慢性咳嗽1讲解.ppt

谢谢! * * Chronic cough Classification Acute: 3 weeks Subacute: 3-8 weeks Chronic: ? 8 weeks Etiology Acute cough: common cold, acute bronchitis Subacute cough: post-infectious cough, acute sinusitis Chronic cough ?8 weeks, the only or main symptom No special in X-ray Most common causes Cough-variant asthma Eosinophilic bronchitis Post-nasal drip syndrome GERD--Gastroesophageal reflux disease Cough-variant asthma Sensitive cough, mainly night cough Responsiveness to bronchodilators Variation PEF (day/night) ≥20％ ICS,LABA,leukotriene-receptor antagonist EB-Clinical features EB CVA N 51 31 Age 40.4±12.3 48.8±10.0 F/M 20/31 17/14 Course(month) 26(2-288) 87(2-456) Night cough 14（27%） 27（87%） Sensitivity 33（66%） 28（90%） EB-Clinical features EB CVA Blood Eos5% 21% 31% TIgE 88% 67% (kU/L) 272.6(46.5-1654.0 ) 97.5(2.0-382.0) ECP(?g/L) 6.0(2-23.4) 15.2(2-89.6) Sputum Eos% 5.5 (3-64)% 7.2 (0.5-66)% Sputum induction 典型哮喘 对照 CVA EB Treatment ① Oral corticosteroids 10-20mg/d， 3-7d ②Inhaled corticosteroids (budesonide 400-800?g bid, 4-8 weeks) Post-nasal drip syndrome 由于鼻、鼻咽及鼻窦的病变，其分泌物后流到咽后壁、会厌甚至气管内，从而导致咳嗽. (1)发 作 性 或 持 续 性 咳 嗽 ,以 白 天 咳 嗽 为 主 ,入 睡 后 较 少 咳 嗽 。 (2)鼻 后 滴 流 和 (或 )咽 后壁黏液附着感 。 (3)有鼻炎 、鼻窦炎 、鼻息 肉或 慢性咽喉炎等病史。 (4)检查发现咽后壁有黏液附 着 、鹅 卵 石 样 观 。 (5)经 针 对 性 治 疗 后 咳 嗽 缓 解 Treatment First-generation antihistamines and pseudoephedrine hydrochloride :（1）nonallergic rhinitis；（2）vasomotor rhinitis；（3）perennialrhinitis；（4）common cold. Chlortrimeton + pseudoephedrine hydrochloride + dextromethorphan hydrobromide，or compound drugs. Several days – 2 weeks. Treatment-Chronic rhinitis Antibiotic: 2-3 weeks 1-gener