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[慢性咳嗽]

[Chronic cough].

作者信息

Kardos Peter

出版信息

Pneumologie. 2023 Aug;77(8):574-585. doi: 10.1055/a-1849-4345. Epub 2023 Aug 24.

Abstract

Chronic cough (i.e., cough lasting >8 weeks) has a global prevalence of approximately 10%. The individual burden can be long-lasting, with some patients experiencing cough for many years. Although chronic cough is often a symptom of respiratory diseases (e.g., lung cancer, tuberculosis, chronic obstructive pulmonary disease) or associated with triggers (e.g., asthma, gastroesophageal reflux disease, rhinosinusitis) and may resolve after targeted treatment of these conditions, some patients continue to cough despite optimal treatment (refractory chronic cough, RCC) or have no identifiable conditions presumed to be contributing to the cough (unexplained chronic cough, UCC). In patients with chronic cough, it is critical to perform a thorough initial patient assessment with adherence to a diagnostic algorithm (e.g., of the German Respiratory Society Cough Guidelines) to identify the cause of the symptom cough and provide appropriate treatment; or diagnose RCC and UCC. Primary care physicians should provide the initial diagnostic workup of patients with chronic cough (history, physical exam, chest X-ray and spirometry). If no cause of the cough can be identified, referral to specialists (e.g., pulmonologists, gastroenterologists, otolaryngologists) may be appropriate. Increased appreciation of chronic cough as a distinct condition, rather than as only a symptom of other diseases, may help overcome current challenges in diagnosing and managing chronic cough.

摘要

慢性咳嗽(即咳嗽持续超过8周)在全球的患病率约为10%。个体负担可能持续很长时间,一些患者会咳嗽多年。虽然慢性咳嗽通常是呼吸系统疾病(如肺癌、肺结核、慢性阻塞性肺疾病)的症状,或与触发因素(如哮喘、胃食管反流病、鼻-鼻窦炎)相关,且在针对这些疾病进行治疗后可能缓解,但一些患者尽管接受了最佳治疗仍持续咳嗽(难治性慢性咳嗽,RCC),或没有可认定的导致咳嗽的疾病(不明原因慢性咳嗽,UCC)。对于慢性咳嗽患者,严格按照诊断流程(如德国呼吸学会咳嗽指南)进行全面的初始患者评估,以确定咳嗽症状的病因并提供适当治疗,或诊断RCC和UCC至关重要。初级保健医生应提供慢性咳嗽患者的初始诊断检查(病史、体格检查、胸部X线和肺功能测定)。如果无法确定咳嗽病因,转诊至专科医生(如肺科医生、胃肠病学家、耳鼻喉科医生)可能是合适的。提高对慢性咳嗽作为一种独立疾病的认识,而不仅仅将其视为其他疾病的症状,可能有助于克服目前在慢性咳嗽诊断和管理方面的挑战。

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