Chinese expert consensus on the diagnosis and treatment of chronic cough after lung surgery / 中国胸心血管外科临床杂志

@# In recent years, the number of lung surgeries has increased year by year, and the number of patients with postoperative cough has also increased gradually. Chronic cough after lung surgery seriously affects patients' quality of life and surgical outcome, and has become one of the clinical problems that clinicians need to solve. However, there is currently no guideline or consensus for the treatment of chronic cough after lung surgery in China, and there is no standardized treatment method. Therefore, we searched databases such as PubMed, Web of Science, CNKI, and Wanfang databases ect. from 2000 to 2023 to collected relevant literatures and research data, and produced the first expert consensus on chronic cough after lung surgery in China by Delphi method. We gave 11 recommendations from five perspectives including timing of chronic cough treatment, risk factors (surgical method, lymph node dissection method, anesthesia method), prevention methods (preoperative, intraoperative, postoperative), and treatment methods (etiological treatment, cough suppressive drug treatment, traditional Chinese medicine treatment, and postoperative physical therapy). We hope that this consensus can improve the standardization and effectiveness of chronic cough treatment after lung surgery, provide reference for clinical doctors, and ultimately improve the quality of life of patients with chronic cough after lung surgery.

Treatment of Chronic Cough of Phlegm-Dampness Syndrome Based on the Theory of “Removing the Earth Stagnation” / 中医杂志

This paper discussed the treatment of chronic cough of phlegm-dampness type based on the theory of “removing the earth stagnation”. It is believed that stagnation of qi in the middle energizer caused malfunction of water metabolism in the human body， which is the key pathogenetic mechanism leading to phlegm-dampness cough. Pathogenesis like cold and dampness attacking the spleen， dampness-heat obstruction， weakness of the middle energizer， failure to ascend clear yang， and internal blazing of yin fire may lead to “earth stagnation”， which triggered phlegm-dampness cough. The treatment advocated “removing the stagnation” to improve qi transformation in the middle energizer， eliminate stagnation， and use different treatment methods such as warming the middle， circulating qi， transforming phlegm and dampness based on different disease cause and mechanism to calm cough. As for prescriptions， Jiangling Banxia Decoction （姜苓半夏汤） could be used for cold-dampness syndrome， Banxia Xiexin Decoction （半夏泻心汤） plus Xiangsu Powder （香苏散） used for damp-heat syndrome， and Buzhong Yiqi Decoction （补中益气汤）， Tiaozhong Yiqi Decoction （调中益气汤）， Shengyang Yiwei Decoction （升阳益胃汤） and Bupiwei Xieyinhuo Shengyang Decoction （补脾胃泻阴火升阳汤） could be selected for spleen-stomach weakness syndrome according to different characteristics and pathogenesis.

Eosinophilic Esophagitis And Chronic Cough Originated Beyond The Respiratory Tree

Background Chronic cough (CC) as the main symptom of eosinophilic esophagitis (EoE), associated or not with other signs of esophageal dysfunction, has been poorly studied. Research the frequency of CC symptoms of EoEObjectives and their characteristics. Comorbidities, adherence to treatment, and evolution. An observational,Methods prospective study. Variables: Epidemiological, demographics, atopic, endoscopic, histological, comorbidities, symptoms, time of evolution, endoscopic phenotype, respiratory function tests. Adherence, response to treatment, complications, and evolution Only 20 patients (5%) with EoE had CC. The mean age:24 years, male 85%. TheResults time of evolution: 5 years. CC: recurrent during the day (never at night), worsened with food intake (during or after), improved when remission EoE and reappeared when active EoE. There were a few severe complications. Conclusion Although the frequency of CC as a symptom in EoE is low, it must be considered, especially if it appears in food intake.

The long-term outcomes of posterior nasal neurectomy with or without pharyngeal neurectomy in patients with allergic rhinitis: a randomized controlled trial / Os resultados no longo prazo da neurectomia nasal posterior com ou sem neurectomia faríngea em pacientes com rinite alérgica: um ensaio clínico randomizado

