Objective To investigate the causes of chronic cough in Chongqing City and assess the efficacy of specific therapy. Methods A total of 233 consecutively non-selected referred patients ( 136 females) whose cough duration more than eight weeks were studied. Their age[ median ( range) ] was 44. 5( 15-78) yrs and cough duration was 2. 6 ( 0. 2-30) yrs. They were diagnosed using a diagnostic protocol based on the Guideline on Diagnosis and Treatment of Chronic Cough established by China Medical Association and American College of Chest Physicians. The etiological diagnosis was made according to clinical manifestations, lab examinations, and response to specific therapy. The effects was assessed four weeks after the drug withdraw. Results The cause of chronic cough was confirmed in 216 patients ( 92. 7% ) . Seventeen patients( 7. 3% ) had not been definitely diagnosed. Cough due to a single cause was found in 163 patients ( 75. 45% ) , and due to multiple causes in 53 patients ( 24. 53% ) . The causes included upper airway cough syndrome ( UACS) in 127 patients( 44. 4% ) , cough variant asthma ( CVA) in 73 patients( 25. 5% ) , gastro-esophageal reflux cough ( GERC) in 26 patients( 9. 1%) , postinfectious cough and angiotensin converting enzyme ( ACE) inhibitor-induced cough in 6 patients( 2. 1% ) , atopic cough in 5 patients( 1. 7% ) , chronic bronchitis in 3 patients ( 1. 0% ) , respectively. After specific therapy based on diagnosis, cough cured in 59 patients ( 25. 3% ) , and alleviated in 114 patients ( 49. 3% ) , no response in 40 patients( 17. 1% ) . Conclusion The causes of chronic cough in different areas maybe variant. UACS, CVA and GREC are the main causes of chronic cough in Chongqing City. Specific therapy is effective in majority of patients with chronic cough.
Objective To explore the effect of lower airway inflammation on the pathogenesis of upper airway cough syndrome( UACS) . Methods Ten cases of UACS and 10 cases of chronic rhinitis or sinusitis without cough were enrolled as group A and group B, respectively. And 10 healthy volunteers were included as controls( group C) . The cough threshold C2 and C5 to inhaled capsaicin, defined as the lowest concentration of capsaicin required to induce ≥2 and ≥5 coughs, was measured. The total and differential cell counts was determined in induced sputum, and the levels of histamine and prostaglandin E2 were analyzed in supernatant of sputum. Results Cough threshold was significantly lower in group A than group B [ C2: ( 0.65 ±0. 08) μmol / L vs ( 3.90 ±1. 37) μmol / L; C5: ( 1.59 ±0. 28) μmol / L vs ( 33.46 ±23. 71) μmol / L, P lt;0. 05] and comparable between group B and group C( P gt; 0. 05) . Group A, similar to group B( P gt; 0. 05 ) , contained more inflammatory cells, with decreased percentage of macrophages and increased percentage of neutrophils in induced sputum than group C( P lt; 0. 05) . Furthermore, the levels of histamine[ ( 9. 55 ±1. 89) ng/mL vs ( 2. 37 ±0. 25) ng/mL, P lt; 0. 05] and prostaglandin E2 [ ( 361. 71 ±39. 38) pg/mL vs ( 144. 34 ±15. 69) pg/mL, P lt; 0. 05] were higher in supernatant of induced sputum from group A than group B, while the latter was not different from group C( P gt; 0. 05) . Conclusion Increased cough sensitivity caused by airway inflammation may be important for the pathogenesis of UACS, and the activation of mast cells in mucosa of lower airway might be an important factor.
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.
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.
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.
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 analyze risk factors for chronic cough after minimally invasive resection of non-small cell lung cancer (NSCLC) and explore the possible prevention measures.MethodsA total of 128 NSCLC patients who received minimally invasive resection in 2018 in our hospital were enrolled, including 63 males and 65 females with an average age of 60.82±9.89 years. The patients were allocated into two groups: a robot-assisted thoracic surgery (RATS) group (56 patients) and a video-assisted thoracic surgery (VATS) group (72 patients). Chronic cough was assessed by visual analogue scale (VAS), meanwhile, other perioperative indicators were compared between the two groups. Univariate and multivariate logistic regression analyses were performed to identify risk factors for postoperative chronic cough and explore the prevention strategies.ResultsOverall, 61 (47.7%) patients were diagnosed with chronic cough after surgery, including 25 (44.6%) patients in the RATS group and 36 (50.0%) patients in the VATS group, and the difference was not statistically significant (P>0.05). Compared with the VATS group, the RATS group got shorter endotracheal intubation time (P=0.009) and less blood loss (P<0.001). The univariate analysis showed that age (P=0.014), range of surgery (P=0.021), number of dissected lymph nodes (P=0.015), preoperative cough (P=0.006), endotracheal intubation time (P=0.004) were the influencing factors for postoperative chronic cough. The multivariate analysis showed that age <57 years (OR=3.006, 95%CI 1.294-6.986, P=0.011), preoperative cough (OR=3.944, 95%CI 4.548-10.048, P=0.004), endotracheal intubation time ≥172 min (OR=2.316, 95%CI 1.027-5.219, P=0.043), lobectomy (OR=2.651, 95%CI 1.052-6.681, P=0.039) were the independent risk factors for chronic cough.ConclusionThere is no statistical difference in postoperative chronic cough between the RATS and VATS groups. The RATS group gets less blood loss and shorter endotracheal intubation time. Patients with younger age (<57 years), preoperative cough, lobectomy, and longer duration of endotracheal intubation (≥172 min) are more likely to have chronic cough after surgery.
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.
