咳嗽是呼吸专科门诊最常见的症状之一，其中大部分又是所谓不明原因的慢性咳嗽(unexplained chronic cough)，即常规影像学检查未发现明确病变者。在此类慢性咳嗽当中，咳嗽变异型哮喘(CVA)是一重要病因，早年Irwin报道，慢性咳嗽的病因包括哮喘和气道高反应(33％)、鼻后滴漏 (28％)、慢性支气管炎(12％)、症状性胃食管反流(10％)、病毒感染后咳嗽(25％)，其他因素包括血管紧张素转换酶抑制剂(ACEI)性咳嗽、精神性咳嗽(10％)以及多因素所致的咳嗽(约占20％) J。在我国尚缺乏CVA发病率的大样本流行病学资料，最近上海同济医院进行了一项调查，在呼吸专科门诊287例由于慢性咳嗽就诊的患者当中，无论是老年人还是中青年患者，CVA均是主要的病因(老年人 34．6％ ，中青年41．5％)，其次为上气道咳嗽综合征(UACS， 19．3％和23．5％)、ACEI相关性咳嗽(16．3％ 和1．7％)、胃食管反流性疾病(GERD，10．6％ 和3．7％) 。由于呼吸科医生以至普通内科医生逐渐熟悉了解这一疾病，在门诊病人当中CVA的比重越来越大，粗略估计CVA大约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，尽管许多临床医生知晓CVA，但涉及其诊治仍存在不少的问题。
Citation：
LIU Chuntao. Some clincical issues oncough variant asthma. Chinese Journal of Respiratory and Critical Care Medicine, 2008, 08(6): 407-409. doi:
Copy
Copyright © the editorial department of Chinese Journal of Respiratory and Critical Care Medicine of West China Medical Publisher. All rights reserved
| 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. |
中华医学会呼吸病分会哮喘学组．支气管哮喘防治指南(支气管哮喘的定义、诊断、治疗和管理方案)．中华结核和呼吸杂志， 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. 中华医学会呼吸病分会哮喘学组．支气管哮喘防治指南(支气管哮喘的定义、诊断、治疗和管理方案)．中华结核和呼吸杂志， 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．.