Abstract Introduction Allergic rhinitis is a form of IgE mediated inflammation of the nasal mucosa in response to specific allergens, resulting in typical symptoms. Objectives This study was designed with the primary goal of comparing the clinical efficacy of posterior nasal neurectomy with or without pharyngeal neurectomy for the treatment of moderate-to-severe perennial allergic rhinitis. Secondary study aims included a comparison of the severity of comorbidities, including chronic cough and asthma, between patients in these two surgical treatment groups. Methods A total of 52 patients were enrolled in this randomized controlled trial and were assigned to either the control group (posterior nasal neurectomy) or the experimental group (posterior nasal neurectomy + pharyngeal neurectomy). The visual analog scale and rhinoconjunctivitis quality of life questionnaire were used to compare the differences in patient symptoms between baseline and 6-, 12-, and 24-months post-treatment. In addition, patient cough and asthma symptoms were monitored during follow-up via visual analog scale and asthma control test respectively. Results No significant differences in preoperative scores were evident between groups (p> 0.05). At 6-months post-treatment, there were significant differences in visual analog scale, rhinoconjunctivitis quality of life questionnaire, and asthma control test scores relative to baseline values in experimental group and control group patients (p< 0.05), and this remained true upon 12- and 24-month follow-up. No significant differences in visual analog scale, rhinoconjunctivitis quality of life questionnaire, or asthma control test scores were observed between the two treatment groups at any postoperative follow-up time point (p> 0.05), while coughing severity was found to be significantly reduced in the experimental group relative to the control group (p< 0.05). Conclusion posterior nasal neurectomy can be safely implemented with or without pharyngeal neurectomy in order to effectively treat allergic rhinitis. Combined posterior nasal neurectomy and pharyngeal neurectomy treatment may offer greater value than posterior nasal neurectomy alone for the treatment of allergic rhinitis patients with chronic cough.

Resumo Introdução A rinite alérgica é uma forma de inflamação da mucosa nasal mediada por IgE em resposta a alérgenos específicos, resulta em sintomas típicos. Objetivos Comparar a eficácia clínica da neurectomia nasal posterior com ou sem neurectomia faríngea para o tratamento da rinite alérgica perene de moderada a grave. Além disso, comparar a gravidade das comorbidades, inclusive tosse crônica e asma, entre os pacientes nesses dois grupos de tratamento cirúrgico. Método Foram incluidos neste ensaio clínico randomizado e designados para o grupo controle (neurectomia nasal posterior) ou para o grupo experimental (neurectomia nasal posterior + neurectomia faríngea) 52 pacientes. A escala visual analógica e o questionário de qualidade de vida na rinoconjuntivite (rhinoconjunctivitis quality of life questionnaire) foram usados para comparar as diferenças nos sintomas dos pacientes entre o período inicial e 6, 12 e 24 meses após o tratamento. Além disso, a tosse e os sintomas de asma dos pacientes foram monitorados durante o acompanhamento por meio da escala visual analógica e do teste de controle da asma (asthma control test ), respectivamente. Resultados Nenhuma diferença significante nos escores pré‐operatórios foi evidenciada entre os grupos (p > 0,05). Aos seis meses pós‐tratamento, houve diferenças significantes nos escores da escala visual analógica, no questionário de qualidade de vida na rinoconjuntivite e no teste de controle de asma em relação aos valores basais dos pacientes no grupo experimental e no grupo controle (p < 0,05), o que permaneceu verdadeiro após 12 e 24 meses de acompanhamento. Não foram observadas diferenças significantes nos escores da escala visual analógica e nem no questionário de qualidade de vida para conjuntivite ou no teste de controle da asma entre os dois grupos de tratamento em qualquer momento do acompanhamento pós‐operatório (p > 0,05), enquanto a gravidade da tosse foi significantemente reduzida no grupo experimental em relação ao grupo controle (p < 0,05). Conclusão A neurectomia nasal posterior pôde ser feita com segurança com ou sem neurectomia faríngea para o tratamento eficaz da rinite alérgica. O tratamento combinado com neurectomia nasal posterior e neurectomia faríngea pode oferecer mais benefício do que a neurectomia nasal posterior isolada para o tratamento de pacientes com rinite alérgica e tosse crônica.

Advances in pathogenesis, diagnosis and treatment of cough variant asthma in children / 国际儿科学杂志

In recent years, the prevalence and medical visits of chronic cough in children are increasing year by year, among which cough variant asthma is one of the main causes of chronic cough in children.The Global Initiative for Asthma points out that cough variant asthma is a disease in which cough is the main or only symptom and is associated with airway hyperresponsiveness.Cough variant asthma, a disease with repeated or persistent cough as the main clinical manifestation, is a subtype of asthma.Due to the lack of typical wheezing symptom, cough variant asthma is easy to be misdiagnosed or missed, leading to lack of standardized treatment.In addition, frequent coughing has a significant impact on the quality of life of children and their family members.In order to improve clinicians′ understanding of cough variant asthma in children, the advances in epidemiology, pathogenesis, diagnosis and treatment of this disease are explained.

