胃食管反流(GER)是指胃酸和其他胃內容物反流進入食管，正常人存在一定程度的反流，稱為生理性反流。GER 可以引起臨床癥狀，甚至組織病理學的改變。當出現胃燒灼、反酸、胸骨后疼痛等臨床癥狀和(或)組織病理學的改變時，也被稱為胃食管反流病(GERD)。以慢性咳嗽為主要臨床表現的GERD稱為胃食管反流性咳嗽(GERC)。2006年蒙特利爾會議提出了反流性咳嗽綜合征的定義 。GERC 是慢性咳嗽的常見原因，發生率為5％~41％ ，存在一定的地區差異。歐美報道極為常見，而日本極為少見，國內 GERC占慢性咳嗽病因的12％。
Gibson等首先發現7例慢性咳嗽患者表現為慢性刺激性干咳或咳少許黏痰，誘導痰嗜酸粒細胞增高，糖皮質激素治療效果良好；但患者肺通氣功能正常，無氣道高反應性 (AHR)，峰流速(PEF)變異率正常，無法診斷為支氣管哮喘，因而稱之為嗜酸粒細胞性支氣管炎(EB)。研究結果發表于 1989年國際著名雜志柳葉刀(Lancet)。從Gibson等提出 EB的診斷以來，受到國內外廣大專家的重視，雖然目前對 EB是否是一種獨立的疾病或哮喘的早期階段尚存在一些爭議，但愈來愈多的證據表明EB是一種獨立的疾病 。下面從EB的定義、病因、病理免疫特征、臨床表現、治療反應及預后等方面對此問題進行討論，說明EB是一種獨立的疾病。
臨床上通常將以咳嗽為唯一癥狀或主要癥狀、時間超過 8周、胸部x檢查無明顯異常者稱為不明原因慢性咳嗽，簡稱慢性咳嗽 。慢性咳嗽是內科門診患者最常見的病癥，與典型支氣管哮喘、肺部感染、肺纖維化和支氣管肺癌等疾病不同，由于缺乏典型的相關癥狀，胸片檢查無異常，一些臨床醫生習慣性地給病人戴上“支氣管炎或慢性支氣管炎”(簡稱“慢支”)的帽子，給予止咳祛痰或反復使用多種抗生素治療，當然臨床療效并不理想。我們進行的流行病學調查結果顯示，72％的慢性咳嗽患者被診斷為“支氣管炎、慢支或慢性咽喉炎”，而病因診斷顯示其中慢性支氣管炎僅占4％(該資料尚未發表)。 慢性咳嗽的病因非常復雜，但并非毫無規律可循。只要掌握正確的診斷方法，按照慢性咳嗽病因診斷程序，大部分患者實際上可以獲得明確的病因診斷，根據病因進行特異性治療能夠取得良好的治療效果。在診斷慢性咳嗽時主要應注意以下幾個問題。
Objective Chronic cough is often present as increasing cough reaction to various physical and chemical stimulating factors. This study is aimed to investigate the difference of cough sensitivity and its mechanisms which are not clear among different causes of chronic cough. Methods Patients with chronic cough were recruited from cough clinic of Guangzhou Institute of Respiratory Diseases between 2005 to 2010. Using a modified diagnostic algorithm of chronic cough, common causes were identified. Capsaicin cough provocation test was also performed in these patients to assess the cough threshold. The relations between cough reflex sensitivity and duration of cough, cough severity, pulmonary function, induced sputum cell counts were then investigated. Results Through the diagnostic algorithm of chronic cough, the current study evaluated 133 adult patients, including 24 cases with upper airway cough syndrome (UACS) , 26 patients with cough variant asthma (CVA) , 31 cases with eosinophilic bronchitis (EB) , 30 patients with atopic cough (AC) , 22 cases with gastroesophageal reflux induced cough (GERC) . There were 30 healthy volunteers recruited as normal control. The cough threshold of LgC5 in AC, CVA, EB, GERC and UACS was 1.70 ±0.70, 2.12 ±0.67, 2.13 ±0.69, 1.69 ±0.73, 2.16 ±0.66, respectively. The LgC5 of the normal group ( 2.63 ±0.39) was higher than those in chronic cough groups( All P lt; 0.05) . The LgC5 of AC and GERC were lower than CVA, EB and UACS ( all Plt;0.05) . Duration and daytime score of cough showed positive correlations with LgC5( r =-0. 280, -0. 168, all P lt;0.05) . Pulmonary function and differential cell count of induced sputumwere not associated with LgC5 ( all Pgt;0.05) . Conclusions Different cause of chronic cough exhbit high cough reflex sensitivity to different extent. The difference of cough sensitivity may reflect the different pathogenesis among different causes, and may be related to the type of nerve fiber dominating the cough reflex.
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 explore the spectrum and frequency of respiratory symptoms in outpatients clinics.MethodsPatients were enrolled from outpatient clinic of Guangzhou Institute of Respiratory Disease. Information about respiratory symptoms especially cough was obtained from the survey questionnaire from July 2013 to August 2013 .ResultsA total of 900 were eligible out of 939 questionnaires. The mean age of the patients was (48.9±18.3) years, 453 (50.3%) were males, 447 (49.7%) were females. The cases of cough, wheeze, polypnea, chest distress, pharyngalgia, catarrh, chest pain, throat itching, fever, hemoptysis and other symptom was 687 (76.3%), 310 (34.4%), 307 (34.1%), 173 (19.2%), 107 (11.9%), 101 (11.2%), 82 (9.1%), 59 (6.6%), 36 (4.0%), 10 (1.1%) and 129 (14.3%) out of the patients, respectively. In patients with cough, 69.5% of them considered cough as their predominant symptom, and 22.1% of them reported that cough was the only symptom. 56.3% of cases were chronic cough, while acute and subacute cough accounted for 29.7% and 14.0%, separately. The proportion of female in acute cough was significantly higher than that of males (60.3%vs. 39.7%, P<0.01).ConclusionsCough, especially the chronic cough is the most common reason for patients who seeking health care in outpatient clinic of respirologist. There are more females suffered from acute cough than males.