似诊断（15.6%比 37.6%，χ²=13.53，P=0.0002）。30 例（27.5%）患者的确诊和疑似病因之间存在差异。与疑似病因相比，确诊的上气道咳嗽综合征（24.8%比 11.9%，χ²=6.0，P=0.01）和胃食管反流病（6.4%比 0，χ²=7.23，P=0.007）作为慢性咳嗽的单一病因更为常见，而咳嗽变异性哮喘加胃食管反流病（3.7%比 11.9%，χ²=5.17，P=0.02）和上气道咳嗽综合征加非哮喘性嗜酸性支气管炎（0比 9.2%，χ²=10.48，P=0.001）作为慢性咳嗽的多病因则更少。
疑似病因和确诊病因之间存在差异很常见。依次治疗疑似病因可能是避免错误的多病因和过度治疗的一种合适的解决方案。
