THE SPECTRUM AND FREQUENCY OF CAUSES, KEY COMPONENTS OF THE DIAGNOSTIC EVALUATION, AND OUTCOME OF SPECIFIC THERAPY
THE SPECTRUM AND FREQUENCY OF CAUSES, KEY COMPONENTS OF THE DIAGNOSTIC EVALUATION, AND OUTCOME OF SPECIFIC THERAPY
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DOI：
10.1164/ajrccm/141.3.640
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发表时间：
1990-03-01
期刊：
影响因子：
--
通讯作者：
FRENCH, CL
中科院分区：
文献类型：
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作者：
IRWIN, RS;CURLEY, FJ;FRENCH, CL
1981年提出了一个成功的、系统的、解剖学的诊断方案，用于评估慢性咳嗽患者。为了确定它是否仍然有效，我们在22个月的时间间隔内，前瞻性地评估了102名连续的和免疫功能正常的患者，他们平均咳嗽53 . ±. 97个月（范围，3周至50岁）。利用解剖学，诊断协议修改，包括延长食管pH值监测（EPH），咳嗽的原因确定在101 102例（99%），导致特定的治疗是成功的98%。73%的人咳嗽是由于一种情况，23%的人咳嗽是由于两种情况，3%的人咳嗽是由于三种情况。鼻后滴漏综合征占41%，哮喘占24%，胃食管反流（格尔）占21%，慢性支气管炎占5%，支气管扩张占4%，其他疾病占5%。咳嗽是哮喘和格尔的唯一表现，分别占28%和43%。虽然病史、体格检查、乙酰甲胆碱吸入激发试验（MIC）和支气管镜检查产生最常见的真阳性结果，但在预测哮喘是咳嗽原因时，MIC有22%的假阳性。实验室检测在排除可疑可能性方面特别有用。我们的结论是，解剖诊断协议仍然是有效的，它有明确的优势和局限性。
A successful, systematic, anatomic, diagnostic protocol for evaluating patients with chronic cough was presented in 1981. To determine whether it was still valid, we prospectively evaluated, over a 22-month interval, 102 consecutive and unselected immunocompetent patients complaining of cough an average of 53 .+-. 97 months (range, 3 wk to 50 yr). Utilizing the anatomic, diagnostic protocol modified to include prolonged esophageal pH monitoring (EPM), the causes of cough were determined in 101 of 102 (99%) patients, leading to specific therapy that was successful in 98%. Cough was due to one condition in 73%, two in 23%, and three in 3%. Postnasal drip syndrome was a cause 41% of the time, asthma 24%, gastroesophageal reflux (GER) 21%, chronic bronchitis 5%, bronchiectasis 4%, and miscellaneous conditions 5%. Cough was the sole presenting manifestation of asthma and GER 28 and 43% of the time, respectively. While history, physical examination, methacholine inhalational challenge (MIC), and EPM yielded the most frequent true positive results, MIC was falsely positive 22% of the time in predicting that asthma was the cause of cough. Laboratory testing was particularly useful in ruling out suspected possibilities. We conclude that the anatomic diagnostic protocol is still valid and that it has well-defined strengths and limitations.