Características demográficas, clínicas, radiológicas y de función pulmonar en pacientes con bronquiectasias / Radiological and pulmonary function clinical demographic characteristics in patients with bronchiectasias

OBJETIVOS: determinar las principales características demográficas, clínicas, radiológicas y de función pulmonar de los pacientes con bronquiectasias en la Clínica del Pulmón. MATERIAL Y MÉTODOS: estudio observacional, retrospectivo. Se revisaron las historias clínicas de 23 pacientes con diagnóstico de dilataciones bronquiales. RESULTADOS: de los 23 pacientes, con una edad media de 49,4 ± 3,87 años, 13 corresponden al sexo femenino y 10 al sexo masculino, el tiempo de evolución de la enfermedad desde el diagnóstico de la patología inicial es de 17,3 ± 2,92 años. La tuberculosis es la etiología principal en 15 pacientes (65,2%). Las manifestaciones clínicas más frecuentes son la tos y expectoración mucopurulenta por varios años en la mayoría de los pacientes, al que añadimos la disnea y hemoptisis, la auscultación pulmonar revela la presencia de crépitos en 17 pacientes (73,9%). La Tomografía de Tórax de Alta Resolución distingue dos tipos de bronquiectasias: La sacular o quística y la cilíndrica, de localización unilobar, bilobar y multilobar (difuso). La Espirometría Forzada fue indicada en 10 pacientes (43,5%) 7 mujeres y 3 varones, el Síndrome Bronquial Obstructivo fue el hallazgo más frecuente. La asociación de Tetraciclina con Metronidazol indicado en 9 pacientes (39,1%) mejoró el cuadro clínico. La fisiopatología de esta entidad clínica está sujeta a una constante actualización. CONCLUSIONES: en pacientes tosedores crónicos, las bronquiectasias deben tener prioridad diagnóstica, se trata de una patología antigua, pero de actualidad permanente.

The purpose of this document is to determine the main epidemiological and clinical characteristics of patients with bronchiectasis at the Lung Clinic. METHOD: observational, retrospective study. The medical records of 23 patients diagnosed with bronchial dilation were reviewed. RESULTS: the results of the 23 patients studied, with a mean age of 49,4 ± 3,87 years, 13 correspond to the female sex and 10 to the male sex, indicate that the time of evolution of the disease from the diagnosis of the initial pathology is: 17,3 ± 2,92 years. Tuberculosis is the main etiology in 15 patients (65,2%). The most frequent clinical manifestations were cough and mucopurulent expectoration of several years in most of the patients, to which we must add dyspnea and hemoptysis, pulmonary auscultation reveals the presence of crepitus in 17 patients (73,9%). High Resolution Chest Tomography distinguishes two types of bronchiectasis: the saccular or cystic and the cylindrical, the localization is unilobar, bilobar and multilobar (diffuse). Forced spirometry was indicated in 10 patients (43,5%), 7 women and 3 men, Chronic Obstructive Pulmonary Disease is the main diagnosis. The association of Tetracycline with Metronidazole indicated in 9 patients (39,1%) had positive results. The pathophysiology of this clinical entity is subject to constant updating. CONCLUSIONS: in chronic coughing patients, bronchiectasis must have diagnostic priority, it is an old pathology, but it is permanently current

Etiology and epidemiology of chronic cough aged 6-14 years in children / 公共卫生与预防医学

Objective To investigate the incidence and risk factors of chronic cough in children aged 6-14 years. Methods The incidence of chronic cough in children aged 6-14 years in Qinhuangdao city was investigated by questionnaire. Results A total of 4 000 questionnaires were distributed, 3 785 of them were effectively recovered, with the recovery rate of 94.6%. The incidence of chronic cough in children aged 6-14 was 5.1% (194/3 785). The prevalence rates of boys and girls were 5.4% (101/1 859) and 4.8% (93/1 926), respectively, with no significant difference (χ2=0.641，P=0.873). The incidence rate of children in industrial town area 6.7% (64/955) was significantly higher than that in urban area 4.4% (85/1 917) and agricultural town 4.9% (45/913) (χ2=55.082，P=0.000). The risk factors showed that chronic cough was associated with long-term allergen exposure, allergic constitution, asthma, rhinitis, reflux esophagitis and other nasopharynx diseases (χ2=17.833，43.370，194.466，27.773，101.92，11.268，P =0.000). Regression model analysis showed that asthma, rhinitis and allergen long-term exposure were independent risk factors of chronic cough (Wald=15.352，10.174，12.625，12.659，P =0.000). Conclusion The incidence rate of children in industrial town is higher in Qinhuangdao City than those in other urban areas, 6~14 years old children. Asthma, rhinitis and allergen exposure are the main causes of chronic cough.

