Mello C J, Irwin R S, Curley F J
Division of Pulmonary, Allergy, and Critical Care Medicine, University of Massachusetts Medical School, Worcester, USA.
Arch Intern Med. 1996 May 13;156(9):997-1003.
It is not clear whether careful history taking with detailed questioning of the characteristics of cough is diagnostically useful.
To determine if the character, timing, or complications of chronic cough were helpful in determining its cause.
A prospective, descriptive study of consecutive, unselected, immunocompetent patients referred to our university outpatient clinic because of chronic cough. All patients were evaluated by a previously published and validated systematic diagnostic protocol, a self-administered questionnaire, and by observing the character of involuntary and voluntary coughs. The final diagnosis of the cause of cough required fulfillment of pretreatment criteria plus having cough disappear or substantially improve as a complaint with specific therapy.
Eighty-eight patients met inclusion criteria and were fully evaluated. The mean +/- SD age was 53.1 +/- 16 years (range, 15-83 years) and 24 were males and 64 were females with a mean +/- SD history of cough for 6.6 +/- 9.8 years (range, 1 month-44 years). The cause of chronic cough was established in 86 (98%) of 88 patients. Eighty-one (92%) of 88 had cough disappear as a complaint. Cough was as a result of a single cause in 39% and multiple causes in 59%. Gastroesophageal reflux disease, postnasal drip syndrome, and asthma were the 3 most common causes of chronic cough and accounted for 90% of diagnoses. Gastroesophageal reflux disease, postnasal drip syndrome, and asthma were again found to be the 3 most common causes of chronic cough irrespective of patient estimated quantity of daily sputum production. These 3 conditions caused chronic cough in 99.4% of patients with the following characteristics: (1) nonsmoker; (2) not receiving an angiotensin-converting enzyme inhibitor drug; and (3) normal or nearly normal and stable chest radiograph. With respect to the spectrum and frequency of diagnoses and their interrelationships with the character, timing, and complications of cough, multiple stepwise linear regression analysis showed that none of the variability of the character, timing, or complications of cough could be explained by any specific diagnosis.
A carefully taken history with detailed questioning of the character, timing, and complications of chronic cough is not likely to be useful in diagnosing the cause of cough. The cause can be determined and successfully treated with specific therapy in the greatest majority of cases. Chronic cough is often caused by multiple, simultaneously contributing causes. Postnasal drip syndrome, asthma, and gastroesophageal reflux disease remain the 3 most common causes of chronic cough and there is a clinical profile that nearly always predicts their presence in immunocompetent patients.
详细询问咳嗽特征的仔细病史采集在诊断上是否有用尚不清楚。
确定慢性咳嗽的特征、发作时间或并发症是否有助于确定其病因。
对因慢性咳嗽转诊至我校门诊的连续、未经选择、免疫功能正常的患者进行前瞻性描述性研究。所有患者均通过先前发表并经验证的系统诊断方案、自行填写的问卷以及观察非自愿性和自愿性咳嗽的特征进行评估。咳嗽病因的最终诊断需要满足治疗前标准，且咳嗽作为一种症状在接受特定治疗后消失或显著改善。
88例患者符合纳入标准并得到全面评估。平均年龄±标准差为53.1±16岁（范围15 - 83岁），男性24例，女性64例，平均咳嗽病史±标准差为6.6±9.8年（范围1个月 - 44年）。88例患者中有86例（98%）明确了慢性咳嗽的病因。88例中有81例（92%）咳嗽作为症状消失。咳嗽由单一病因引起的占39%，由多种病因引起的占59%。胃食管反流病、鼻后滴漏综合征和哮喘是慢性咳嗽最常见的3种病因，占诊断病例的90%。无论患者估计的每日痰量如何，胃食管反流病、鼻后滴漏综合征和哮喘再次被发现是慢性咳嗽最常见的3种病因。这3种情况在具有以下特征的99.4%的患者中导致慢性咳嗽：（1）非吸烟者；（2）未服用血管紧张素转换酶抑制剂药物；（3）胸部X线片正常或接近正常且稳定。关于诊断的范围和频率及其与咳嗽特征、发作时间和并发症的相互关系，多元逐步线性回归分析表明，咳嗽特征、发作时间或并发症的变异性均无法由任何特定诊断来解释。
仔细采集病史并详细询问慢性咳嗽的特征、发作时间和并发症，在诊断咳嗽病因方面可能并无用处。在大多数情况下，病因可以通过特定治疗确定并成功治疗。慢性咳嗽常由多种同时起作用的病因引起。鼻后滴漏综合征、哮喘和胃食管反流病仍然是慢性咳嗽最常见的3种病因，并且存在一种临床特征几乎总能预测免疫功能正常患者中这些病因的存在。
