Expert opinion on the cough hypersensitivity syndrome in respiratory medicine
Expert opinion on the cough hypersensitivity syndrome in respiratory medicine
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DOI：
10.1183/09031936.00218613
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发表时间：
2014-11-01
影响因子：
24.3
通讯作者：
Smith, Jaclyn A.
中科院分区：
文献类型：
--
作者：
Morice, Alyn H.;Millqvist, Eva;Smith, Jaclyn A.
2011年，欧洲呼吸学会特别工作组开始着手确定咳嗽过敏综合征在慢性咳嗽患者管理中的地位和临床相关性。咳嗽过敏综合征是一种以令人头痛的咳嗽为特征的疾病，通常由低水平的热、机械或化学暴露引发。在文献回顾的支持下，采用迭代法编制了一份21项问卷。选取44位呼吸医学关键意见领袖进行访谈，了解他们的意见。在得到的答复中有高度的一致，所有意见领袖都支持咳嗽过敏的概念作为临床有用的范例。将咳嗽分为哮喘型、鼻炎型和反流相关表型的经典分层得到了支持。在对慢性咳嗽治疗的两个问题的回答中可以看到显著的意见差异。首先，抑酸在反流性咳嗽中的作用受到质疑。其次，意见领袖在口服类固醇试验是否适用于嗜酸性粒细胞性咳嗽的诊断上存在分歧。意见领袖显然赞同咳嗽过敏综合征是一个有效和有用的概念。他们认为对慢性咳嗽患者的支持不够，工作队建议在这一被忽视的领域迫切需要进一步开展工作。
In 2011, a European Respiratory Society Task Force embarked on a process to determine the position and clinical relevance of the cough hypersensitivity syndrome, a disorder characterised by troublesome coughing often triggered by low levels of thermal, mechanical or chemical exposure, in the management of patients with chronic cough. A 21-component questionnaire was developed by an iterative process supported by a literature review. 44 key opinion leaders in respiratory medicine were selected and interviewed as to their opinions.There was a high degree of unanimity in the responses obtained, with all opinion leaders supporting the concept of cough hypersensitivity as a clinically useful paradigm. The classic stratification of cough into asthmatic, rhinitic and reflux-related phenotypes was supported. Significant disparity of opinion was seen in the response to two questions concerning the therapy of chronic cough. First, the role of acid suppression in reflux cough was questioned. Secondly, the opinion leaders were split as to whether a trial of oral steroids was indicated to establish a diagnosis of eosinophilic cough.The cough hypersensitivity syndrome was clearly endorsed by the opinion leaders as a valid and useful concept. They considered that support of patients with chronic cough was inadequate and the Task Force recommends that further work is urgently required in this neglected area.