咳嗽变异性哮喘的最佳治疗方法

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咳嗽变异性哮喘是哮喘的一种特殊类型,咳嗽是其唯一或主要临床表现,无明显喘息、气促等症状或体征,但存在气道高反应性。

咳嗽变异性哮喘的最佳治疗方法

就诊科室:
呼吸科
是否医保
英文名称:
cough variant asthma,CVA
是否常见:
是否遗传:
并发疾病:
慢性阻塞性肺病、肺源性心脏病
治疗周期:
3个月左右
临床症状:
顽固、刺激性咳嗽
好发人群:
任何人群均可发病,女性居多
常用药物
布地奈德、福莫特罗、沙美特罗、氟替卡松
常用检查
肺功能检查、血常规、胸部CT检查、诱导痰细胞学检查、支气管激发试验

咳嗽变异性哮喘病因未明,但目前认为与典型支气管哮喘相似,其发病与遗传和环境因素有关。

主要病因

遗传因素

调查资料表明,哮喘亲属患病率高于群体发病率,且亲缘关系越近,患病率越高。

环境因素

包括某些激发因素,如吸入物、花粉、尘螨等过敏原刺激和物理冷空气刺激。

气道慢性炎症

气道高反应

各种刺激因子导致气道出现收缩反应,造成支气管狭窄。

过敏及特应性体质

咳嗽大多与季节以及环境中的过敏原有关系。

气道重构

长期持续性的炎症反复发作,会引起支气管的变化。

运动过度和换气过度

特别对于运动性过敏性咳嗽患者,运动可能为致病原因,经过预定量的运动后会出现喘息症状。

诱发因素
  • 感染是最常见的诱发因素之一。
  • 油烟、灰尘、冷空气及接触过敏原。
  • 吸烟会刺激气道,从而引起气道炎症,诱发该病。
  • 抵抗力低下人群患病的几率增大。
流行病学

新近硏究发现慢性咳嗽的全球患病率高达96%,来自日本的一项硏究发现,咳嗽变异性哮喘是成人慢性咳嗽的最常见病因,占慢性咳嗽病因的42.2%。我国多中心研究结果发现,咳嗽变异性哮喘占中国人群成人慢性咳嗽病因构成的32.6%。

好发人群

咳嗽变异性哮喘发病人群不限,年幼儿和成人均可发病,尤其是女性患者。

刺激性咳嗽是最主要的症状,也是唯一的症状,无明显喘息、胸闷、气急等症状。

典型症状

咳嗽变异性哮喘的典型症状为阵发性干咳,通常咳嗽比较剧烈,夜间及凌晨咳嗽为其重要特征,感冒、冷空气、灰尘及油烟等容易诱发或加重咳嗽。同时具有典型哮喘的发病特点,即反复发作性、季节性和时间节律性。

并发症

咳嗽变异性哮喘长期未控制,会导致肺功能不可逆损害,出现典型哮喘、慢性阻塞性肺病、肺源性心脏病、呼吸衰竭。

如果出现咳嗽时间较长,常大于8周以上,需要及时就医,查明病因。根据慢性咳嗽病史及特点、支气管激发试验和抗哮喘治疗的有效性综合分析做出诊断。

就医指征

反复咳嗽,且难以缓解,应该去医院就诊,进行详细检查,查明慢性咳嗽的病因,及时治疗,避免引起慢性咳嗽的并发症,或者延误病因诊断,耽误及时治疗。尤其是患者出现持续咳嗽时间大于8周,以夜间与及凌晨咳嗽为其重要特征,不伴有胸闷、气急、喘息,需要考虑咳嗽变异性哮喘。

就诊科室

咳嗽变异性哮喘一般去呼吸科就诊。

医生询问病情
  • 你本次咳嗽持续时间大概有多久了?
  • 咳嗽是什么性质的?是干咳还是伴有咳痰?如果有痰,痰液是什么颜色?什么性状?
  • 咳嗽时候有什么诱发或加重因素吗?咳嗽受体位影响吗?伴随有其他症状吗?
  • 有吸烟吗?如果有,一天吸烟多少包?
  • 您的职业是什么?是否接触有刺激性职业的油漆或者汽油?
  • 您有过敏史吗?咳嗽时有伴有反酸、嗳气、胸骨后烧灼感或餐后加重吗?
需要做的检查

