收稿日期: 2023-09-05
网络出版日期: 2024-03-18
基金资助
国家自然科学基金面上项目(82270114);上海市科委创新研究专项项目(21Y11901400)
Pay attention to standardized diagnosis and treatment of corticosteroid-responsive cough
Received date: 2023-09-05
Online published: 2024-03-18
全球成人慢性咳嗽的患病率为9.6%。2008年,《柳叶刀》咳嗽专刊上发表了按照嗜酸性粒细胞性气道炎症是否存在或激素治疗是否敏感,区分慢性咳嗽病因的诊治方案。2014年,我国赖克方教授首先提出了中文名称“激素敏感性咳嗽”(corticosteroid-responsive cough, CRC)。CRC是指糖皮质激素(corticosteroids, CS)治疗有效的慢性咳嗽,在我国占慢性咳嗽病因的63%,包括咳嗽变异性哮喘、嗜酸性粒细胞性支气管炎和变应性咳嗽这3种常见的慢性咳嗽病因,其中咳嗽变异性哮喘是我国慢性咳嗽最常见的病因,占30%~50%。慢性咳嗽病因复杂,涉及的检查众多,尤其是支气管激发试验、诱导痰细胞分析、多通道食管阻抗pH监测等这些检查在很多三级医院都未开展,而且也不是所有慢性患者都能接受相关检查后再确认诊断,进而予以治疗。CRC概念的提出对于慢性咳嗽的经验性治疗具有重要的指导意义,适合在基层医院推广,在临床实践中仅需根据患者的临床特征判断是否为CRC,而无需再进行诱导痰细胞分析、支气管激发试验等检查鉴别咳嗽变异性哮喘、嗜酸粒细胞性支气管炎和变应性咳嗽,就可以给予患者经验性治疗。但目前部分临床医师对于CRC规范化诊疗的认识不足,比如对判断是否为CRC、选用何种激素治疗、激素治疗周期等问题还缺乏统一的认识,需要进一步强调并推广CRC的相关概念及诊治方案。
时翠芹, 余莉 . 重视激素敏感性咳嗽的规范化诊疗[J]. 诊断学理论与实践, 2023 , 22(06) : 527 -533 . DOI: 10.16150/j.1671-2870.2023.06.003
The global prevalence of chronic cough in adults is 9.6%.In 2008, the cough special issue of Lancet published a diagnosis and treatment plan to distinguish the causes of chronic cough based on eosinophilic airway inflammation or sensitivity to glucocorticoids therapy. In 2014, Professor Lai Kefang of China first proposed the Chinese name “corticosteroid-responsive cough” (CRC). CRC refers to chronic cough that is effectively treated with glucocorticoids, accounting for 63% of the causes of chronic cough in China, including cough variant asthma, eosinophilic bronchitis, and atopic cough. Cough variant asthma is the most common cause of chronic cough in China, accounting for 30% to 50% Chronic cough has a complex etiology and involves numerous examinations, especially bronchial provocation tests, induced sputum cell analysis, multi-channel esophageal impedance pH monitoring, etc., which have not been carried out in many tertiary hospitals, and not all chronic patients can undergo relevant examinations to confirm diagnosis and receive treatment. The concept of corticosteroid-responsive cough has important guiding significance for the empirical treatment of chronic cough, and is suitable for promotion in grassroots hospitals. In clinical practice, it is only necessary to determine whether it is a CRC based on the clinical characteristics of the patient without the need for further tests, such as induced sputum cell analysis and bronchial provocation tests to distinguish cough variant asthma, eosinophilic bronchitis, and allergic cough, and then empirical treatment can be given. However, there is currently insufficient understanding of the standardized diagnosis and treatment of CRC. For example, there is still a lack of consensus on determining whether it is CRC, how to select hormone treatment and the duration of hormone treatment. It is necessary to further emphasize and promote the relevant concepts and diagnosis and treatment plans of corticosteroid-responsive cough.
Key words: Corticosteroid-responsive cough; Chronic cough; Glucocorticoids
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