Physiotherapy Department and Adult Bronchiectasis Service Freeman Hospital, Newcastle Upon Tyne, UK.
Room M2060, Institute of Cellular Medicine, The Medical School Newcastle University and Adult Bronchiectasis Service Freeman Hospital Newcastle Upon Tyne Hospitals Trust, UK.
Pulm Pharmacol Ther. 2017 Dec;47:77-83. doi: 10.1016/j.pupt.2017.04.010. Epub 2017 Jun 7.
Bronchiectasis is a chronic lung disease with permanent airway dilatation, mucus retention and recurrent lower respiratory tract infections. Bronchiectasis is increasing in prevalence and has a significant morbidity and an excess mortality rate over age matched controls. It is increasingly identified during investigations into chronic cough and is evident high resolution CT scanning. There remain significant knowledge gaps in our understanding of the epidemiology, pathophysiology, prognosis and optimal treatments in bronchiectasis. This article reviews current concepts in bronchiectasis and focusses on the complex aspects of chronic cough in this setting. Cough is important in bronchiectasis as it is one of the most common presenting symptoms, it affects a patients' quality of life and in conjunction with cough hypersensitivity and airway hyper responsiveness may limit the successful uptake of treatment modalities such as inhaled antibiotics and/or inhaled mucoactive therapies. Effective coughing often assisted by physiotherapy is a cornerstone of bronchial toileting in bronchiectasis. Some patients however have ongoing non-productive cough symptoms suggesting a cough sensitisation syndrome. Post nasal drip and gastro-oesophageal reflux may complicate bronchiectasis and further lead to intractable cough syndromes. There may be multiple cough syndromes within an individual at interplay and careful assessment and multidisciplinary working is needed to optimize symptom control. This article also highlights the many unknowns in chronic cough in bronchiectasis.
支气管扩张症是一种慢性肺部疾病，其特征为气道永久性扩张、黏液潴留和反复发生的下呼吸道感染。支气管扩张症的发病率在不断增加，其发病率和死亡率均高于同龄对照组。在对慢性咳嗽进行调查时，支气管扩张症的发病率明显增加，并且高分辨率 CT 扫描可明确诊断。目前，我们对支气管扩张症的流行病学、病理生理学、预后以及最佳治疗方法仍存在许多认识上的空白。本文回顾了支气管扩张症的现有概念，并重点讨论了该疾病背景下慢性咳嗽的复杂方面。咳嗽在支气管扩张症中非常重要，因为它是最常见的症状之一，会影响患者的生活质量，并且与咳嗽高敏性和气道高反应性相结合，可能会限制吸入抗生素和/或吸入黏液溶解治疗等治疗方法的成功应用。有效的咳嗽（通常通过物理治疗辅助）是支气管扩张症支气管灌洗的基石。然而，有些患者仍有持续的无痰咳嗽症状，提示存在咳嗽敏化综合征。鼻后滴注和胃食管反流可能使支气管扩张症复杂化，并进一步导致难治性咳嗽综合征。在个体中可能存在多种相互作用的咳嗽综合征，需要进行仔细评估和多学科合作，以优化症状控制。本文还强调了支气管扩张症慢性咳嗽中许多未知的问题。