Progress of evaluation scales in chronic cough / 国际儿科学杂志

With the further understanding and the accumulation of experiences in diagnosis and treatment for chronic cough, a growing number of evaluation scales about chronic cough are used in clinical practice.Medical workers try to quantitatively evaluate chronic cough and accurately guide clinical practices with evaluation scales.At present, the evaluation scales of chronic cough mostly focus on health-related quality of life, because chronic cough will seriously affect the quality of life for patients, and further affect the psychology, daily life and family members of patients.

Evaluation of chronic cough in children aged 2 year to 12 years

Background: Chronic cough is a common complaint in children which causes distress and affects the quality of life of parents and children. While cough may be seen as a common condition of childhood without serious consequences, ignoring a cough that may be the sole presenting symptom of an underlying illness can lead to delayed diagnosis and progression to a chronic respiratory morbidity. Aims and objectives of the study was to evaluate the specific diagnosis and prognosis of chronic cough in children aged 2 to 12 years.Methods: A prospective study was done in 100 children with chronic cough (history of cough >4 weeks) at Narayana Hospital, Nellore. Routine investigations like complete blood count with differential count, Mantoux test, sputum examination, and X ray chest and other investigations like bronchoscopy, HIV, CT scan chest and paranasal sinuses, barium swallow, endoscopy and biopsy whenever needed. Pearson Chi square test carried out to quantify significance difference, p value <0.05, considered significant.Results: The mean duration of chronic cough was 56.27 days (1-5 months). Most of the children belonged to <6 years age with higher boys' prevalence. Breathlessness and fever noticed in 79% cases; it was found mostly in pneumonia cases as compared to other diagnosis (p=0.001). Sputum production noticed in 4, which found to be bronchiectasis. 1 case noticed with regurgitation, which is gastro oesphageal reflux disease. History of triggers for the symptoms of cough, wheeze and breathlessness is found to have a significant correlation with asthma (p=0.000). Asthma in 14% of cases, of which 12 were mild persistent and 2 were moderate persistent. Tuberculosis was diagnosed in 14% cases, Pneumonia in 12% cases, and Bronchiectasis in 12 cases. Undernourished children noticed in 56%, maximum number in tuberculosis group. Asthma was associated with pneumonia, mucous plug obstruction and collapse lung. Recurrent pneumonia was associated with airway anomaly, gastro esophageal reflux disease.Conclusions: It should be remembered that a prolonged cough can be indicative of a more serious underlying condition, and always warrants thorough investigation.

Risk factors and prevention strategies for chronic cough after robotic versus video-assisted thoracic surgery in non-small cell lung cancer patients / 中国胸心血管外科临床杂志

@#Objective    To analyze risk factors for chronic cough after minimally invasive resection of non-small cell lung cancer (NSCLC) and explore the possible prevention measures. Methods    A total of 128 NSCLC patients who received minimally invasive resection in 2018 in our hospital were enrolled, including 63 males and 65 females with an average age of 60.82±9.89 years. The patients were allocated into two groups: a robot-assisted thoracic surgery (RATS) group (56 patients) and a video-assisted thoracic surgery (VATS) group (72 patients). Chronic cough was assessed by visual analogue scale (VAS), meanwhile, other perioperative indicators were compared between the two groups. Univariate and multivariate logistic regression analyses were performed to identify risk factors for postoperative chronic cough and explore the prevention strategies. Results    Overall, 61 (47.7%) patients were diagnosed with chronic cough after surgery, including 25 (44.6%) patients in the RATS group and 36 (50.0%) patients in the VATS group, and the difference was not statistically significant (P>0.05). Compared with the VATS group, the RATS group got shorter endotracheal intubation time (P=0.009) and less blood loss (P<0.001). The univariate analysis showed that age (P=0.014), range of surgery (P=0.021), number of dissected lymph nodes (P=0.015), preoperative cough (P=0.006), endotracheal intubation time (P=0.004) were the influencing factors for postoperative chronic cough. The multivariate analysis showed that age <57 years (OR=3.006, 95%CI 1.294-6.986, P=0.011), preoperative cough (OR=3.944, 95%CI 4.548-10.048, P=0.004), endotracheal intubation time ≥172 min (OR=2.316, 95%CI 1.027-5.219, P=0.043), lobectomy (OR=2.651, 95%CI 1.052-6.681, P=0.039) were the independent risk factors for chronic cough. Conclusion    There is no statistical difference in postoperative chronic cough between the RATS and VATS groups. The RATS group gets less blood loss and shorter endotracheal intubation time. Patients with younger age (<57 years), preoperative cough, lobectomy, and longer duration of endotracheal intubation (≥172 min) are more likely to have chronic cough after surgery.

