Some clincical issues oncough variant asthma_Chinese Journal of Respiratory and Critical Care Medicine

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LIU Chuntao

West china hospital sichuan university;

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咳嗽變異型哮喘

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咳嗽是呼吸專科門診最常見的癥狀之一，其中大部分又是所謂不明原因的慢性咳嗽(unexplained chronic cough)，即常規影像學檢查未發現明確病變者。在此類慢性咳嗽當中，咳嗽變異型哮喘(CVA)是一重要病因，早年Irwin報道，慢性咳嗽的病因包括哮喘和氣道高反應(33％)、鼻后滴漏 (28％)、慢性支氣管炎(12％)、癥狀性胃食管反流(10％)、病毒感染后咳嗽(25％)，其他因素包括血管緊張素轉換酶抑制劑(ACEI)性咳嗽、精神性咳嗽(10％)以及多因素所致的咳嗽(約占20％) J。在我國尚缺乏CVA發病率的大樣本流行病學資料，最近上海同濟醫院進行了一項調查，在呼吸專科門診287例由于慢性咳嗽就診的患者當中，無論是老年人還是中青年患者，CVA均是主要的病因(老年人 34．6％，中青年41．5％)，其次為上氣道咳嗽綜合征(UACS， 19．3％和23．5％)、ACEI相關性咳嗽(16．3％和1．7％)、胃食管反流性疾病(GERD，10．6％和3．7％) 。由于呼吸科醫生以至普通內科醫生逐漸熟悉了解這一疾病，在門診病人當中CVA的比重越來越大，粗略估計CVA大約占不明原因慢性咳嗽病例1／3左右，占哮喘病例1／3左右。另一方面，盡管許多臨床醫生知曉CVA，但涉及其診治仍存在不少的問題。

Citation： LIU Chuntao. Some clincical issues oncough variant asthma. Chinese Journal of Respiratory and Critical Care Medicine, 2008, 08(6): 407-409. doi: Copy

1.	Irwin RS，Corran WM ，Pratter MR．Chronic persistent cough in the dult：the spectrum and frequency of causes and successful outcome of specific therapy．Am Rev Respir Dis，1981，123(4 Pt 1)：413-417.
2.	1 Takemura M，Niimi A，Matsumoto H．Atopic features of cough variant asthma and classic asthma with wheezing．Clin Exp Allergy ，2007， 37：1833-1839.
3.	8 Spector SL．Tan RA．Effectiveness of montelukast in the treatment of cough variant asthma．Ann Allergy Asthma Immunol，2004，93：232- 236.
4.	Wei W ，Yu L，La H．Comparison of Cause Distribution between Eld— erly and Non—Eldedy Patients with Chronic cough．Respiration．2008 Jul 3．[Epub ahead of print].
5.	Global Strategy for asthma management and prevention[DB／OL]. Hamilton：GIAN Executive Committee，2006[2007-7—11]．http：／／ www．ginasthma．corn.
6.	De Diego A，Martinez E，Perpifid M，et al．Airway inflammation and cough sensitivity in cough—variant asthma．Allergy ，2005，60：1407- l411.
7.	Yon Y，Koh YY，Kang H，et al．Sputum eosinophil counts and eosino phil cationic protein levels in cough—variant asthma and in classic asthma，and their relationships to airw ay hypersensitivity or maximal airway response to methacholine．Allergy ，2004，59：1055—1062.
8.	Abouzgheib W ，Pratter MR，Bartter T．cough and asthma．Curr Opin Pulm Med，2007，13：4448.
9.	Matsumoto H，Niimi A，Takemura M ，et al．Prognosis of cough variant asthma：a retrospective analysis．J Asthma，2006，43：131-135.
10.	Nakajima T．Nishimura Y．Nishiuma Characteristics of patients with chronic cough who developed classic asthma during the course of cough variant asthma：a longitudinal study．Respiration，2005，72： 606-611. 9 Fujimura M，Nishizawa Y，Nishitsuji M．Predictors for typical asthma onset from cough variant asthma．J Asthma，2005，42：107-111.
11.	Koh YY，Park Y，Kim CK，et al．The impo~ance of maximal airw ay response to methacholine in the prediction of wheezing development in patients with cough-variant asthma．Allergy，2002，57：1 165-1 170.
12.	Koing P．Hidden asthma in childhood．Am J Dis Child，1981，135： 1053．1055.
13.	中華醫學會呼吸病分會哮喘學組．支氣管哮喘防治指南(支氣管哮喘的定義、診斷、治療和管理方案)．中華結核和呼吸雜志， 2008，31：177-185.
14.	Sato S，Saito J，Sato Y，et al．Ishii TClinical usefulness of fractional exhaled nitric oxide for diagnosing prolonged cough．Respir Med， 2008，102：1452 1459.
15.	Fujimura M，Ohkura N，Abo M，et al．Exhaled nitric oxide levels in patients with atopic cough and cough variant asthma．Respirology， 2008，13：359—364.
16.	Antoniu SA ，Mihaescu T，Donner CF．Pharmacotherapy of eough-variant asthma．Expe~Opin Pharmaeother，2007，8：3021-3028.
17.	Nobata K，Fujimura M，Tsuji H，et al．Longitudinal changes of pulmonary function and bronchial responsiveness in cough-variant asthma treated with bronchodilators alone．Allergy Asthma Proc，2006， 27：479-485.
18.	Tinkelman DG，Bronsky EA，Gross G，et al．Eficacy an d safety of budesonide inhalation powder(Pulmieort Turbuhaler) during 52 weeks of treatment in adults and children with persistent asthma．J Asthma，2003，40：225-236.
19.	Matsumoto H ，Niimi A，Takemura M ，et al．Prognosis of cough variant asthma：a retrospective analysis．J Asthma，2006，43：131-135.
20.	Fujimura M，Hara J，Myou S，et al．Change in bronchial responsiveness and cough refex sensitivity in patients with cough variant asthma： effect of inhaled cortieosteroids．cough，2005 1：5．.