肺功能检查、支气管激发试验

如果肺功能检查中最大呼气流速(PEF)平均变异率>10%,支气管舒张试验、支气管激发试验阳性可以明确诊断。

胸部X线检查或胸部CT检查

胸部x线检查或胸部CT检查为了排除患者是否是感染、肺不张等其他原因所致。

诱导痰液检查做细胞分类

诱导痰嗜酸性细胞增高,可有助于诊断咳嗽变异性哮喘。

过敏原检查

部分患者可以通过过敏原检查可以查出致敏原。

血常规

血常规检查为了排除感染,另外,可见嗜酸性粒细胞增高。

诊断标准
  • 慢性咳嗽,常伴有明显的夜间刺激性咳嗽。
  • 支气管激发试验阳性,或最大呼气流速(PEF)平均变异率>10%,或支气管舒张试验阳性。
  • 抗哮喘治疗有效。
鉴别诊断

上气道咳嗽综合征

由于鼻部疾病引起分泌物倒流鼻后和咽喉等部位,直接或间接刺激咳嗽感受器,导致以咳嗽为主要表现的临床综合征,也称鼻后滴流综合征。除咳嗽、咳痰外,可表现鼻塞、鼻腔分泌物增加、频繁清嗓、咽后黏液附着及鼻后滴流感,依据这一点可于该疾病进行鉴别。

慢性支气管炎

咳嗽、咳痰连续2年以上,每年累积或持续至少3个月,并排除其他引起慢性咳嗽的病因。咳嗽、咳痰一般晨间明显,咳白色泡沫痰或黏液痰,加重期亦有夜间咳嗽。咳嗽变异性哮喘多为阵发性干咳并且较为剧烈,夜间、凌晨咳嗽,并且会伴有典型的哮喘发病特点,可以此来进行鉴别。

食管反流性咳嗽

胃食管返流性咳嗽是因胃酸和其他胃内容物反流进入食管,导致以咳嗽为突出表现的临床综合征,属于胃食管反流病的一种特殊类型,是慢性咳嗽的常见原因。临床表现除咳嗽外,40%~68%的胃食管反流性咳嗽患者可伴反酸、胸骨后烧灼感及嗳气等典型反流症状,但也有不少患者以咳嗽为唯一的表现。咳嗽大多发生在日间和直立位以及体位变换时,干咳或咳少量白色黏痰。进食酸性、油腻食物容易诱发或加重咳嗽。咳嗽变异性哮喘以刺激性咳嗽为主要特征,也是本病的唯一症状。

嗜酸粒细胞性支气管炎

嗜酸粒细胞性支气管炎是慢性咳嗽的常见病因,主要为慢性刺激性咳嗽,常是唯一的临床症状,干咳或咳少许白色黏液痰,多为白天咳嗽,少数伴有夜间咳嗽。患者对油烟、灰尘、异味或冷空气比较敏感,常为咳嗽的诱发因素。患者无气喘、呼吸困难等症状。嗜酸性细胞性支气管炎并无气道高反应特征,通过这一点可与咳嗽变异性哮喘进行鉴别。

咳嗽变异性哮喘治疗原则与典型哮喘相同,如果能找到致敏原,应立即脱离过敏原的接触,药物治疗主要是吸入糖皮质激素和支气管扩张剂。

治疗周期
咳嗽变异性哮喘治疗至少12周以上,部分患者反复发作,转变成典型哮喘者需要长期治疗。
药物治疗
  • 吸入性糖皮质激素(ICS)联合支气管舒张剂治疗,比单用ICS或支气管舒张剂治疗能更快速和有效地缓解咳嗽症状。推荐使用吸人糖皮质激素和支气管舒张剂(β2受体激动剂)的复方制剂,如布地奈德、福莫特罗、氟替卡松、沙美特罗。建议治疗时间至少8周以上,部分患者需要长期治疗。
  • 如果患者症状或气道炎症较重,或对吸人激素治疗反应不佳时,建议短期口服糖皮质激素治疗。如果口服激素治疗无效,需注意是否存在诊断错误,支气管激发试验假阳性或其他疾病,如早期的嗜酸性肉芽肿性多血管炎,或存在一些影响疗效的因素。
  • 白三烯受体拮抗剂治疗咳嗽变异性哮喘有效,能够减轻患者咳嗽症状、改善生活质量并减缓气道炎症。少数对ICS治疗无效的患者,使用白三烯受体拮抗剂治疗可能有效。治疗疗程及对气道炎症的抑制作用仍有待进一步研究。
  • 茶碱类药物,例如茶碱缓释片。
  • 口服激素类药物,当吸入激素无效时,医生可能会嘱患者口服醋酸泼尼松。
中医治疗

