Clinical Application Of Airway Hyperresponsiveness And Its Associated Risk Factors In Subacute Cough

Objective1.To explore the value of Airway Hyperresponsiveness(AHR)in subacute cough;2.To explore the risk factors related to AHR in subacute cough.MethodFrom May 2019 to February 2020,199 cases of subacute patients in the outpatient department of respiratory and critical care medicine of the 940 Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army in Lanzhou(the original Lanzhou General Hospital of Lanzhou Military Command)were collected.The main collection content included the general information,clinical history,pulmonary function,bronchial provocation test(BPT)and fraction exhaled nitric oxide(FeNO)of patients.According to the results of BPT,the patients were divided into two groups: positive group(group A,142 cases)and negative group(group B,57 cases).We used the therapy of budesonide forterol powder inhalation 160μg/4.5μg twice daily and montelukast sodium tablets 10mg/night for the initial treatment of group A.Two weeks later,montelukast sodium was stopped,and the treatment of budesonide forterol powder was continued.The patients in group A were followed up to observe the changes of cough symptom score,lung function and FeNO level during the treatment,and the results were statistically analyzed;Group B was given symptomatic treatment initially(Dingchuan Zhike Capsule 1600 mg 2/day or Compound methoxamine capsule 2 capsules 3/day),and follow-up symptoms,if the symptoms were not relieved or worsened,given the treatment of group A.According to the general datas,clinical symptoms,pulmonary functions and FeNO values of patients in group A and B screen and analyze the influencing factors of airway hyperresponsiveness.Result1.A total of 199 patients were finally collected,142 in group A and 57 in group B.2.The scores of cough symptoms in daytime,night and total decreased with the prolongation of treatment time was decreased in group A;Compared with initial cough symptoms score,the second week and the fourth week were statistical difference;there was statistical difference between the second and the fourth week,P<0.001.3.Comparison of pulmonary function changes in group A after second and fourth week: FEV1 pred%,FEV1/FVC pred%,PEF pred%,FEF25% pred% and MVV pred% had statistical difference in the initial pulmonary function between the 2nd and 4th weeks of treatment(P<0.05);MMF pred%,FEF50% pred% and FEF75% pred% were significantly different from the initial treatment in the fourth week after treatment(P<0.05).The pulmonary function changes of group A after fourth week were: FVC pred%,FEV1 pred%,PEF pred%,FEF25% pred%,FEF75% pred%,MVV pred% in the fourth week of treatment,compared with that of the initial treatment,there was statistical difference(P<0.05).4.In group A,the difference of FeNO<25ppb,25ppb≤FeNO<50ppb and FeNO≥50ppb was statistically significant(P<0.001).5.In group A,the FeNO value of patients with FeNO≥25ppb was reexamined in the fourth week of treatment.The results showed that the difference of FeNO value in the fourth week of treatment was statistically significant compared with the initial FeNO value of treatment(P<0.001).6.Single factor logistic regression analysis: allergic history,dry cough,cough at night,pharyngeal symptoms(itching,dry throat,foreign body sensation in pharynx),nasal symptoms(congestion,sneezing,runny nose,itching),MMF pred%<80%,FEF25% pred%<80%,FEF50% pred%<80%,FEV1/FVC pred%<92% were related factors of airway hyperresponsiveness(P<0.05).7.The results of multivariate logistic regression analysis: dry cough,cough at night,pharyngeal symptoms(itchy throat,dry throat,foreign body sensation in pharynx),MMF pred%<80%,FEV1/FVC pred%<92% were risk factors of airway hyperresponsiveness(P<0.05).Conclusion1.The incidence of AHR was higher in patients with subacute cough.The examination of AHR was helpful to the early diagnosis and treatment of subacute cough and prevent it from developing into chronic cough.2.The cough symptom score,lung function and FeNO value of subacute cough with AHR patients were improved obviously after ICS+LABA treatment.The subacute cough patients of AHR supported ICS+LABA treatment.3.Dry cough,cough at night,pharyngeal symptoms(itching,pharyngeal dryness,foreign body sensation in pharynx),MMF pred%<80%,FEV1/FVC pred%<92% were the risk factors of AHR.If the BPT can not be achieved,we can analyze whether there was AHR according to the risk factors,made further ICS+LABA treatment.