1. Irwin RS，Corran WM ，Pratter MR．Chronic persistent cough in the dult：the spectrum and frequency of causes and successful outcome of specific therapy．Am Rev Respir Dis，1981，123(4 Pt 1)：413-417.
2. 1 Takemura M，Niimi A，Matsumoto H．Atopic features of cough variant asthma and classic asthma with wheezing．Clin Exp Allergy ，2007， 37：1833-1839.
3. 8 Spector SL．Tan RA．Effectiveness of montelukast in the treatment of cough variant asthma．Ann Allergy Asthma Immunol，2004，93：232- 236.
4. Wei W ，Yu L，La H．Comparison of Cause Distribution between Eld— erly and Non—Eldedy Patients with Chronic cough．Respiration．2008 Jul 3．[Epub ahead of print].
5. Global Strategy for asthma management and prevention[DB／OL]. Hamilton：GIAN Executive Committee，2006[2007-7—11]．http：／／ www．ginasthma．corn.
6. De Diego A，Martinez E，Perpifid M，et al．Airway inflammation and cough sensitivity in cough—variant asthma．Allergy ，2005，60：1407- l411.
7. Yon Y，Koh YY，Kang H，et al．Sputum eosinophil counts and eosino phil cationic protein levels in cough—variant asthma and in classic asthma，and their relationships to airw ay hypersensitivity or maximal airway response to methacholine．Allergy ，2004，59：1055—1062.
8. Abouzgheib W ，Pratter MR，Bartter T．cough and asthma．Curr Opin Pulm Med，2007，13：4448.
9. Matsumoto H，Niimi A，Takemura M ，et al．Prognosis of cough variant asthma：a retrospective analysis．J Asthma，2006，43：131-135.
10. Nakajima T．Nishimura Y．Nishiuma Characteristics of patients with chronic cough who developed classic asthma during the course of cough variant asthma：a longitudinal study．Respiration，2005，72： 606-611. 9 Fujimura M，Nishizawa Y，Nishitsuji M．Predictors for typical asthma onset from cough variant asthma．J Asthma，2005，42：107-111.
11. Koh YY，Park Y，Kim CK，et al．The impo~ance of maximal airw ay response to methacholine in the prediction of wheezing development in patients with cough-variant asthma．Allergy，2002，57：1 165-1 170.
12. Koing P．Hidden asthma in childhood．Am J Dis Child，1981，135： 1053．1055.
13. 中華醫學會呼吸病分會哮喘學組．支氣管哮喘防治指南(支氣管哮喘的定義、診斷、治療和管理方案)．中華結核和呼吸雜志， 2008，31：177-185.
14. Sato S，Saito J，Sato Y，et al．Ishii TClinical usefulness of fractional exhaled nitric oxide for diagnosing prolonged cough．Respir Med， 2008，102：1452 1459.
15. Fujimura M，Ohkura N，Abo M，et al．Exhaled nitric oxide levels in patients with atopic cough and cough variant asthma．Respirology， 2008，13：359—364.
16. Antoniu SA ，Mihaescu T，Donner CF．Pharmacotherapy of eough-variant asthma．Expe~Opin Pharmaeother，2007，8：3021-3028.
17. Nobata K，Fujimura M，Tsuji H，et al．Longitudinal changes of pulmonary function and bronchial responsiveness in cough-variant asthma treated with bronchodilators alone．Allergy Asthma Proc，2006， 27：479-485.
18. Tinkelman DG，Bronsky EA，Gross G，et al．Eficacy an d safety of budesonide inhalation powder(Pulmieort Turbuhaler) during 52 weeks of treatment in adults and children with persistent asthma．J Asthma，2003，40：225-236.
19. Matsumoto H ，Niimi A，Takemura M ，et al．Prognosis of cough variant asthma：a retrospective analysis．J Asthma，2006，43：131-135.
20. Fujimura M，Hara J，Myou S，et al．Change in bronchial responsiveness and cough refex sensitivity in patients with cough variant asthma： effect of inhaled cortieosteroids．cough，2005 1：5．.

Chinese Journal of Respiratory and Critical Care Medicine

Some clincical issues oncough variant asthma

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