Loma Linda University School of Medicine, Loma Linda, California.
Loma Linda Voice and Swallowing Center, Loma Linda, California.
J Voice. 2021 Mar;35(2):324.e9-324.e13. doi: 10.1016/j.jvoice.2019.08.026. Epub 2019 Oct 1.
Previous investigations have reported that a chronic cough that is refractory to medical therapies improves with behavioral therapies. However, the treatment parameters that may account for improvement in cough symptoms have not yet been objectively documented. The purpose of this study was to document changes in chronic refractory cough using a breath training protocol.
The charts of 27 patients with a long-term chronic cough (>6 months) refractory to various medical treatments were reviewed. These patients received 2-4 sessions of breath training therapy over a 6-month period. Treatment sessions consisted of breathing modification exercises such as those reported in the literature. Aerodynamic parameters including mean estimated subglottal air pressure, mean airflow rate, laryngeal airway resistance, and maximum phonation time were obtained before treatment and 6 months after therapy. Patients also completed the Cough Severity Index at the first visit and 6 months after treatment.
Twenty four of the 27 patients (M:F = 6:21), with a mean age of 62.4 (range = 28-78, median = 66) had significant Cough Severity Index improvement from 16.74 to 10.04 (P< 0.001) after therapy. Maximum phonation time increased significantly from 12.00 to 16.38 seconds (P= 0.006); mean estimated subglottic air pressure decreased significantly from 7.58 to 6.36 cm HO (P= 0.004); laryngeal airway resistance decreased significantly from 52.97 to 40.64 ppm (P= 0.013).
This investigation provides evidence that patients who followed a protocol that focused on a breath training program reduced their chronic cough. Significant relationships between patient self-assessment of chronic cough and aerodynamic measures of subglottic pressure and glottal airway resistance were found in this group.
既往研究报告称，经行为疗法治疗后，对药物治疗无反应的慢性咳嗽可得到改善。然而，导致咳嗽症状改善的治疗参数尚未得到客观记录。本研究旨在通过呼吸训练方案记录慢性难治性咳嗽的变化。
回顾了 27 例长期慢性咳嗽（>6 个月）对各种药物治疗无反应的患者的病历。这些患者在 6 个月的时间内接受了 2-4 次呼吸训练治疗。治疗课程包括呼吸修正练习，如文献中报道的那些。在治疗前和治疗后 6 个月，获取平均估计声门下空气压力、平均气流率、声门气道阻力和最长发音时间等气动参数。患者还在首次就诊和治疗后 6 个月时完成了咳嗽严重程度指数。
27 例患者中有 24 例（男：女=6：21），平均年龄 62.4 岁（范围 28-78 岁，中位数 66 岁），治疗后咳嗽严重程度指数从 16.74 降至 10.04（P<0.001），差异有统计学意义。最长发音时间从 12.00 秒增加到 16.38 秒（P=0.006），差异有统计学意义；平均估计声门下空气压力从 7.58cmH₂O 降低到 6.36cmH₂O（P=0.004），差异有统计学意义；声门气道阻力从 52.97ppm 降低到 40.64ppm（P=0.013），差异有统计学意义。
本研究表明，遵循专注于呼吸训练方案的方案的患者可减轻其慢性咳嗽。在该组患者中发现了慢性咳嗽的患者自我评估与声门下压力和声门气道阻力的气动测量之间存在显著关系。