Two Cases of Chronic Cough Successfully Treated with Kumibinroto / 日本東洋医学雑誌

Cough-variant asthma is the most common cause of chronic cough. It may progress to classic asthma and therefore requires adequate treatment intervention. We experienced two cases of cough-variant asthma that was refractory to standard drug therapy but improved after additional administration of kumibinroto. In Case 1, the patient was a 46-year-old woman receiving hormone therapy after breast cancer surgery. She developed cough-variant asthma 5 years ago, and though she has received drug therapy, the symptoms aggravated. Cough continued to appear at night without improvement of asthma symptoms. However, the symptoms improved with subsequent administration of kumibinroto. In Case 2, the patient was a 47-year-old woman who developed cough-variant asthma after childbirth, which repeatedly worsened and improved. The cough-variant asthma aggravated after change of workplace and did not improve with drug therapy. However, asthma symptoms improved with oral administration of kumibinroto and hangekobokuto, and subsequent administration of kumibinroto alone. In both patients, the asthma was seasonal. These cases suggest that kumibinroto administration may contribute to the improvement of cough-variant asthma.

Tracheobronchopathia osteochondroplastica:A case report and literature review / 中南大学学报(医学版)

Tracheobronchopathia osteochondroplastica (TBO) is a rare disease with unknown etiology characterized by ossifying nodules in the trachea and bronchial walls without involvement of the posterior wall of trachea. A 35-year-old woman admitted to Second Xiangya Hospital, Central South University, in August 2018 was diagnosed as TBO. She complained of dyspnea for over two years, worsening in autumn and winter, and was detected with tracheal ossification via bronchoscopy and biopsy. The patient received no special treatment, and no improvement or deterioration of symptoms was observed during the 3-month follow-up. We reviewed 60 TBO cases and found that 60％ of them were female, with ages of 20-80 (53.62±15.97) years. The involved lesion sites were from the vocal cords to the bronchial segments, mainly in the trachea and bilateral main trachea, and the lower part of the trachea was more common. Combined respiratory symptoms were common. The diagnosis mainly depends on bronchoscopy and biopsy. Symptomatic treatment is the main strategy for symptomatic TBO patients, including endoscopic intervention and surgery. It is generally believed that the short-term prognosis of TBO is good, but the long-term prognosis still needs to be further studied.

Acercamiento a la tos crónica en adultos / An approach to chronic cough

RESUMEN La tos crónica en los adultos puede ser causada por muchas causas, existen cuatro principales: el síndrome de tos de la vía aérea superior, enfermedad por reflujo gastroesofágico, reflujo laringofaríngeo, asma bronquial, y bronquitis eosinofílica no asmática. Todos los pacientes deben evaluarse clínicamente con espirometria, y comenzar con tratamiento empírico. Otras causas potenciales incluyen el uso de inhibidores de la enzima convertidora de la angiotensina, cambios medioambientales, uso del tabaco, enfermedad pulmonar obstructiva crónica, y la apnea obstructiva del sueño. La radiografía del tórax puede orientar hacia causas infecciosas, inflamatorias, y malignas. Los pacientes con tos crónica refractaria pueden remitirse a la consulta especializada de un neumólogo u otorrinolaringólogo, además de un ensayo terapéutico con gabapentin, pregabalin, y psicoterapia.

ABSTRACT Although chronic cough in adults can be caused by many etiologies, four conditions account for most cases: upper airway cough syndrome, gastro-esophageal reflux disease, also known as laryngo- pharyngeal reflux disease, bronchial asthma, and non-asthmatic eosinophilic bronchitis. All patients should be evaluated clinically with spirometry, and empiric treatment should be initiated. Other potential causes include angiotensin-converting enzyme inhibitor use, environmental triggers, tobacco use, chronic obstructive pulmonary disease, and obstructive sleep apnea. Chest radiography can rule out concerning infectious, inflammatory, and malignant thoracic conditions. Patients with refractory chronic cough should be referred to a pulmonologist or otolaryngologist in addition to a therapeutic trial of gabapentin, pregabalin, and psychotherapy.

The correlation between the changes in pulmonary function and chronic cough in children with Mycoplasma pneumoniae pneumonia / 中华实用儿科临床杂志

