| BackgroundDue to numerous etiologies,chronic cough with normal chest imaging is often difficult to be treated clinically,while different cough guidelines have different sequences of etiologies for chronic cough.In Chinese 2009 and 2015 cough guidelines,cough variant asthma(hereinafter referred to as CVA)was listed as the most common cause,and upper airway cough syndrome(hereinafter referred to as UACS)was the second leading cause of chronic cough.However,according to the ACCP guideline of the United States and most epidemiological survey results of European countries such as the United Kingdom,Canada and Italy,as well as Australia and South Korea,UACS is the most common cause of chronic cough.In view of the above contradictory epidemiological survey results,this study analyzed the etiologies of adult patients with chronic cough patients who were admitted into Guangzhou No.1 People's Hospital from June 1,2019 to January 31,2020,so as to analyze the etiologies of chronic cough.MethodsThis study belongs to a retrospective study.First of all,according to the inclusion criteria,the patients who meet the requirements of chronic cough were collected;the etiology was classified according to the diagnostic procedure and methods,and statistical analysis was carried out.SPSS 23.0 statistical software was used for data analysis.The measurement data with normal distribution was expressed by(x ± s),and the difference was compared by two independent sample t-test and one-way ANOVA;the data with non-normal distribution was expressed by median,and the difference of mean between different groups was compared by rank sum test;the enumeration data was expressed by constituent ratio n(%),and chi square test was adopted.Bilateral P < 0.05 was defined as statistically significant difference.Result1.A total of 180 patients with chronic cough met the requirements of this study,included 90 males and 90 females,with an average age of(47.5 ± 16.3)years old and a median disease course of 4(2-240)months.Among the 180 patients,23(12.8%)had a history of smoking;radiology report of chest radiograph showed that about one-third of the cases suffered from bronchitis;106(58.9%)patients were previously diagnosed as bronchitis;26(14.4%)patients were previously diagnosed as pharyngitis;in addition,most of the patients were treated with antibiotics and cough medicine,accounting for 82.8% and 90%,respectively.After statistical analysis,it was found that there were significant differences in smoking history between different genders(X2 = 14.406,P < 0.001),and the smoking rate of male was higher than that of female.2.Among 180 cases,the etiologies of 163 cases could be determined,including 55 cases with UACS(30.6%),38 cases with CVA(21.1%),18 cases with EB(10.0%),15 cases with anxiety cough(8.3%),8 cases with ACEI related cough(4.4%),6 cases with allergic cough(3.3%),6 cases with reflux cough(3.3%),17 cases with chronic bronchitis.In the other 17 cases,the etiology could not be determined because of incomplete auxiliary examination and poor treatment effect.3.There were significant differences in the average age,pulmonary function(FEV1pred%,FEV1 / FVC%)and the different proportions of previous diagnosis(bronchitis,pharyngitis and etiological examination of cough)(P < 0.05).After the multiple comparison,it could be seen that CVA was higher than UACS,EB,anxiety cough and atopic cough in terms of average age;ACEI related cough was higher than anxiety cough and atopic cough.The average FEV1pred% and FEV1 / FVC% of CVA were lower than those of other etiologies.In terms of previous diagnosis,UACS was higher than CVA in the proportion of patients diagnosed as laryngitis.UACS was lower than reflux cough in the proportion of patients diagnosed as pharyngitis.ConclusionAmong 180 patients with chronic cough,UACS is the most common disease,followed by CVA and EB.Anxiety-related cough is also one of the causes of chronic cough,accounting for a considerable proportion.Background As one of the common causes of chronic cough,UACS has a low diagnostic rate in daily clinical work.Many PATIENTS with UACS have been misdiagnosed and treated incorrectly for a long time,with recurrent attacks and protracted illnesses.It has a serious impact on patients' work,study and life quality,and also aggravates the economic burden on individuals and society.In China,there are relatively few studies on the diagnosis and treatment