噻托溴铵粉雾剂治疗感染后咳嗽的疗效
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摘要
目的探讨噻托溴铵粉雾剂治疗感染后咳嗽的临床疗效。方法在2017年6月至2018年6月完成30 d随访的咳嗽患者中,选择接受噻托溴铵单药治疗的感染后咳嗽患者46例,采用回顾性研究方法,根据随访得到的症状描述,完成中文莱切斯特问卷(LCQ)和视觉模拟评分(VAS),评估临床疗效。并根据患者是否合并咽痒,是否有夜间加重及干咳和湿咳,根据呼出气一氧化氮(FeNO)值将患者划分亚组,比较亚组间的临床疗效。观察有效的患者30 d随访的复发情况及不良反应。结果噻托溴铵治疗7 d后,达到咳嗽临床控制4例(8. 7%),显著有效10例(21. 74%),有效13例(28. 26%),无效19例(41. 3%),总有效27例(58. 7%);有效的患者起效时间3～5 d。各亚组间噻托溴铵总有效率无明显差异。27例有效的患者在随访30 d期间均未出现复发,有3例(11. 1%)患者有口干口渴症状,1例(3. 7%)患者有头晕症状,未出现严重不良反应。结论噻托溴铵粉吸雾剂对部分感染后咳嗽有效且安全。
Objective To investigate the clinical efficacy of tiotropium in the treatment of postinfection cough.Methods A-mong the cough patients who completed the 30-day follow-up in the respiratory department of this hospital during 2017.6 ～ 2018.6,46 patients with postinfection cough were treated with tiotropium monotherapy. Using a retrospective approach,based on the symptom de-scriptions obtained during follow-up,the Chinese Leicester Questionnaire( LCQ) and Visual Analog Scale( VAS) were completed toassess clinical outcomes. And according to whether the patient had itching,whether there was nighttime aggravation and dry cough andwet cough,and the patients were divided into subgroups according to the exhaled nitric oxide( Fe NO) value,clinical efficacy betweensubgroups was compared. The recurrence and adverse reactions of the effective patients at 30 days of follow-up were observed.Results7 days after tiotropium treatment,the number of patients who achieved clinical control of cough was 4( 8.7%),10 patients( 21.74%)were significantly effective,13 patients( 28.26%) were effective,19 patients( 41.3%) were ineffective,and 27 patients( 58.7%)were effective.Effective patient onset time was 3 ～ 5 days. There was no significant difference in the total effective rate of tiotropium be-tween the subgroups. 27 patients that were effective had no recurrence during the 30-day follow-up period. 3 cases( 11.1%) had drymouth and thirst,and 1 case( 3.7%) had dizziness and there was no serious adverse reaction. Conclusions Tiotropium is effectiveand safe for section postinfectious cough.
Objective To investigate the clinical efficacy of tiotropium in the treatment of postinfection cough.Methods A-mong the cough patients who completed the 30-day follow-up in the respiratory department of this hospital during 2017.6 ～ 2018.6,46 patients with postinfection cough were treated with tiotropium monotherapy. Using a retrospective approach,based on the symptom de-scriptions obtained during follow-up,the Chinese Leicester Questionnaire( LCQ) and Visual Analog Scale( VAS) were completed toassess clinical outcomes. And according to whether the patient had itching,whether there was nighttime aggravation and dry cough andwet cough,and the patients were divided into subgroups according to the exhaled nitric oxide( Fe NO) value,clinical efficacy betweensubgroups was compared. The recurrence and adverse reactions of the effective patients at 30 days of follow-up were observed.Results7 days after tiotropium treatment,the number of patients who achieved clinical control of cough was 4( 8.7%),10 patients( 21.74%)were significantly effective,13 patients( 28.26%) were effective,19 patients( 41.3%) were ineffective,and 27 patients( 58.7%)were effective.Effective patient onset time was 3 ～ 5 days. There was no significant difference in the total effective rate of tiotropium be-tween the subgroups. 27 patients that were effective had no recurrence during the 30-day follow-up period. 3 cases( 11.1%) had drymouth and thirst,and 1 case( 3.7%) had dizziness and there was no serious adverse reaction. Conclusions Tiotropium is effectiveand safe for section postinfectious cough.