Objective To discuss the correlation between dynamic changes in pulmonary function and chronic cough in 5-to-14-year-old children with Mycoplasma pneumoniae pneumonia(MPP)after acute period(about 2 weeks after admission). Methods One hundred and fifty - six hospitalized children diagnosed with MPP from Lianyungang Maternal and Child Health Care Hospital Affiliated to Yangzhou University from February 2014 to May 2017 were selected. According to the results of routine ventilatory pulmonary function before discharge(10-14 days in hospital;acute phase group),there were 50 patients with normal pulmonary function and 106 patients with abnormal pulmonary function. All patients continued to take oral azithromycin for 2 to 3 courses after discharge,and the indexes of lung function were dynamically tracked in 1 month(1-month group)and 2 months(2-month group)in the group of abnormal lung function after leaving the hospital,and the incidences and causes of chronic cough were followed up. Results (1)There were 106 cases with abnormal pulmonary function in 156 cases with MPP in acute phase group,and the rate of incidence was 67. 95%. Twenty-seven(29. 35%)out of 97 children were still abnormal in pulmonary functional testing 1 month after leaving hospital( 1-month group). Among the 27 cases,about 18. 52%(5/27 cases) of them still did not return to normal 2 months after discharge( 2-month group ). There were significant differences in the occurrence of abnormal pulmonary function among 3 groups mentioned above(χ2 ＝162. 64,P<0. 001).(2)Ratios of measured values and predicted ones of forced vital capacity( FVC ),forced expiratory volume in one second (FEV1 ),peak expiratory flow(PEF)and maximum mid-expiratory flow(MMEF 25% -75%)in the lung function of 2-month group after the acute phase of MPP were significantly higher than those of 1-month group and acute phase group,and the values of 1 -month group were better than those in acute phase one,which were statistically different among 3 groups(P<0. 01).(3)The rate of occurrence of chronic cough in normal lung function group was about 18. 00%(9/50 cases),and in abnormal pulmonary function group,it was about 70. 75%(75/106 cases). There was a significant difference between them(χ2 ＝35. 96,P<0. 05). Abnormal pulmonary functions were the influencing factors of chronic cough(r＝0. 55,P<0. 01).(4)There were 5 cases with upper airway cough syndrome(UACS)and 4 cases with post-infection cough(PIC)found in the normal lung function group. By contrast,75 cases suffered from chronic cough in abnormal pulmonary functions group,of which 36 cases with cough variant asthma( CVA),24 cases with UACS,8 cases with comorbidity of CVA and UACS and 7 cases with PIC. Conclusions Abnormal lung function after acute period of MPP may last 4 to 8 weeks,or probably even longer. In normal lung function group,UACS is the most common cause,then followed by PIC. On the contrary,the main cause of chronic cough in abnormal pulmonary function group is CVA,followed by UACS. Chronic cough is related to abnormal lung function after acute phase of MPP.

Value of Exhaled Nitric Oxide and FEF(25–75) in Identifying Factors Associated With Chronic Cough in Allergic Rhinitis

PURPOSE: Chronic cough in allergic rhinitis (AR) patients is common with multiple etiologies including cough variant asthma (CVA), non-asthmatic eosinophilic bronchitis (NAEB), gastroesophageal reflux-related cough (GERC), and upper airway cough syndrome (UACS). Practical indicators that distinguish these categories are lacking. We aimed to explore the diagnostic value of the fraction of exhaled nitric oxide (FeNO) and forced expiratory flow at 25% and 75% of pulmonary volume (FEF(25–75)) in specifically identifying CVA and NAEB in these patients. METHODS: Consecutive AR patients with chronic cough were screened and underwent induced sputum, FeNO, nasal nitric oxide, spirometry, and methacholine bronchial provocation testing. All patients also completed gastroesophageal reflux disease questionnaires. RESULTS: Among 1,680 AR patients, 324 (19.3%) were identified with chronic cough, of whom 316 (97.5%) underwent etiology analyses. Overall, 87 (27.5%) patients had chronic cough caused by NAEB, 78 (24.7%) by CVA, 16 (5.1%) by GERC, and 81 (25.6%) by UACS. Patients with either NAEB or CVA (n = 165, in total) were further assigned to a common group designated as CVA/NAEB, because they both responded to corticosteroid therapy. Receiver operating characteristic curves of FeNO revealed obvious differences among CVA, NAEB, and CVA/NAEB (area under the curve = 0.855, 0.699, and 0.923, respectively). The cutoff values of FeNO at 43.5 and 32.5 ppb were shown to best differentiate CVA and CVA/NAEB, respectively. FEF(25–75) was significantly lower in patients with CVA than in those with other causes. A FEF(25–75) value of 74.6% showed good sensitivity and specificity for identifying patients with CVA. CONCLUSIONS: NAEB, CVA, and UACS are common causes of chronic cough in patients with AR. FeNO can first be used to discriminate patients with CVA/NAEB, then FEF(25–75) (or combined with FeNO) can further discriminate patients with CVA from those with CVA/NAEB.

