The Retrospective Analysis On The Etiology And Treatment Of Chronic Cough

National survey data show that treatment of patients with chronic coughclinics accounted for about20%of the total year. Chronic cough is a commonclinical symptom,for no obvious abnormalities on imaging studies of chroniccough,routine antibiotic treatment is poor, leading to patients misdiagnosed,causing some economic pressure, affecting the quality of life of patients. Severeand long term cough can cause circulatory, respiratory, digestive, urinary andreproductive, skeletal and nervous system complications. After the increase inthe frequency of cough, the incidence of complications will increase by morethan2-fold and cough complications will increase0.4-fold.Now researchers athome and abroad on the etiology and treatment of chronic cough are in a certainconsensus. But when patients visit the hospital for treatment, due to economicconditions,their own influence, physical condition, and some laboratory tests cannot be carried out,these brought difficulties for the diagnosis and treatment ofthe cause.Objective:This article aims to analyze retrospectively through the etiology andtreatment of chronic cough, sensitivity and specificity to further clarify thecauses of chronic cough,distribution and characteristics of the existinglaboratory methods.We want to find differences between the definite causes andthe presumptive causes and find the diagnostic processes in the actual clinicalwork to achieve savings of resources and better treatment.Methods:Patients with chronic cough selected from February2013to January2014for treatment of respiratory medicine clinic at the First Hospital of Jilin University meet the standards of123cases. Asking in detail about the patient’shistory and physical examination referring to "2009cough diagnosis andtreatment guidelines ".The patients meeting the criteria should be in line ofinduced sputum, bronchial provocation plus pulmonary function tests, exhalednitric oxide measurement,24hours esophagus pH monitoring. According to thesymptoms and laboratory examination, we set the presumed etiology, and thengive the experimental treatment. Such as treatment is effective, the diagnosis isclear.If cough partial remission, then consider the presumed etiology basis withother causes in the initial, namely to have many causes, according to clinicalexperience and laboratory examination and assum the cause one by one untilmultiple etiology is clear. If cough without remission, we negative initialpresumed etiology, and consider other causes, further examination (such asnasopharyngoscope, bronchoscopy, IgE), and give symptomatic treatment untilthe patient cough relief. If several kinds of common cough treatment in patientswith cough do not alleviate, consider other rare causes of existence (psychogeniccough,hormone responsive cough),one by one, symptomatic treatment until thedefinite etiology is clear.Results:1. According to the diagnostic procedures and the results of diagnosistherapy,5patients in123patients with bronchial provocation test did notexecute successfully. There were7patients lost to follow-up, because of noregular medication and other reasons. A total of111patients completed thestudy. In111patients, single cause that accounted for76cases (68.5%),whilesingle etiology diagnosis accounted for98cases (88.3%),and between thedifference was statistically significant (X2=14.99, P<0.01).Multiple causesaccounted for35cases (31.5%),while diagnosed causes accounted for13cases(11.7%),and between the difference was statistically significant (X2=13.50,P<0.01).The diagnosis of the cause to single etiology, the order of CVA46cases (41.4%), UACS30cases (27%), NAEB8cases (7.2%), GERD6cases (5.4%).Diagnosis of the cause, a double cause to UACS+CVA4patients (3.6%) ismore common, and three cause to UACS+CVA+GERD2cases (1.8%) ismore common.2.There are75cases (67.6%), assuming consistent with the diagnosis of thecause,but another36cases (32.4%) assume that there are differences betweenthe etiology and diagnosis of the cause. There are differences in36patients,because of seting assumed single cause,6cases (16.7%), assuming multipleetiologies,30cases (83.3%), after experimental treatment, final diagnosis singlecause,33cases (91.7%), diagnosed multiple etiologies,3cases (8.3%). Due to theassumed cause of error, the error is set to cause more than a single cause,leading to differences between the presumptive cause and the definite cause.3. Bronchial provocation test was positive in60people, who were finallydiagnosed as CVA54causes, kappa value of0.77indicates that the laboratorymethods comply with the disease is good.Increased sputum eosinophils were24causes. Finally11people with normal airway responsiveness were diagnosed asNAEB, kappa value of0.57, conforming to the degree of general.24hoursesophageal pH monitoring showed abnormalities in18people, eventuallydiagnosed as GERD by14people, kappa value of0.64,conforming to the degreeof general. Measuring exhaled NO was positive in62people, who were finallydiagnosed as CVA54causes, in line with good kappa value of0.76degree. Thelaboratory results the false positive rate of between7%and19%,false negativerate at0-21%. According to the diagnosis of CVA, bronchial provocation tests asensitivity of92.6%,specificity of82.5%,breath NO measurement sensitivity of94.4%,specificity of80.7%,visibly determination of breathing NO also plays acertain role to the diagnosis of CVA.Conclusion:1. The definite causes are usually consistent with presumptive causes, and there are differences accounting for a small number of patients. So for thediagnosis and treatment of chronic cough can be taken to pre-set presumptivecauses, conduct experimental treatments, and ultimately a clear cause, it canavoid the waste of medical resources.2. There are discrepancy between presumptive and definite causes, becausewhen we set the presumed etiology, we are easy to set single etiology to multiplecauses.3. The cause of chronic cough is in the main single cause, and CVA, UACSis common.4. Exhaled NO measurement (30ppb) for the sensitivity and specificity ofCVA is high, so it can be used as a method of the filter in the patients who arenot suitable with bronchial provocation tests.