咳嗽症状严重程度评价

咳嗽是临床上常见的症状,可由许多疾病引起。评价患者咳嗽程度能够帮助了解患者生活质量受影响程度以及评估治疗效果。近年,发展出了许多咳嗽评估方法包括有咳嗽评分,生活质量问卷,咳嗽监测以及咳嗽反射敏感性测定。在临床实际中应综合使用这些方法以互为补充。     

咳嗽症状严重程度评价

咳嗽是临床上常见的症状，可南许多疾病引起。评价患者咳嗽程度能够帮助了解患者生活质量受影响程度以及评估治疗效果。近年，发展出了许多咳嗽评估方法包括有咳嗽评分，生活质量问卷，咳嗽监测以及咳嗽反射敏感性测定。在临床实际中应综合使用这些方法以互为补充。     

咳嗽症状严重程度评价

咳嗽是临床上常见的症状,可由许多疾病引起.评价患者咳嗽程度能够帮助了解患者生活质量受影响程度以及评估治疗效果.近年,发展出了许多咳嗽评估方法包括有咳嗽评分,生活质量问卷,咳嗽监测以及咳嗽反射敏感性测定.在临床实际中应综合使用这些方法以互为补充.     

呼出气一氧化氮在慢性咳嗽严重程度评估中的应用价值

目的 探讨呼出气一氧化氮(FeNO)在慢性咳嗽严重程度评估中的临床价值.方法 根据我院呼吸内科门诊2014年6月至2015年2月明确诊断为慢性咳嗽的连续病例68例,对所有患者根据FeNO水平分组,研究组间主观评分差异,并在治疗4周后进行FeNO检测、并评价咳嗽症状积分、莱赛斯特生活质量问卷(LCQ)评分.结果 以FeNO水平分组后,患者LCQ评分及咳嗽症状日间积分各组间差异有统计学意义(P＜0.01).将患者根据咳嗽病因分组,咳嗽变异性哮喘(CVA)组FeNO均值[(67.5±17.1) ppb]显著高于EB组[(34.6±9)ppb],2组高于其他病因组[(23.4±8.9) ppb](Z=-4.9,P＜0.01),治疗后FeNO水平、LCQ值和咳嗽积分相较治疗前均有改善(Z=-3.975,P＜0.01),3组病因间FeNO下降程度不同(P＜0.01),CVA组平均改善率[(33.2±3.9)％]高于其他2组病因患者,FeNO治疗前后总体下降变化与LCQ评分(r=0.48,P＜0.01)及咳嗽症状积分变化呈正相关,其中CVA组及EB组与LCQ评分治疗变化呈较强的相关性,相关系数分别为0.55和0.66(P＜0.01).结论 FeNO与患者的咳嗽症状和生活质量存在相关性,在慢性咳嗽病情评估中具有重要参考价值.     

咳嗽、发热、腹痛

病历摘要 患者女性,36岁,工人。因反复喘憋7a余,加重伴咳嗽、咳痰10余天,于2008年1月7日入院。7a前患者无明显诱因出现喘憋,无咳嗽、咳痰、发热、胸痛等症状,当时诊断为支气管哮喘（哮喘）,给予氨茶碱、地塞米松等药物治疗后病情缓解。以后反复出现上述症状,经解痉、消炎、止喘等药物治疗后病情可控制。3a前因病情复发憋喘加重,一直口服强的松治疗,病情时有反复。10d前患者因受凉后出现咳嗽、咳痰（黄脓痰）伴喘憋,     

新型冠状病毒肺炎患者的早期识别和病情评估

2019年12月中国武汉爆发的新型冠状病毒肺炎(2019-novel coronavirus,2019-nCoV)引发了全球广泛关注,新型冠状病毒具有传播速度快,临床症状不典型、双肺易受累等特点,易导致漏诊误诊,早期识别及病情评估困难。发热、咳嗽肌痛、乏力、呼吸困难等症状及影像学表现可有助于新型冠状病毒肺炎的早期识别。同时病情进展速度、发热情况CT表现、缺氧程度、年龄、基础疾病、实验室指标等可作为新型冠状病毒肺炎病情程度的评估依据。     

