Weinberger Miles, Hurvitz Manju
Rady Children's Hospital, University of California San Diego, San Diego, CA, USA.
F1000Res. 2020 Jul 22;9. doi: 10.12688/f1000research.25468.1. eCollection 2020.
Cough is a natural process that protects the airway. Cough can occur spontaneously or voluntarily. It is considered chronic when it is present for longer than 4 weeks in children or 8 weeks in adults. In both, chronic cough causes patient distress and increased healthcare utilization. Etiologies of pediatric chronic cough include asthma, protracted bacterial bronchitis, tracheomalacia, habit cough, and various systemic disorders. While some diagnoses are identifiable by careful history alone, others require testing guided by specific pointers. Flexible fiberoptic bronchoscopy has been an important tool to identify etiologies of chronic cough that were not otherwise apparent. In adults, asthma and bronchitis are well-defined etiologies of chronic cough, but much chronic cough in adults is largely a conundrum. Reviews of adult chronic cough report that at least 40% of adults with chronic cough have no medical explanation. Gastroesophageal reflux and upper airway cough syndrome (a.k.a. post-nasal drip) have been common diagnoses of chronic cough, but those diagnoses have no support from controlled clinical trials and have been subjected to multiple published critiques. Cough hypersensitivity is considered to be an explanation for chronic cough in adults who have no other confirmed diagnosis. Gabapentin, a neuromodulator, has been associated with a modest effect in adults, as has speech pathology. While habit cough has not generally been a diagnosis in adults, there is evidence for a behavioral component in adults with chronic cough. Treatment for a specific diagnosis provides a better outcome than trials of cough suppression in the absence of a specific diagnosis. More data are needed for chronic cough in adults to examine the hypothesized cough hypersensitivity and behavioral management. This article reviews etiologies and the treatment of chronic cough in children and the conundrum of diagnosing and treating chronic cough in adults.
咳嗽是一种保护气道的自然过程。咳嗽可自发或自主发生。在儿童中咳嗽持续超过4周或在成人中持续超过8周时，被认为是慢性咳嗽。在这两种情况下，慢性咳嗽都会导致患者不适并增加医疗资源的使用。小儿慢性咳嗽的病因包括哮喘、迁延性细菌性支气管炎、气管软化、习惯性咳嗽和各种全身性疾病。虽然有些诊断仅通过仔细询问病史即可确定，但其他诊断则需要根据特定线索进行检查。可弯曲纤维支气管镜检查一直是识别那些原本不明显的慢性咳嗽病因的重要工具。在成人中，哮喘和支气管炎是明确的慢性咳嗽病因，但成人的许多慢性咳嗽在很大程度上仍是一个难题。对成人慢性咳嗽的综述报告称，至少40%的慢性咳嗽成人患者没有医学上的解释。胃食管反流和上气道咳嗽综合征（又称鼻后滴漏）一直是慢性咳嗽的常见诊断，但这些诊断缺乏对照临床试验的支持，并受到了多篇已发表评论的批评。咳嗽高敏反应被认为是无其他确诊诊断的成人慢性咳嗽的一种解释。加巴喷丁，一种神经调节剂，在成人中显示出一定效果，言语病理学也是如此。虽然习惯性咳嗽在成人中通常不是一种诊断，但有证据表明成人慢性咳嗽存在行为因素。针对特定诊断进行治疗比在没有特定诊断的情况下进行止咳试验能取得更好的效果。对于成人慢性咳嗽，需要更多数据来研究假设的咳嗽高敏反应和行为管理。本文综述了儿童慢性咳嗽的病因和治疗以及成人慢性咳嗽诊断和治疗的难题。