of UACS,so the misdiagnosis analysis of UACS is of practical significance to improve the diagnosis rate,reduce misdiagnosis and reduce the burden of patients' economic and life quality.Therefore,we conducted an analysis of UACS to investigate the causes of misdiagnosis.Methods 1.This study is a single-center,single-arm,open prospective trial.First,40 adult chronic cough patients with UACS were collected according to the admission and discharge criteria.2.1 Clinical data collation and misdiagnosis analysis.2.2 in all patients with nasal inhaled corticosteroids(furoic acid mo betamethasone 50 ug or fluticasone propionate 50 ug or budesonide nasal spray 64 ug 1 bid)absorption,first-generation antihistamines and decongestants compound preparation(compound pseudoephedrine capsule 1 grain of bid),leukotriene receptor antagonists(meng Lu Si 10 mg qn)combination therapy in January,better after nasal inhaled corticosteroids leukotriene receptor antagonist and maintenance treatment in March.The scores of cough symptoms before and after treatment were recorded and analyzed statistically.Result 1.A total of 40 eligible UACS patients were enrolled,including 19 males and 21 females,with an average age of 47.1±17.0 years.Median course of disease was 12 months(2-216).There were 25 cases of rhinitis.There were 4 cases with smoking history and 36 cases without smoking history.One patient had a family history of atopic disease(asthma,allergic rhinitis,atopic dermatitis).2.Among the 40 patients,32(80%)had nasal symptoms,and 8(20%)had no nasal symptoms.Among the nasopharyngeal signs,there were 14 cases(35%)of unilateral inferior turbinate hypertrophy and hyperemia,24 cases(60%)of bilateral inferior turbinate hypertrophy and hyperemia,1 case(2.5%)of pharyngeal hyperemia and follicular hyperplasia,and no abnormal 2 cases(5%).Sinus CT results showed unilateral turbinate hypertrophy in 15 cases(37.5%),bilateral inferior turbinate hypertrophy in 24 cases(60%),paranasal sinus inflammation in 6 cases(15%),and nasal polyp in 1 case(2.5%).The Fe No test was completed in 23 cases,4 cases were over 32 ppb.Five patients completed sputum induction test(Eos%>=2.5% in 4 cases(3.5%-25.7%).3.The distribution of basic etiology in 40 patients was mainly composed of single chronic rhinitis,34 cases(85%),only 1 case(2%),and 5 cases(13%).Distribution of misdiagnosed diseases: 22 cases(55.0%)were misdiagnosed as bronchitis,8 cases(20%)as chronic bronchitis,5 cases(12.5%)as chronic pharyngitis,4 cases(10%)as EB and 1 case(2.5%)as GERC.Cough suppressants were used in 35(87.5%),antibiotics in 29(82.9%),leukotriene receptor antagonists in 18(45%),second-generation antihistamines in 24(60%),and nasal inhalant hormones and decongestants in none.4.Among the previous diagnosis and treatment data of 40 patients,16 patients(40%)visited tertiary hospitals,and 24 patients(60%)visited secondary hospitals or below.Fifteen patients(37.5%)were asked about nasal symptoms,and 25(62.5%)were not asked about nasal symptoms.Seven patients(17.5%)had the history of rhinitis,and 33 patients(82.5%)had no history of rhinitis.There were 0 cases with visual examination of nasal cavity,40 cases(100%)without examination,5 cases(12.5%)with CT examination of paranasal sinus,and 35 cases(87.5%)without examination of paranasal sinus.4 cases underwent induced sputum examination,and Eos% of induced sputum were all >= 2.5%.5.The scores of cough symptoms before and after treatment were 4.28±0.91 VS 1.58±0.87 respectively.T =16.778,P<0.001 The difference was statistically significant,and the score of cough symptom after treatment was significantly lower than before treatment.All patients achieved clinical control of cough symptoms at different stages of the trial.Conclusion 1.UACS patients with chronic cough are often misdiagnosed as other diseases,with bronchitis being the most common,followed by chronic bronchitis,and a few patients being misdiagnosed as chronic pharyngitis and EB.2.The clinician neglected to inquire about rhinitis related symptoms and history of rhinitis,neglected nasal signs and sinus CT examination,which were the factors that could easily lead to misdiagnosis in the process of seeking treatment.3.Due to the presence of patients without conscious nasal symptoms,physical examination of the nose and auxiliary examination of the nose should be paid attention to. |
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