咳嗽变异型哮喘2例报告

咳嗽变异型哮喘 (CVA)是一种以咳嗽为主要或唯一症状的哮喘 ,缺乏典型的喘息症状 ,它与典型的支气管哮喘一样均具有气道高反应性 ,但临床特点不尽相同。已知 CVA是一种包括嗜酸粒细胞参与的气道慢性炎症 ,与典型哮喘相似 ,但其气道炎症和临床病情程度相对较轻 ,因此 ,气道反应性测定对其早期确诊至关重要 ,临床上通常将咳嗽作为呼吸系统表现的唯一症状 ,持续时间大于三周 ,胸部影象学未见异常 ,未使用ACEI的慢性咳嗽 ,抗感染效果不佳 ,均应做肺功能及支气管激发试验检查。例 1　女性 ,4 2岁 ,因“咳嗽咳痰一月 ,加重伴气短半月”入院 ,…     

哮喘-慢阻肺重叠综合征1例诊疗分析

正1病历资料患者男,61岁,因"反复咳嗽、喘息10年,加重1个月"为主诉于2016年3月28日入院。患者10年前每逢季节变化或受凉感冒后反复出现咳嗽、喘息,无咳痰、发热、咯血、胸痛,在家自服平喘的药物后症状可缓解,在当地医院诊断为"慢性阻塞性肺疾病",未予以重视。患者病情反复呈逐年加重的趋势。1月前,患者上述症状明显加重,咳嗽,咳白色泡沫痰,伴胸闷、气憋,夜间发作性喘息,无恶心、呕吐,     

沐舒坦治疗老年人肺炎的疗效观察

目的 评价祛痰剂沐舒坦针剂治疗老年人肺炎咳嗽、咳痰的临床疗效及安全性。方法 观察50例老年人肺炎患者分别用沐舒坦、必嗽平治疗前后咳嗽、咳痰（排痰难易程度、痰性状、痰黏度）等临床症状的变化。结果 沐舒坦治疗老年人肺炎的临床症状、体征的临床疗效有效率为60％；祛痰作用为92％。患者在临床疗效、祛痰作用和综合临床评价等方面其治疗后积分都较治疗前有显著改善（P〈0．05）；特别是祛痰疗效，即排痰难易程度、痰性状、痰黏度的改善方面，有更显著的改善。在所有接受药物临床观察的老年人肺炎患者中，患者的体温、心率、呼吸、收缩压、舒张压均无异常改变（P〉0．05）。结论 沐舒坦用于老年人肺炎咳嗽、咳痰的临床疗效明显，特别是痰液黏稠、排痰困难患者其祛痰疗效确切，使用安全，值得临床进一步推广使用。     

尘肺病患者心理特征及护理措施

尘肺病是目前较为常见的职业病之一,占综合职业病总比例的80%之多,我国是患有尘肺病较多的国家之一。尘肺病是由于在职业活动吸入生产性矿物粉尘而引起的以肺组织弥漫纤维化为主的全身性疾病。尘肺病主要以咳嗽、咳痰、胸痛、呼吸困难为主要病症。早期尘肺病患者咳嗽多不明显,但随着病情进展,多合并慢支,晚期常合并肺部感染,使咳嗽加重。呼吸困难是尘肺病的固有症状,随着肺组织纤维化程度的加重而逐渐加重。咳痰是尘肺病病人的常见症状。有合并咯血,较少见,要注意是否合并肺结核。尘肺病合并肺心病者可见心衰的各种临床表现,如缺氧、黏膜发绀、怒张、下肢水肿、肝脏肿大等。尘肺病的并发症是患者常见的直接死因,其中肺结核、气胸、肺心症比较常见。     

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尽管临床上变异性或上呼吸道感染后引起的慢性咳嗽比较常见,但有关的研究报告比较少,目前对其了解尚比较粗浅。1变应性咳嗽目前对变应性慢性咳嗽的界定还是处于描述性的阶段,缺乏系统性研究观察。目前狭义的定义:临床上某些慢性咳嗽,具有一些特应性的因素,抗组胺药物和糖皮质激     

