鼻后滴漏与慢性咳嗽：一项开放式干预研究
2009/08/11
背景：鼻后滴漏（PND）综合征常为慢性咳嗽的一个原因，虽然该观点尚存在争议。
目的：在患有慢性咳嗽伴鼻后滴漏或鼻部卡他症状的患者中，研究针对鼻窦炎的特异性局部治疗对咳嗽的作用。
方法：患有慢性咳嗽和主诉PND的患者入选本研究，患者的PND和咳嗽症状分别采用问卷调查和辣椒素咳嗽反应测试进行评价。鼻窦炎采用问卷调查和直接鼻腔检查以及高分辨率CT检查进行评估。在本项开放性研究中，患者应用氟替卡松滴鼻剂、异丙托溴铵和氮卓斯汀鼻喷剂治疗28天，治疗结束后再次对患者进行评价。
结果：21名患者中有18名完成本项研究。所有患者均主诉咽喉部有粘液。治疗后平均咳嗽评分得到改善（p<0.05），但辣椒素咳嗽反应敏感性和鼻部卡他症状问卷调查评分无显著差异。治疗后鼻前庭卡他症状评分（p=0.005）及鼻腔内窥镜评分均有所改善（p<0.01），PND评分也有改善趋势。
结论：本项对慢性咳嗽和PND综合征患者进行的开放式真实治疗研究显示，针对鼻窦炎的治疗可以改善咳嗽症状。但还需随机对照试验来进一步验证本研究的结论。
（陈欣 审校）
Macedo P, et al. Respir Med. 2009 May 28. [Epub ahead of print]
Postnasal drip and chronic cough: An open interventional study.
Macedo P, Saleh H, Torrego A, Arbery J, Mackay I, Durham SR, Chung KF.
Royal Brompton Hospital, Imperial College, London SW3, UK; National Heart & Lung Institute, Imperial College, London SW3, UK.
BACKGROUND: The postnasal drip (PND) syndrome is often linked as a cause of chronic cough although this is disputed.
OBJECTIVES: We examined the effect of specific topical treatment of rhinosinusitis on cough in patients presenting with a chronic cough associated with a postnasal drip or ’nasal catarrh’.
METHODS: Patients presenting with a chronic cough and who complained of PND were enrolled and symptoms of PND and cough were assessed by questionnaire and by a capsaicin cough response. Rhinosinusitis was assessed by questionnaires, direct examination of the nose and by high-resolution computed tomography. In an open study, they were treated with fluticasone nasules, ipratropium bromide and azelastine nasal sprays for 28 days, after which they were re-assessed.
RESULTS: Eighteen out of 21 patients completed the study. All patients reported having the presence of mucus in the throat. Mean cough score improved post-treatment (p<0.05), but there was no significant change in capsaicin cough sensitivity or nasal catarrh questionnaire score. There was improvement in anterior nasal discharge symptom scores (p=0.005) and in endoscopic nasal scores post-treatment (p<0.01), with a tendency to improved PND scores.
CONCLUSION: In a pilot open ’real-life’ study treatment targeted towards rhinosinusitis accompanying PND syndrome and chronic cough led to an improvement in cough. A randomised controlled study is now needed to confirm or refute these findings.