引文
1中华医学会呼吸病学分会哮喘学组.咳嗽的诊断和治疗指南(2015)[J].中华结核和呼吸杂志,2016;39(5):323-40.
2 Irwin RS,French CT,Lewis SZ,et al.Overview of the management of cough:CHEST Guideline and Expert Panel Report[J].Chest,2014;146(4):885-9.
3周琼,骆天炯.感染后咳嗽发病机制的研究进展[J].中华肺部疾病杂志(电子版),2018;11(3):373-6.
4 Braman SS.Postinfectious cough:ACCP evidence-based clinical practice guidelines[J].Chest,2006;129(1 Suppl):138-46.
5 Capristo C,Rossi GA.Post-infectious persistent cough:pathogenesis and therapeutic options[J].Minerva Pediatr,2017;69(5):444-52.
6 Vestbo J,Papi A,Corradi M,et al.Single inhaler extrafine triple therapy versus long-acting muscarinic antagonist therapy for chronic obstructive pulmonary disease(TRINITY):a double-blind,parallel group,randomised controlled trial[J].Lancet,2017;389(10082):1919-29.
7 Donohue JF,Fogarty C,L9tvall J,et al.Once-daily bronchodilators for chronic obstructive pulmonary disease:indacaterol versus tiotropium[J].Am J Respir Crit Care Med,2010;182(2):155-62.
8卫生部呼吸系统药理临床基地.镇咳、平喘药物临床研究指导原则[J].中国临床药理学杂志,1989;5(2):127-8.
9 Niimi A,Chung KF.Evidence for neuropathic processes in chronic cough[J].Pulm Pharmacol Ther,2015;35(1):100-4.
10 El-Hashim AZ,Jaffal SM.Cough reflex hypersensitivity:A role for neurotrophins[J].Exp Lung Res,2017;43(2):93-108.
11 Kummer W,Lips KS,Pfeil U.The epithelial cholinergic system of the airways[J].Histochem Cell Biol,2008;130(2):219-34.
2 Irwin RS,French CT,Lewis SZ,et al.Overview of the management of cough:CHEST Guideline and Expert Panel Report[J].Chest,2014;146(4):885-9.
3周琼,骆天炯.感染后咳嗽发病机制的研究进展[J].中华肺部疾病杂志(电子版),2018;11(3):373-6.
4 Braman SS.Postinfectious cough:ACCP evidence-based clinical practice guidelines[J].Chest,2006;129(1 Suppl):138-46.
5 Capristo C,Rossi GA.Post-infectious persistent cough:pathogenesis and therapeutic options[J].Minerva Pediatr,2017;69(5):444-52.
6 Vestbo J,Papi A,Corradi M,et al.Single inhaler extrafine triple therapy versus long-acting muscarinic antagonist therapy for chronic obstructive pulmonary disease(TRINITY):a double-blind,parallel group,randomised controlled trial[J].Lancet,2017;389(10082):1919-29.
7 Donohue JF,Fogarty C,L9tvall J,et al.Once-daily bronchodilators for chronic obstructive pulmonary disease:indacaterol versus tiotropium[J].Am J Respir Crit Care Med,2010;182(2):155-62.
8卫生部呼吸系统药理临床基地.镇咳、平喘药物临床研究指导原则[J].中国临床药理学杂志,1989;5(2):127-8.
9 Niimi A,Chung KF.Evidence for neuropathic processes in chronic cough[J].Pulm Pharmacol Ther,2015;35(1):100-4.
10 El-Hashim AZ,Jaffal SM.Cough reflex hypersensitivity:A role for neurotrophins[J].Exp Lung Res,2017;43(2):93-108.
11 Kummer W,Lips KS,Pfeil U.The epithelial cholinergic system of the airways[J].Histochem Cell Biol,2008;130(2):219-34.