ObjectiveTo evaluates the values of fractional exhaled nitric oxide (FENO) in the treatment of chronic cough prospectively.MethodsSubjects with chronic cough were recruited from the outpatient clinic of China-Japan Friendship Hospital. All the patients accepted FENO tests, sputum cell counts, pulmonary function tests, bronchial provocation tests, serum IgE, cough symptom scores and Leicester Cough Questionnaire before and after treatment of 4 weeks.ResultsThere were 29 patients with cough variant asthma (CVA), 19 patients with eosinophilic bronchitis (EB) and 39 patients with other causes. The baseline FENO level of the subjects whose coughs were relieved after inhaled corticosteroids (ICS) therapy of 4 weeks was (63±42) ppb, significantly higher than those with bad-response [(28±13) ppb, P<0.01]. The proportion of FENO decrease after ICS therapy was not only significantly related to the proportion of eosinophilic decrease (r=0.54, P<0.01), but also significantly related to the proportion of decrease of cough symptom scores (r=0.48, P<0.01). To distinguish the good responders from bad responders, the optimal baseline FENO cutoff value was 36 ppb, with sensitivity of 82%, specificity of 93%, positive predictive value of 94%, negative predictive value of 87%, accuracy of 83%.ConclusionsThere is a good relationship between the FENO decreasing levels after ICS therapy and the reliefs of cough symptoms in the CVA and EB patients. Chronic cough patients with FENO value more than 36 ppb are indicated to respond to ICS therapy.
Objective To investigate the etiological diagnosis of chronic cough with pharyngitis-like manifestations. Methods Patients with chronic cough and pharyngitis-like manifestations were recruited from Outpatient Department of Guangzhou Institute of Respiratory Diseases between December 2002 to March 2010. The causes of chronic cough were investigated using a well-established diagnostic protocol, including history taking and physical examination, pulmonary function tests, induced sputum cytology, 24-h esophageal pH monitoring, etc. The final diagnosis depended on clinical manifestations, examination findings, and a successful response to therapy. Results 326 patients with chronic cough and pharyngitislike manifestations were included in the study with amedian duration of 24 ( 2 ～480) months, amean age of 41 ±13 years. The causes of chronic cough were identified as follows: post nasal drip syndrome or upper airway cough syndrome in 73 cases ( 23. 31% ) , cough variant asthma in 61 cases( 18. 71% ) , eosinophilic bronchitis in 70 cases( 22. 47% ) , gastroesophageal reflux-induced cough in 54 cases ( 16. 56% ) , atopiccough in 48 cases ( 14. 72% ) , and others in 40 cases ( 12. 27% ) . There is no significant difference in percentage of common causes of chronic cough ( P gt; 0. 05) . Conclusion The proportions of upper airway syndrome and other common causes are similar in chronic cough with pharyngitis-like manifestatioins, whichsuggest pharyngitis-like manifestations are not specific for diagnosis of upper airway cough syndrome.
ObjectiveTo systematically review the efficacy and safety of Yangyinqingfei decoction for chronic cough and chronic obstructive pulmonary disease (COPD) patients.MethodsWe electronically searched databases including PubMed, Web of Science, CBM, CNKI, VIP and WanFang Data for randomized controlled trials (RCTs) of Yangyinqingfei decoction for chronic cough and COPD patients from inception to August 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, RevMan 5.3 software was used for meta-analysis.ResultsTwenty-four RCTs involving 2 268 patients with COPD and chronic cough were included. The results of meta-analysis showed that compared with the control group, Yangyinqingfei decoction combined with the conventional medicine could significantly improve clinical effective rate (RR=1.21, 95%CI 1.16 to 1.27, P<0.000 01) and lung function (SMD=0.76, 95%CI 0.59 to 0.94, P<0.000 01) in patients with COPD. Yangyinqingfei decoction combined with the conventional medicine group was superior to the control group (RR=1.41, 95%CI 1.22 to 1.64, P<0.000 01) in clinical efficacy for adults patients with chronic cough. In terms of safety, seven cases occurred adverse reactions in the Yangyinqingfei decoction group, while 13 were found in the control group, the types and degree of adverse reactions in both groups were almost the same.ConclusionThe combination of Yangyinqingfei plus conventional medicine may significantly improve the clinical efficacy for chronic cough and COPD with reliable safety. However, due to the limited quality and quantity of included studies, the above conclusions are needed to verify by more high quality studies.
Detection of the fraction of exhaled nitric oxide (FeNO) is a safe, simple and easy method to assess airway inflammation noninvasively. Thus, FeNO detection has been paid more attention to diagnosis and guide treatment of pulmonary diseases. The common feature of pneumonia, asthma, chronic obstructive pulmonary disease and chronic cough is the existence of varying degrees of airway inflammation. In this review, FeNO production and its potential pathologic and physiologic role in various pulmonary diseases were discussed.
ObjectiveTo investigate the diagnostic value of bronchial provocation test in patients with chronic cough.
