Clincal Analysis Of Airway Inflammation Exists In Patient With Gastroesophageal Reflux-associated Cough

Background and purposes:Cough can be divided into three classifications: acute cough(<3week), subacute cough(3-8week), and chronic cough(>8week). It brings great burden to people’s production and life, approximately 12% of people in Britain are bothered by chronic cough; In the USA, nearly 30 million people seek evaluation for cough at outpatient clinics every year. In 2006,The ACCP Evidence-Based Clinical Practice Guidelines raised that in patients with chronic cough and a normal chest roentgenogram finding who are nonsmokers and are not receiving therapy with an angiotensin-converting enzyme inhibitor, the diagnostic approach should focus on the detection and treatment of UACS, asthma, EB, or GERD. Multiple studies from European and American countries have shown that gastroesophageal reflux disease accounted for 5%-40% of the proportion of chronic cough, although the prorortion in Asian population is not high, but a recent study from japan had shown that the morbidity of gastroesophageal reflux-associated cough(GERC) trend to rising. So the research of GERC have definite clinical and social significance.Cough is one of the most common symptoms of gastroesophageal reflux disease, people usually referred to the cough caused by gastroesophageal reflux disease as gastroesophageal reflux-associated cough(GERC). The pathogenesis of GERC are not clearly until now, and the main hypothesis includes the following points:1、Reflux direct stimulation;2、Esophageal- bronchial indirect reflection;3、The increased sensitivity of cough receptors;4、acid-forming bacteria;5、Nonstomach type H + / K + atpase;6、Psychological factors;7、Reflux and cough cause each other. Irwin RS and colleagues put forward that observe the change of airway chronic inflammation may offer some clues to the search for the pathogenesis of chronic cough. Induced sputum cell count is recognized as a non-invasive 、 safe and efficient inspection, to a certain extent, reflects the characteristics of airway inflammation,and play an important role in evaluate the efficacy of the drug treatment and is of great significance for the diagnosis and treatment of chronic cough. Therefore, exploring the characteristics of airway inflammation of gastroesophageal reflux-associated cough by induce sputum has very important significance to further explore the pathogenesis of gastroesophageal reflux-associated cough.Despite domestic studies show that patients with GERC induced sputum neutrophil increased airway inflammation, such as performance, such as, but not notes GERC mainly neutrophils in patients with airway inflammation and anti reflux treatment and the relationship between symptoms of cough, and later published research has not fully confirmed the findings. Therefore, in order to further study the mechanism and the characteristics of airway inflammation in GERC patients, this study takes GERC patients as the main target of observation, and other causes of chronic cough as the comparison at the same time, to observe the difference of induced sputum cell count group in GERC patients compare with other causes, and to explore the characteristics of airway inflammation in GERC patients and its relationship of cough symptom.Objects and methods:Patients with chronic cough which consult doctor in outpatient department of Third military medical university XinQiao hospital from October,2013 to June,2014 was enrolled in, the criteria for the patients with chronic cough:1、The age between 18 to 75 years old,and suffer from cough symptom for more than 8 weeks;2、Normal chest X-ray;3、Non-smoker or quit smoking for more than 1 year;4、No history of airway infection within 8 weeks;5、Without taking ACEI and history of inhaled corticosteroids in nearly 8 weeks;Then the patients are diagnosed according to the Chinese guidelines for the diagnosis and treatment of cough(2009 edition) provides by the Chinese medical association.Result:1.The general clinical data:The age of chronic cough patient are significant higher than the health group, and the rest of the indicators have no significant differences between groups. The age have no significant differences between different chronic cough groups.2.The comparison of induced sputum of GERC patients with other causes of chronic cough indicate that the UACS and GERC present the neutrophils ncreased airway inflammation while the EB and CVA are mainly eosinophils.3.In the GERC group, after treatment, the percentage of neutrophil in induced sputum cell count was significantly reduced, at the same time cough score also significantly lower.Conclusion:1. Patients with GERC have airway neutrophilic inflammation;2. Through the targeted treatment, the number of induced sputum neutrophils decreases which is consistent with improvement of cough symptom, showing there may be some relation between the airway neutrophils inflammation and cough symptom.