中医认为咳嗽变异性哮喘与风邪犯肺、肺气失宣有关,治疗宜疏风宣肺、止咳利咽,采用苏黄止咳胶囊治疗有效。

咳嗽变异性哮喘患者如经过早期干预、积极治疗,一般可完全控制。若未经规范治疗,大约30%~40%的患者会逐渐发展成典型哮喘,儿童的比例更高。

能否治愈

该病通过治疗可以缓解,部分患者再不发作,大多数患者会反复发作,需要长期甚至终身用药,因此通常无法治愈。因该病为过敏所致咳嗽变异性哮喘,如果再次接触过敏原,会引发再次发作,可能需要长期用药。

复诊

患者接触过敏原后、感染后均可诱发再次出现咳嗽变异性哮喘发作,及时就诊。

咳嗽变异性哮喘的患者,应避免接触有可能会导致过敏食物及物质,尽量清淡饮食,少吃辛辣、刺激性食物。

饮食调理
  • 患者避免进食可能会导致过敏的食物,多食用富含ω-3-脂肪酸的食物。
  • 避免进食有高度刺激的食物,如辛辣食物、酒等,以免诱发该病的发生。
  • 多食新鲜蔬菜,尤其是富含维生素C的食物,如西红柿、葡萄等。
  • 避免进食高脂肪、高热量的食物。尽量控制体重,以防加重哮喘症状。

    咳嗽变异性哮喘患者平时宜避免接触各种有刺激性的物品,远离刺激性环境等,以免诱发过敏性症状的出现。

    日常护理
    • 注意平常个人生活卫生,勤洗被子、衣物及床上生活用品。
    • 保持室内环境的整洁,避免灰尘沉积。
    • 避免在室内放置花草、接触宠物、皮毛等易致敏东西。
    • 掌握正确的药物吸入技术,特别是干粉吸入器的正确使用。
    • 规律锻炼身体,增强体质,但应避免剧烈运动。
    • 保持健康体重,超重或营养不良人群应相应减重或增重。
    特殊注意事项
    • 反复咳嗽>8周,尤其是以夜间与及凌晨咳嗽为其重要特征,需要尽快到医院就医,明确诊断。
    • 雾化吸入激素类药物,一定要规律吸入,且吸完后漱口。如果口服激素,疗程不要超过5天。
    • 需要定期到医院呼吸科肺功能室进行肺功能检测,评估哮喘控制状态。

      咳嗽变异性哮喘具体病因不明,但避免接触已知的过敏原,保持良好的生活卫生习惯,避免诱发疾病发生的因素,规律的正确的吸入糖皮质激素和支气管扩张剂是控制病情的关键。

      早期筛查

      对初次发生咳嗽变异性哮喘患者应彻底治疗;检査有无肺部其他疾病,如变态反应性肺曲霉菌病或者支气管结核等,及时发现并进行过敏原筛查。

      预防措施
      • 保持生活环境的卫生,避免接触易致过敏的物质,如粉尘、皮毛、花粉及有害气体的吸入。
      • 加强患者自我管理及正确使用吸入糖皮质激素和支气管扩张剂,定期规律门诊随访,避免突然停用吸入药物,导致疾病发作及加重。
      • 吸烟人群要戒烟,同时避免吸入二手烟。
      • 增强体质,积极规律锻炼。
      • 积极治疗过敏性疾病,避免接触过敏原,健康饮食,避免接触过敏食物。
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康恩贝金笛复方鱼腥草合剂18瓶感冒咳嗽喉咙痛清热解毒扁桃体炎 券后价¥33.90 天猫 优惠券¥5.00 立即领券
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【高性价比】欧姆龙雾化机 家用儿童雾化器C25S 成人哮喘化痰止咳 券后价¥248.00 天猫 优惠券¥50.00 立即领券
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