MethodsA total of 550 chronic cough patients were selected in the 452nd Military Hospital from March 2011 to February 2012. These patients all underwent the basic lung function test and the bronchial provocation test (BPT) to acetylcholine so as to assess the bronchial hyper-reactivity by inhaling methacholine. The diagnostic value of BPT was then evaluated.
ResultsAll included patients had normal lung function. There were 267 patients (48.5%) who showed positive results in BPT, of whom, 236 BPT-positive patients were finally diagnosed as cough variant asthma. After regular treatment, the cough symptoms were well controlled.
ConclusionCough variant asthma is one of the main causes of chronic cough. The BPT is an important method of aiding the diagnosis of cough variant asthma which helps early diagnosis of it.
Objective To explore the association between cough patterns and cerebrovascular disease risk, and to provide epidemiological evidence for the early diagnosis and prevention of cerebrovascular disease. Methods During the period from 2010 to 2012 in Guizhou Province, a multi-stage proportional stratified cluster sampling method was used to recruit people with the inclusion criteria of the study into a cohort and a baseline questionnaire for demographic information, lifestyle, and disease history was administered. The incidence of cerebrovascular disease was followed up from 2016 to 2020. Results A total of 4804 subjects were followed up, and 4589 (53.5% were female) subjects were enrolled in final investigation. Compared with non-chronic cough group, there was no statistical significance in the risk of cerebrovascular diseases (P>0.05), however, chronic cough (the risk ratio was 2.00 and the 95% confidence interval ranged from 1.08 to 3.69) was twice as likely to develop cerebrovascular disease as non-cough. Conclusions People with chronic cough are more likely to develop cerebrovascular disease than people without cough. More attention to the management and control of cough should be paid to avoid chronic cough, so as to reduce the risk of cerebrovascular diseases.
Objective To investigate the clinical characteristics of upper airway cough syndrome ( UACS) and the relationship of UACS with upper airway diseases, cough variant asthma ( CVA) , and gastroesophageal reflux disease ( GERD) . Methods 92 subjects with chronic cough and throat symptoms and signs were included in the study. The medical records were collected fromall subjects, and 49 subjects suspected for CVA undertook bronchial provocation test. Then the efficacy was evaluated and etiology were analyzed based on the efficacy of targeted treatment. Results Bronchial provocation test yielded positive results in 14 subjects suspected of CVA, accounting for 15. 2% of all cases ( 14/92) . 18. 5% ( 17 /92) of patients had a history of chronic gastritis or combined symptoms of GERD, of whom anti-gastroesophagealreflux treatment was effective. The patients with rhinitis, sinusitis history and/ or symptoms accounted for 33. 7% of cases ( 31 cases) . 51. 1% ( 47/92) of patients had only signs and symptoms of chronic pharyngitis. Conclusions UACS is not only due to the rhinitis and/ or sinusitis but also chronic pharyngitis. Chronic pharyngitis may be secondary to chronic rhinitis/ sinusitis with post nasal drip and gastroesophageal reflux, also may be an independent cause of chronic cough.
Objective Using a simple management strategy to investigate the etiologic spectrum of chronic cough in Chengdu city and its suburbs. Methods Chronic cough patients were randomly recruited fromthe outpatient clinic of Sichuan Provincial People ’s Hospital between July 2011 to May 2012. A conception of “Chronic Airway Inflammatory Cough Syndrome, CAICS”was established including several common causes of cough such as cough variant asthma ( CVA) , eosinophilic bronchitis ( EB) , atopic cough ( AC) , and atypical chronic bronchitis. Based on CAICS, a simplified suspected diagnosis procedure of chronic cough was conducted. Patients were empirically treated. Etiology and efficiency of chronic cough was analyzed. Results A total of 148 patients of chronic cough were recruited. The mean age was ( 43. 0 ±13. 0) years old. There were 72 male and 76 female patients with mean ages of ( 39. 7 ±10. 7) and ( 45. 0 ± 14. 2) years old respectively. The males were younger than the females ( P lt; 0. 05) . There was 96. 6% ( 143/148) of patients suspectedly diagnosed and 3.4% ( 5/148) patients were undiagnosed. The suspected causes of these chronic cough patients were as follows, ie. CAICS ( 57. 5% ) , upper airway cough syndrome ( UACS, 21. 5%) , gastroesophageal reflux cough ( GERC, 9. 1% ) , and others ( 8. 4% ) . A single possible cause was found in 95 patients ( 64.1% ) , two possible causes in 41 patients ( 27. 7% ) , and three possible causes in 3 patients( 2. 0% ) . 12.2% of chronic cough patients were combined with allergic rhinitis ( AR) . Among the diseases, CVA, CAICS and UACS were disposed to coexist with AR. The overall efficiency of empiric management strategy of chronic cough was 83. 7% .Conclusions The etiological spectrum of chronic cough in Chengdu acquired by this strategy was generally consistent with previous findings in China.The three most important causes of chronic cough in Chengdu were CAICS, UACS and GERC. This strategy was simple, effective, economic and feasible. It could be a primary management for chronic cough in some hospital.
