Ojoo Josephine C, Everett Caroline F, Mulrennan Siobhain A, Faruqi Shoaib, Kastelik Jack A, Morice Alyn H
Department of Cardiovascular and Respiratory Studies, Castle Hill Hospital, University of Hull, Cottingham, HU16 5JQ, UK.
Cough. 2013 Jan 24;9(1):2. doi: 10.1186/1745-9974-9-2.
Chronic cough is a common symptom the aetiology of which can be challenging to diagnose. Diagnostic protocols for chronic cough have required the use of specialist investigations which are not always easily available. We wanted to determine whether patients with chronic cough can be successfully managed using a clinical algorithm.
112 consecutive patients with chronic cough were prospectively recruited into this study. They were assessed by history, physical examination, chest radiograph, spirometry and reversibility to nebulised salbutamol. A clinical diagnosis was made and the patient had an 8-week trial of appropriate therapy. Further therapeutic trials were carried out depending on response to treatment and the possible differential diagnoses. Investigations were carried out in cases of failed clinical trials and to exclude specific pathology. The "clinical arm" comprised patients managed on the basis of clinical assessment and without any investigations. The "investigative arm" comprised those who needed further investigations.
81 (72%) were managed in the clinical arm. Of these 74 (66%) were discharged following response to therapy. 31 (28%) patients were converted to the investigative arm after failure of diagnosis in the clinical protocol. The commonest causes of cough were gastroesophageal reflux, asthma and chronic rhinitis. 51 (45.5%) patients responded to therapy based on diagnosis at initial assessment while a further 23 (20.5%) patients responded to sequential clinical trials for the commonest causes of cough. Cough severity score improved by a mean of 3.6 points on a numeric response score (from 0-10, p < 0.0001).
It is possible to manage a majority of chronic cough patients successfully using a protocol based on presenting symptoms and therapeutic trials for the common causes of cough.
慢性咳嗽是一种常见症状，其病因诊断可能具有挑战性。慢性咳嗽的诊断方案需要使用专业检查，而这些检查并非总是容易获得。我们想确定慢性咳嗽患者是否可以通过临床算法成功管理。
前瞻性招募了112例连续的慢性咳嗽患者进入本研究。通过病史、体格检查、胸部X光片、肺功能测定以及对雾化沙丁胺醇的反应性进行评估。做出临床诊断，并让患者进行为期8周的适当治疗试验。根据治疗反应和可能的鉴别诊断进行进一步的治疗试验。在临床试验失败的情况下进行检查，以排除特定病理情况。“临床组”包括基于临床评估进行管理且未进行任何检查的患者。“检查组”包括那些需要进一步检查的患者。
81例（72%）在临床组进行管理。其中74例（66%）在治疗有反应后出院。31例（28%）患者在临床方案诊断失败后转入检查组。咳嗽的最常见原因是胃食管反流、哮喘和慢性鼻炎。51例（45.5%）患者在初始评估时根据诊断接受治疗有反应，另外23例（20.5%）患者对咳嗽最常见原因的序贯临床试验有反应。咳嗽严重程度评分在数字反应评分上平均提高了3.6分（从0至10分，p < 0.0001）。
基于出现的症状和对咳嗽常见原因的治疗试验的方案，有可能成功管理大多数慢性咳嗽患者。