Research on Treatment of Chronic Cough Based on Cluster Analysis and Factor Analysis / 中国实验方剂学杂志

Objective:To summarize medication law of prescription and clinical experience on the treatment of chronic cough through data mining technology. Method:The formula information of 650 cases of chronic cough cases diagnosed and treated by professor HAN Ming-xiang was processed with data mining technology, and system cluster analysis and factor analysis were conducted by SPSS Statistics 22.0. Result:High-frequency medicines of professor HAN Ming-xiang for treating chronic cough were Stemonae Radix, Citri Reticulatae Pericarpium, Asteris Radix et Rhizoma and other 37 herbs, their frequency of occurrence accounted for 80.52%. According to the efficacy, the medicines could be classified into 10 categories, such as expectorant cough antiasthmatic drugs, tonifying deficiency drugs, and diaphoretic drugs. Cluster analysis showed 5 combinations of drugs. Factor analysis yielded 13 common factors, such as Stemonae Radix-Asteris Radix et Rhizoma-Farfarae Flos-Cynanchi Stauntonii Rhizoma et Radix, Asari Radix et Rhizoma-Schisandrae Chinensis Fructus-Zingiberis Rhizoma-Fritillariae Thunbergii Bulbus. Conclusion:Combined with clinical experience, it can be concluded that clinical treatment of professor HAN Ming-xiang for chronic cough attaches great importance to the pathogenesis of wind-evil, Yang deficiency and cold phlegm underlying lung, phlegm and blood stasis and Qi stagnation. The treatment mainly starts from the lung and spleen, with the method of warm and moist, or with some traditional Chinese medicines with the function of removing phlegm by warming the lung, dispersing cold by thinning the surface, strengthening the spleen and resolving phlegm, strengthening the lung and fixing the surface, and relieving spasmolysis by wind.

Application value of simple exercise provocation test combined with small airway function test in early diagnosis of cough variant asthma / 中国综合临床

Objective To explore the value of simple exercise provocation test ( 6?minute running test) combined with small airway function test in early diagnosis of cough variant asthma ( CVA ) in children.Methods Ninety?four children with chronic cough from September 2017 to September 2018 in the pediatric clinic of the Affiliated Hospital of Xuzhou Medical University were selected for routine pulmonary ventilation function examination,simple exercise stimulation test and questionnaire survey.The differences of pulmonary function,clinical manifestations and allergens between positive and negative children with simple exercise stimulation test were compared and analyzed.Results The forced expiratory volume in one second (FEV1) of 94 children with chronic cough were all more than 70% by routine pulmonary function test,and the exercise provocation test was successfully completed.Among them,32 (34.04%) were positive in simple exercise provocation test.Among the positive patients,30 cases ( 93.75%) were diagnosed as CVA after further examination,clinical treatment and follow?up.In CVA group, FEV1 ( 81.52 ± 14.22)%,forced vital capacity (FVC) (89.00 ± 14.31)%, peak expiratory flow ( PEF) ( 65.05 ± 15.10)%, one?second rate (FEV1／FVC) (92.18±13.59)%,and instantaneous flow at 50% forced expiratory flow were observed after exercise.The vital capacity ( FEF50 ) ( 57.57 ± 22.49 )%, forced expiratory flow at 75% vital capacity (FEF75) (41.15±18.28)%,maximum expiratory flow ( MMEF75／25) (53.14±22.53)% were significantly lower than those before exercise ((94.07±9.69)%,( 92.30± 13.60)%,(80.73± 17.85)%,(101.07± 13.79)%,(66.71±19.29)%,(51.32±18.38)%,(63.75±19.43)%),(t values were 8.592 ,2.617 , 10.246 ,5.428,3.590 ,3.646 ,3.687 ,respectively,all P＜0.05)) In routine examination of pulmonary ventilation function,FEF50 (66.71 ± 19.29)% and FEF75 ( 51.32 ± 18.38)% in the positive group were significantly lower than those in the negative group (( 79.75 ± 21.94)%、( 69.08 ± 29.28)%),( t values were －2.841,－3.123,all P＜0.01).The proportion of night cough,morning cough and severe dry cough in positive group was significantly higher than that in negative group,while the proportion of day cough and wet cough was significantly lower than that in negative group ( P＜0.01).The proportion of eczema history in positive group was significantly higher than that in negative group ( P＜0.01).Conclusion Patients with CVA have high airway responsiveness and small airway dysfunction.Combination of simple motor stimulation test and small airway function test has important clinical value in the early diagnosis of CVA.

