| Cough variant asthma(CVA),also known as occult asthma,cough asthma,the main clinical manifestations are cough,wheeze and more difficulty in breathing,and so on.Its pathophysiological changes are characterized in chronic persistent airway inflammation and airway hyperresponsiveness,which is similar to typical patients with asthma,so the majority of scholars believe that it isthe performance of a typical pre-asthma.In recent years the disease are common in many respiratory diseases,and gradually become a research hot spot,but there is no exact conclusion on the incidence of disease-related machine.Though in western medicine for cough variant asthma treatment the use of hormones and bronchoditators can be achieved certain effects,to the patients and their families either from mind or body are heavry burden.Especially the application of hormones make the patients with low compliance and acceptance difficulties,so many seek traditional Chinese medicine.Based on the advantages of Chinese medicine practitioners,the scholars put forward wind,sputum,blood,virtual and non-transfer and other organs pathogenesis,the use of within the governance and outside the governance,inside and outside the administration,etc.All methods have achieved good clinical efficacy.Therefore,this study maintained and built up to find reliable data of this disease,found the incidence of pathogenic factors,Constitution characteristics and syndromes,not only for treatment,more to provide a reliable basis for preventing CVA.This is not only the future focus of medical research in West CVA,but also provide a better use of space of Chinese medical in the diagnosis and treatment of the disease.1 Theoretical Study1.1 Modern medicine's cognition of cough variant asthma(CVA)In this section,summarized the Western medical concept,diagnostic criteria and pathogenesis of the disease.After the concept of cough variant asthma had been put forward, the attention was growing.After repeated study of clinical observation,China Chinese Medical Association of Respiratory Diseases Studies in asthmatic group credits developped diagnostic criteria for CVA in 2005(Draft).Thus a more scientific diagnosis could be offered,and proposed that the pulmonary function and airway hyperresponsiveness check was the key method of diagnosis of CVA.At present,the pathogenesis of CVA whic reached a consensus wereseveral main aspects:1 With the variability in airway inflammation;2 Bronchial smooth muscle stimulate the cough receptors.3 Imbalance of TH1/TH2 immunology;4 Imbalance of neural regulation of airway,led to airway obstruction,induce the disease.Looking at its mechanism,covered genetic,immune,neural regulation, inflammation and other factors.1.2 Chinese medicine's cognition of cough variant asthma(CVA)This section collated summary of the disease,pathogenesis,syndrome differentiation these aspects and Chinese medicine's awareness on the status and research of cough variant asthma.In the disease,there were not fully corresponded to the CVA in the history of Chinese medicine works.Most scholars believed that it belonged to the scope of the "cough". But there were also scholars analyzed from the development of vesting characters of the disease,considerd that it could be treated according to the Treatment of Asthma. Summarized the following three points of etiology and pathogenesis of CVA:1 Arguing from wind,mainly suffering from wind-pathogen,cold,dryness,it was recognized that the clinical manifestations of CVA were in line with the characteristics of wind-pathogen.2 Arguing from the inside deficiency,it was recognized that lung,spleen and kidney deficiency was the key to the incidence.3 Arguing from phlegm and blood stasis,it was recognized that it had the same pathogenesis with typical asthma.The remain pathogen of phlegm and water pathogens were the major internal factors to the incidence.Scholars had suggested that according to "ill for a long time into the network" theory,stagnation of qi and blood also one of the pathogenesis that lead to cough variant asthma,which made patients with chronic cough could not be fully recovered.Collated the relevant syndromes of the disease as follows: syndrome of invasion of lung by wind-pathogen,syndrome of invasion of lung by cold diarrhea,syndrome of wind-heat of lung meridian,syndrome of deficiency of the lung yin, syndrome of phlegm-heat obstructing the lung,syndrome of invasion of lung by liver fire, syndrome of qi insufficiency of the lung and spleen and syndrome of qi insufficiency of the lung and kidney.Comprehensive literature study showed that CVA related to liver,kidney,lung,spleen four organs.Causes focused on the "Wind","Fire","cold","hot".Deficiency in origin mainly embodied in three organs:lung,spleen and kidney.On their theory of governance,the more treatment from the following aspects:1.dispelling wind and lung,relieving cough and spasm, soothing the throat;2,warming the lung and dispeling cold,lowering the rebellious qi to relieve cough;3.regimening lung and kidney,relieving cough by improving the kidney's function of receiving qi;4.nourishing yin to moisten dryness,soothing the liver ang relieving cough by improving the kidney's function of receiving qi.Treatment was still the key to grasping the main card,and evidence identified for the syndrome differentiation system.1.3 Constitution factors associated with disease《Jing Yue Quan Shu》said:"Exopathic of cough,caused by deficiency of blood and yin, or spleen and lung were the most susceptible to evil."These words indicated,when cough caused by exogenous pathogen,there must be the basis deficiency of internal factors,which led to exogenous pathogen take advantage of.Cough on the performance of the disease,was different from simple invasion of lung by exogenous pathogen,and different from asthma caused by lung sputum.Summary reports from the clinical characteristics of CVA incidence showed that the majority of patients had a personal or family history of allergy.Reflected the specificity of individual endowments, often led to a certain disease or disease susceptibility factor.Therefore,the part from the constitution factors,the pathogenesis and treatment of the cause analyzed constitution factors were important for disease control and prevention.Constitution refered to the process of individual lives,in the congenital and acquired formed the basis of the performance of the structure,physiological function,psychological status and the relative stability of the integrated nature.Syndrome was a general summary of pathological process of the body in a certain stage of diseases,reflecting characteristics of the disease process in a certain stage of pathological changes.However,there was inextricably link between constitution