Clinical Analysis For 124 Adult Patients Of Chronic Cough

Objective:Through analyzing to the 124 adult patients of Chronic Cough who diagnosed and treated in our hospital, to investigate the causes of Chronic Cough.Methods:We choose 124 adult patients in China-Japan Friendship Hospital with Chronic Cough from Febrory,2009 to January,2011.58 cases were male,66 cases were female. The patients'age were between 19 and 75 years old, the average age was 49 years old. The course of cough ranged from 2 months to 3 years. The patients who were chosed met the following standards: cough was the only or major symptoms; the course of cough was over 8 weeks; the X ray or CT of the chest was normal; non-smoking; non-acute respiratory infections in 8 weeks; over 14 years old.To diagnose the causes of Chronic Cough through the following program:①inquested the case histories and examined the bodies;②if using the drug of ACEI , stopped the drug and observed the changes of the symptoms;③examined the X ray of the chest ;④if the X ray was normal, examined the bronchial provocation test or the reversibility test, cells of sputum;⑤if it was like UACS, examined the X ray or CT of sinus ;⑥if it was like GERC , examined the stomach mirror or 24h PH of the esophagus;⑦if necessary, examined the CT of the chest or fiberopitic brochoscopy,et. According to the above program, diagnosed the initial causes, then treated, if the symptoms became better, the diagnosis was right.The standard of the diagnosis of Chronic Cough was:①UACS: the patients had the history of rhinitis or sinusitis , with itchy-throat, frequently cough ; through examined the body we could find nasal congestion , there was mucus in the snuff , the mucoca was like the pebbles ; the imaging appearances of the chronic sinusitis was, the thickness of the mucoca exceed over 6mm , air-fluid level; the treatment of rhinitis or sinusitis was effective, like taking the anti-allergic drug, dropping the glucocorticoids into the nose, local drainage, antibiotics,et.②CVA : the obvious and irritating cough especially in the night , non-dyspnoea ; non-pulmonary rales ; with airway hyperreactivity, the bronchial provocation test or the reversibility test was positive; the treatment of glucocorticoids or bronchodilator was effective.③EB: chronic irritating dry cough, non- phlegm or little white phlegm; the proportion of the eosinophils was over 3%;non- airway hyperreactivity, the lung communication function was normal ; the treatment of taking or inhaling the glucocorticoids was effective.④GERC: Chronic Cough with burning behind the sternum, sour regurgitation, uncomfortabal of the chest,et; the stomach mirror or 24h PH of the esophagus indicated the gastro-esophageal reflux disease; the treatment of PPI or medicines for stomach power was effective.⑤cough related to ACEI: irritating dry cough especially in the night; the history of using the drug of ACEI; the cough gradually reduced and disappeared after stopped the drug of ACEI.Results:According to the results of the diagnose program and the treatment, among the 124 patients of Chronic Cough, 37 patients were UACS(29.84%),32 patients were CVA(25.81%),13 patients were EB(10.48%),8 patients were GERC(6.45%),20 patients were PIC(16.13%),4 patients were caused by ACEI(3.23%),4 patients were caused by thyroid disease (3.23%),6 patients'causation were unclear. The percentage of the diagnosis of disease was 95.16%.Patients of UACS, took cetirizine(10mg,po,qd),for 4 weeks; budesonide bid or tid, intranasal. The patients became better after 2 to 3 weeks. Over 4 weeks of the treatment, the symptoms of cough was all effectively controlled. Patients of CVA, inhaled salmeterol/fluticasone, bid; montelukast 10mg,po,qd; compoung methoxyphenamine hydrochloride capsudes,2 caps, po, tid. After 1 to 2 weeks, the patients'symptoms became much better. Over 3 months of the treatment, the symptoms of cough was all effectively controlled.The patients of EB, firstly took prednisone po, for 1 week, then inhaled glucocorticoids and lasted for over 4 weeks. After1 week of treatment, the symptoms was effectively alleviated.Patients of GERC, treated them with omeprazole(40mg,po,bid), domperidone(10 mg,po,tid). The treatment should lasted for longer, about over 4 weeks, the symptoms became alleviated. After actively treated, the cough was all obviously cotrolled.Conclusion:The causes of Chronic Cough are complicated, we should take more attention about them. To diagnose the disease according to the right program, pay attention to the medical history and the physical examination, the diagnostic therapy is very important, we should also attach weight to the X ray of the chest, the bronchial provocation test or the reversibility test, cells of sputum, the X ray or CT of sinus, the stomach mirror or 24h PH of the esophagus,et. Upper Airway Cough Syndrome (UACS), Cough variant asthma (CVA) , Eosinophilic bronchitis (EB), Gastro-esophageal reflux disease (GERD) are the most common causes. Among the 124 patients, the cause of UACS accounts for 29.84%, is the most common cause; the PIC is also very common, that might because the weather of the north is cold and dry, people in the north area are easy to take rhinitis or sinusitis, acute respiratory infections, and are easy with airway hyperreactivity. Moreover, using the drug of ACEI can cause Chronic Cough, the thyroid disease can also cause the Chronic Cough, we should take more attention about them. Through the diagnosis of Chronic Cough, we should demonstrate the causes through the medical history and the physical examination, choose the right examination, pay attention to the diagnostic therapy. We should also pay more attention on follow-up, demonstrate the causes according to the therapeutic results, improve the accurate rate of the diagnosis.