Tos persistente y neuropatía laríngea / Persistent cough and laryngeal neuropathy

RESUMEN La tos persistente es un síntoma de consulta frecuente, de origen multifactorial, que involucra a diferentes especialidades como la neumología, la gastroenterología y la otorrinolaringología. Sus causas más frecuentes son la descarga nasal posterior, tos como variante del asma y reflujo gastroesofágico/faringolaríngeo. Una vez descartadas dichas causas, cobran importancia los trastornos sensoriales del nervio vago, una entidad relativamente nueva que también es conocida como neuropatía laríngea sensitiva. En la neuropatía laríngea, una injuria a nivel neuronal aferente del reflejo de la tos produce un estado de hipersensibilidad laríngea en la que estímulos normalmente ignorados (que no producen respuesta tusígena) comienzan a gatillar el reflejo. Las características clínicas de la tos y el descarte de las causas más frecuentes permite llegar a este diagnóstico. Su tratamiento tiene como objetivo la modulación de las vías neuronales alteradas basándose en 3 pilares: educación sobre la patología, recomendaciones conductuales (higiene vocal, estrategias de reducción de tos) y los fármacos entre los que se usan los inhibidores de bomba de protones, mucolíticos y neuromoduladores.

ABSTRACT Persistent cough is a common symptom for medical consultation, it is of multifactorial origin and involves different specialties such as pneumology gastroenterology and otorhinolaryngology. The most frequent causes are postnasal drip, cough variant asthma and gastroesophageal/pharyngolaryngeal reflux. Once these causes are discarded the vagus nerve sensory disorder becomes of importance, it is a relatively new entity also known as laryngeal sensitive neuropathy. In the laryngeal neuropathy, an injury in the afferent neuronal pathway of the cough reflex produces laryngeal hypersensitivity in which normally ignored stimulus (i.e. do not cause cough) start to trigger the reflex. The clinical features of the cough and the rule out of the most frequent causes allow the diagnosis. The objective of the treatment is to modulate the altered neuronal pathways based on 3 pillars: education regarding the pathology, behavioral recommendations (vocal hygiene, cough reduction strategies) and drugs among which proton pump inhibitors, mucolytics and neuromodulators are used.

Understanding causes of Sub-acute cough in community - A clinico-pathological research

Cough is one of the most common complaints of patients seeking medical attention. A number of patients attend our OPD for complaint of Sub acute cough lasting 3-8 weeks. Majority of such cough are due to Ear, Nose and Throat pathologies. This study aims to evaluate the Otorhinolaryngology causes of Cough in these patients. Inflammation of Sinuses (Acute/Sub-acute) and Gastro-oesophageal reflux disorder (Reflux) form a bulk of cases presenting with Sub-acute cough in community. Clinicians need to maintain a high degree of suspicion for these two most common entities in cough patients not responding to conventional line of management.

Detection of levels of serum interleukin-17, interleukin-33 and concentration of fractional exhaled nitric oxide in patients with chronic cough and its clinical significance / 吉林大学学报(医学版)

Objective:To investigate the relationships between the levels of serum interleukin-17 (IL-17),interleukin-33 (IL-33) and the concentration of fractional exhaled nitric oxide (FeNO) in the patients with chronic cough,and to further evaluate their effects in the pathogenesis of chronic cough.Methods:A total of 160 patients diagnosed with chronic cough for more than 8 weeks were chosen and used as chronic cough group.At the same time,60 healthy controls received physical examination were selected as healthy control group.The levels of serum IL-17 and IL-33 of the subjects were examined and pulmonary function test,FeNO concentration test and comprehensive allergen test were performed.All data were analyzed by GraphPad Prism statistical software.The levels of serum IL-17 and IL-33 were compared between chronic cough group and healthy control groups.The correlations between the levels of serum IL-17 or IL-33 and lung function or FeNO in the patients with chronic cough were further analyzed.Results:The serum IL-17 and IL-33 levels of the patients in chronic cough groups were higher than those in healthy control group (P＜0.05).The serum IL-17 and IL-33 levels in the patients with chronic cough showed a significant negative correlations with the percentage of the first second force expiratory volume to the estimated value (FEV1％) of the patients (r=-0.624 5,r=-0.672 2),and the level of serum IL-33 in the patients with chronic cough was positively correlated with the concentration of FeNO;the higher the concentration of FeNO,the higher the level of serum IL-33 (rs =0.758,P＜0.05).The FeNO concentration geometric mean of the patients with the serum total IgE＜100 IU · mL-1 (33 ppb) was significantly lower than those with the serum total IgE＞200 IU · mL-1 (78 ppb) and IgE 100-200 IU · mL 1 (69 ppb) among the chronic cough patients (P＜0.01),but there was no significant difference between the later two groups (P=0.082 4).Conclusion:The serum IL-17 and IL-33 may play an important role in the pathogenesis of chronic cough as proinflammatory factors.The levels of serum IL-17 or IL-33 have negative correlations with the pulmonary ventilation function in the patients with chronic cough.The increasing of serum IL-33 level may predict the formation of eosinophilic airway inflammation and reflect the severity of eosinophilic airway inflammation.