| Backgroup:The Chinese guideline of cough pointed out that the four major causes of chronic cough are cough variant asthma(CVA)ã€upper airway cough syndrome(USCS)ã€eosinophilic bronchitis(EB)and gastroesophageal reflux-related chronic cough(GERC), moreover,atopic cough(AC) and bronchiectasis are also common causes of chronic cough.The guideline suggested that cause-directed treatment is the mainstay of the current diagnostic approaches for chronic cough,but the induced sputum test and the 24 h ambulatory esophageal p H monitoring are not common in most of primary care units and some large general hospitals,in addition,the above tests cost much,while the empiric therapy cost little and has become an accepted clinical approach.Objective:The Epidemiological data has shown that what are the most common causes of chronic cough.The purpose of this study was to evaluate the clinical significance of combined bronchial provocation test and empirical treatment in the management of chronic cough.Methods:Consecutive patients with chronic cough(n=113),who had self-referred to the cadre healfh clinics of First Affiliated Hospital of Guangdong Pharmaceutical University,were selected for the study between March 2014 and December 2015.Get the detailed history and physical examination of all the patients,and carried out the chronic cough questionnaire,then Pulmonary function tests and Routine Test of Finger Blood before the empirical treament.If FEV1>70%,then the bronchial provocation test is the next step.We made a initial diagnosis of CVAã€EB/ACã€UACS or GERC to all the patients after comprehensive analysis of the above information,then gave the Targeted therapies.Symptoms were considered to be controlled when cough disappered completely,and considered improved when cough symptom score decreased by one or more,considered uncontrolled when the cough worsened or was not alleviated to any noticealble degree.If controll,consider the daignosis;Plus other targeted treatment while partly controll(improve),then consider dual etiology when cough disappered;Change another targeted treatment while uncontrolled,then consider single or dual etiology until the cough disappered completely.Those patients need further examination while all the impirical treatment does not work.Then Statistical analysis of the treatment efficiency,etiology,clinical features and Peripheral blood eosinophils.Result:All the patienst(n=113) accepted based pulmonary function tests and Routine Test of Finger Blood before the empirical treament,108 patients FEV1 >70% predicted and accepted the bronchial provocation test;5 patients 60%<FEV1<70% predicted,3 of them FEV1/FVC>0.7 and accepted bronchial provocation test while Adequate preparation,2 of them FEV1/FVC<0.7 and accepted Bronchodilation test.The bronchial provocation test positive in 40/111,preliminary diagnosis of CVA.The Bronchodilation test are negetive(n=2).There are 37 patients were diagnosis of EB/AC,25 patients were UACS,and 11 patients were GERC,respectively. 61 patients controlled and 21 patients partly controlled after the initial empirical treatment,the effective rate was 73.5%.Those patients who were diagnosis of CVA,EB/AC,UACS,GERC,their effective rate was 85.0%ã€62.5%ã€58.8%ã€63.6%,respectively,after the initialy empirical treatment.There are 96 patients(85.0%) performed controlled or partly controlled after the adjusted treatment,and made the final diagnosis,77 patients are single etiology, and the diagnosis of CVA,EB/AC,UACS,GERC is 28,23,16,9,respectively.19 patients were considered dual etiology.The stugy also found that the peripheral blood eosinophils in the CVA group is higher than that in the UACS group and the GERC group.Conclusion:Empirical therapy is a simple and useful approach to the management of chronic cough,and can be an alternative to the cause-directed treatment.Carry out the bronchial provocation test before empirical therapy can help us to identify the CVA early,that is significance for the prevention and control of asthma. |