Currently available cough suppressants for chronic cough

Chronic cough is a common symptom but only a fraction of patients seek medical attention. Addressing the causes of chronic cough may lead to control of cough; however, this approach is not always successful since there is a certain degree of failure even when the cause(s) of cough are adequately treated; in idiopathic cough, there is no cause to treat. Persistent cough may be associated with deterioration of quality of life, and treatment with cough suppressants is indicated. Currently available cough suppressants include the centrally acting opioids such as morphine, codeine, and dextromethorphan. Peripherally acting antitussives include moguisteine and levodropropizine. Early studies report success in reducing cough in patients with chronic bronchitis or COPD; however, a carefully conducted study showed no effect of codeine on cough of COPD. Success with these cough suppressants can be achieved at high doses that are associated with side effects. Slow-release morphine has been reported to be useful in controlling intractable cough with good tolerance to constipation and drowsiness. There have been case reports of the success of centrally acting drugs such as amitryptiline, paroxetine, gabapentin, and carbamezepine in chronic cough. New opioids such as nociceptin or antagonists of TRPV1 may turn out to be more effective. Efficacy of cough suppressants must be tested in double-blind randomised trials using validated measures of cough in patients with chronic cough not responding to specific treatments. Patients with chronic cough are in desperate need of effective antitussives that can be used either on demand or on a long-term basis.     

Reflux cough

Cough can be an extraesophageal manifestation of gastroesophageal reflux disease. This article summarizes recent progress in our understanding of the pathophysiology, diagnosis, and treatment of the reflux cough syndrome. Recent studies have provided further evidence for a role of weakly acidic gastroesophageal reflux in inducing cough. It has also been established that although reflux may induce cough, cough may also trigger reflux in some patients, and distinguishing between the two requires objective detection of cough burst (ie, by esophageal manometry). Treatment of the reflux cough syndrome is an issue of ongoing controversy and further studies.     

Pertussis-induced cough

Pertussis (whooping cough) is one of the commonest vaccine preventable diseases in the UK, despite vaccination coverage being maintained for the last 15 years at over 90% among infants and the addition of a pre-school booster to the UK national immunisation programme in 2001. However, it is known that pertussis vaccine does not confer long-term immunity to clinical infection. Evidence of pertussis infection has been reported in 37% of children presenting in UK primary care and 20% of adolescents and adults presenting in Canadian health centres with persistent cough. In children and adults with persistent cough, paroxysmal coughing is the most sensitive indicator of pertussis, but has poor specificity and limited diagnostic value. Vomiting and whooping, particularly in combination, are stronger predictors of pertussis. Cough duration is longer in children than in adults with pertussis (median cough duration 112 days versus 42 days); individuals may take even longer to recover fully and regain previous levels of exercise tolerance. A diagnosis of pertussis may be confirmed by culture, Polymerase Chain Reaction (PCR) or serology. Single estimates of anti-pertussis toxin (PT) antibody titres in blood or oral fluid samples are highly specific. There are currently no proven efficacious treatments for pertussis-induced cough. Treatment with macrolide antibiotics reduces the duration of an individual's infectious period, but does not alter the duration of cough. Further research is needed to re-examine the epidemiology of pertussis in countries with different vaccination schedules, find efficacious treatments and develop methods of measuring cough frequency and severity in patients with pertussis-induced cough.     

Altitude-related cough

Cough is a troublesome condition which affects many visitors to high altitude. Traditionally it has been attributed to the inspiration of the cold, dry air which characterizes the high altitude environment. This aetiology was brought into question by observations and experiments in long duration hypobaric chamber studies in which cough still occurred despite controlled temperature and humidity. Anecdotally however, exercise, possibly via the associated increase in ventilation, does appear to precipitate cough at altitude. It is likely that the term, altitude-related cough, covers a number of conditions and aetiologies. These aetiologies are discussed and include water loss from the respiratory tract; high altitude pulmonary oedema; acute mountain sickness; bronchoconstriction; respiratory tract infections; vasomotor rhinitis and post-nasal drip; and alterations in the central control of respiration. We hypothesize that there are two forms of altitude-related cough: a cough which may occur at relatively low altitudes and which is related to exercise and persists despite descent and a cough which does not occur at altitudes below 5000-6000 m and which improves rapidly with descent to lower altitude. The treatment of altitude-related cough is symptomatic and frequently ineffective. Further work is required to understand the nature and aetiology of the cough which occurs at high altitude before effective therapies can be developed.     

Captopril-induced cough

Since the advent of angiotensin-converting enzyme inhibitors (captopril and enalapril), cough has been recognized sporadically as a side effect, but has received little attention in the pulmonary literature. To emphasize that angiotensin-converting enzyme (ACE) inhibitors should be considered among possible etiologies of cough, we report recent experience with two patients and review the available experience with ACE inhibitor-induced cough.