01-慢性咳嗽-jiangyi(王立波)案例.ppt

7．存在鼻后滴流或频繁清喉时，可先按UACS治疗，联合使用第一代H1受体阻断剂和鼻减充血剂。对变应性鼻炎可加用鼻腔吸入糖皮质激素。 治疗1～2周症状无改善者，可摄鼻窦CT或鼻咽镜??? 8．对于饮水或喂奶呛咳者，可考虑改用稠厚食品，必要时进行短期鼻饲喂养。?? 9．上述检查仍未确诊，或试验治疗仍继续咳嗽者，应考虑进行高分辨率CT和纤支镜以及心脏超声检查，除外支气管扩张症、支气管内膜结核及左心功能不全等疾病。? ?? 10．反复发作的慢性咳嗽患者，夜间不咳，较敏感，如上述各项检查和针对性治疗均无效时，应除外心因性咳嗽。??? 注意点：??? 1．经相应治疗后咳嗽缓解，病因诊断方能确立。??? 2．部分患者可同时存在多种病因。如果患者治疗后， 咳嗽症状部分缓解，应考虑是否同时合并其它病 因 * Background: Cough variant asthma (CVA) is diagnosed in some children with chronic cough who do not have wheezing. However, the precise mechanism of CVA in children is unclear. Objective: To evaluate the physiologic differences in the airways of children with classic asthma and CVA, the methacholine dose-response curves of respiratory resistance (Rrs) were studied. Patients and methods: CVA was diagnosed in 31 children with chronic cough (age range, 5 to 14 years; 19 boys and 12 girls; mean age, 8.5 years) on the basis of methacholine inhalation challenge using an oscillation method. For comparison, the study included 86 age-matched children with classic asthma (age range, 5 to 15 years; 42 boys and 44 girls; mean age, 9.5 years), 25 age-matched children with cough (age range, 5 to 15 years; 17 boys and 8 girls; mean age, 8.8 years), and 23 age-matched control subjects (8 boys and 15 girls; mean age, 9.2 years). Consecutive doses of methacholine were doubled until a 200% increase in Rrs from baseline was reached. The cumulative dose of methacholine at the inflection point of Rrs was considered to represent the bronchial sensitivity to inhaled methacholine (minimum dose of methacholine [Dmin]). The slope of the methacholine dose-response curve (SRrs), which was considered to represent bronchial reactivity, was measured from the increasing Rrs curve. Results: The values of Dmin in classic asthma patients and in CVA patients were significantly lower than those for cough patients and control subjects. There was no significant difference inthe values of Dmin between the classic asthma and CVA patients. The value