and syndrome.Constitution in many cases determined the body's susceptibility to Certain diseases and pathological changes in the process of preference.More or less behind the syndrome manifested the constitution characteristics of individuals.Constitution was the basis of syndrome,syndrome contained constitution ingredients,and the constitution differences led to variability of disease.Therefore,the relationships and the similarities and differences between the syndrome and constitution were brifely proposed.2 Clinical Research2.1 Study of cough variant asthma on risk factorsThe survey got 80 cases diagnosed as having cough variant asthma patients,80 cases with a comparative study of normal population.Using single-factor regression analysis to analyzed each of the factors involved in the the questionnaire.The results showed that the incidence of cough variant asthma was significantly associated with the main 14 factors of the questionnaire.Did further multi-factor regression analysis about14 significantly related factors.Give the following findings:Body obesity,family history of allergic,milk as the main feeding within four months after birth,cold lasted for a long time and respiratory tract infection a long time associated significantly with the occurrence of CVA.Descripted that cough variant asthma closely related to allergy and infection factors.Anatysising 80 cases from the of patients with cough induced factors and the incidence with season and time,statistics indicated that winter and night were the multi-incidence.And it was more easily induced by cold air.These showed that the occurrence of CVA cough related with lower protective effect of airway epithelial and the enhanced sensitivity of the respiratory tract mucosa.So they were easily stimulated by the small bowel and thus gave rise to cough.The timing of Cough might be related to the biological rhythm,which led to a night-time airway hyperresponsiveness.(bronchial hyper responsiveness,BHR).2.2 Study of cough variant asthma on constitution factorsSelected《Categorization study of Chinese medicine constitution》questionnaire developed by the topic group leaded by Professor wangqi.Questionnaire was contained by mild constitution,qi defficiency constitution,yin defficiency constitution,yang defficiency constitution,phlegm-damp constitution,damp-heat constitution,blood stasis constitution,qi stagnation constitution,special gift constitution nine hypo-questionnaire and 60 items. Categorization questionnaire count scores from 1 to 5,nine hypo-questionnaire count scores respectively,then found out that the constitution.Statistized the distribution of constitution and got the result of this study,the frequency from more to less were special gift constitution, qi defficiency constitution,yin defficiency constitution,damp-heat constitution,qi stagnation constitution,yang defficiency constitution,phlegm-damp constitution,blood stasis constitution,mild constitution.The frequency normal comparison group from more to less were mild constitution,qi defficiency constitution,yang defficiency constitution,qi stagnation constitution,damp-heat constitution,phlegm-damp constitution,yin defficiency constitution,special gift constitution,blood stasis constitution.Contrasted and analyzed the constitution characters between the two groups,found that constitution characters of cough variant asthma had positive correlation with yin defficiency constitution and special gift constitution,had negative correlation with mild constitution.It manifested that the frequency of mild constitution in the cough variant asthma was lower than the normal group.The results made it clear that in addition to special gift constitution,yin defficiency constitution related important with the cough variant asthma.Therefore the cough variant asthma patiants should pay attention to nourish the yin.2.3 Study of cough variant asthma on constitution factorsThis study through statistical of cough variant asthma symptoms frequency,selected common symptoms of cough variant asthma.Then in accordance of the diagnostic criteria developed by the subject expert group,assessed syndrome of medical records collected of the each patient.At last selected common syndromes of cough variant asthma.The statistical results on symptoms showed that the symptoms of frequency in more than 50%were pharyngeal itch,the smell or cold-induced cough,xerostomia and dry pharynx,less expectoration,array cough.The distribution of tongue and pulse showed that light tongue color,thin white coating,string pulse were most.By the results of differentiation analysis and statistics,we found that invasion of the lung by the exogenous pathogen was the most prominent,wind-pathogen was the main pathogenic factors of occurrence,development and evolution of cough variant asthma.Other syndromes by frequency of occurrence from the more to the less were:syndrome of deficiency of the lung yin,syndrome of qi insufficiency of the lung,syndrome of invasion of lung by liver fire,syndrome of phlegm-heat obstructing the lung,syndrome of invasion of lung by cold diarrhea,syndrome of invasion of lung by wind-pathogen,syndrome of invasion of lung by cold diarrhea, syndrome of yang insufficiency of kidney,syndrome of qi insufficiency of spleen,syndrome of yang insufficiency of spleen,syndrome of yin insufficiency of kidney,syndrome of wind-heat of lung meridian,syndrome of blood stasis obstructing the lung.The results suggested that asthenia in origin and asthenia in superficiality was the nature o f cough variant asthma.It existed insufficiency of lung,spleen,kidney three oranges,Qi-deficiency and yin-deficiency.Its superficiality were the wind-hyper,qi stagnation,phlegm,blood stasis, superficiality and origin matched from above.The theoretical research found that countries put more emphasis on airway hyperresponsiveness and the effectiveness of bronchodilators in the diagnosis of cough variant asthma.From the view of Chinese medicine in patients with CVA and clinical common symptoms,it was more in line with the statement of"cough due to wind-attack". And analyzed constitution,attached importance to the whole concept of Chinese medicine and was propitious to the comprehensive prevention and treatment.Clinical studies results suggested that pathogenic factors related closely with allergic factors and infection factors.In addition,the constitution prompted the individuals whose constitution were the special gift and yin deficiency were more susceptible to cough variant asthma.Finally,the statistical frequency of symptoms and syndromes of CVA showed that wind evil was the main pathogenic factors of occurrence,development and evolution of the disease. |
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