Mikami Masaaki, Tomita Katsuyuki, Yamasaki Akira
Hosshoji Internal Clinic, Nanbu 683-0351, Japan.
Department of Respirology Medicine, National Hospital Organization Yonago Medical Center, Yonago 683-8518, Japan.
Yonago Acta Med. 2021 Nov 29;64(4):353-359. doi: 10.33160/yam.2021.11.005. eCollection 2021 Nov.
Many patients visit primary care clinics with a complaint of cough. General practitioners (GPs) developed a list of the causative diseases of cough that can produce a patient's symptoms and signs. Then, the patients' medical histories were evaluated to determine whether the diagnosis of cough variant asthma (CVA) or post-infectious cough (PIC) could have been predicted.
We retrospectively investigated 195 outpatients with a complaint of cough. Medical histories of "recurrent episodes of prolonged cough" and "upper respiratory infection" were obtained during the initial visit. The accuracy of medical histories in predicting CVA and PIC was calculated on the area under the curve (AUC).
Among eligible patients with cough, PIC was diagnosed in 99 patients (50.8%), CVA in 40 patients (20.5%), upper airway cough syndrome in 28 patients (14.4%), and chronic obstructive pulmonary disease in 11 patients (5.6%). Among the patients with CVA and those with PIC, 93% and 12%, respectively, had a history of recurrent episodes of prolonged cough. For the diagnosis of CVA, having a history of recurrent episodes of prolonged cough showed a moderately accurate AUC (0.76, 95% CI: 0.71-0.82). On the other hand, for the diagnosis of PIC, having no history of recurrent episodes of prolonged cough also showed a moderately accurate AUC (0.87, 95% CI: 0.82-0.92).
The medical history of recurrent episodes of prolonged cough is useful for the prediction of CVA as well as PIC.
许多患者因咳嗽症状前往基层医疗诊所就诊。全科医生（GPs）列出了一系列可能导致患者出现咳嗽症状和体征的病因。然后，对患者的病史进行评估，以确定是否可以预测咳嗽变异性哮喘（CVA）或感染后咳嗽（PIC）的诊断。
我们回顾性调查了195例咳嗽患者。在初次就诊时获取了“反复长时间咳嗽发作”和“上呼吸道感染”的病史。通过曲线下面积（AUC）计算病史对CVA和PIC预测的准确性。
在符合条件的咳嗽患者中，99例（50.8%）被诊断为PIC，40例（20.5%）被诊断为CVA，28例（14.4%）被诊断为上气道咳嗽综合征，11例（5.6%）被诊断为慢性阻塞性肺疾病。在CVA患者和PIC患者中，分别有93%和12%有反复长时间咳嗽发作的病史。对于CVA的诊断，有反复长时间咳嗽发作的病史显示出中等准确性的AUC（0.76，95%CI：0.71 - 0.82）。另一方面，对于PIC的诊断，没有反复长时间咳嗽发作的病史也显示出中等准确性的AUC（0.87，95%CI：0.82 - 0.92）。
反复长时间咳嗽发作的病史对CVA和PIC的预测都有用。
