Clinical analysis of subacute cough in patients with allergic rhinitis

doi:10.3969/j.issn.1004-583X.2023.10.007

Abstract

Abstract: Objective To analyze the characteristics and severity of cough, as well as the increase in fractional exhaled nitric oxide (FeNO) and the treatment of subacute cough in patients with allergic rhinitis. Methods A total of 526 patients with subacute cough were divided into experimental group and control group according to the presence of allergic rhinitis or not. The severity of cough, FeNO, nocturnal cough and throat itching between the experimental group and control group were statistically analyzed. According to the FeNO test results and with the combination of allergic rhinitis, patients were further divided into subgroup A, B, C and D. They were treated with antitussive, antiallergic, inhaled corticosteroids alone or in the combination, followed by the analysis of the 1-week remission rate of cough. Results A total of 526 patients were included in the study, including 216 males with the mean age of (39.68±11.95) years and 310 females with the mean age of (38.18±12.17) years. There were 94 cases (17.9%) in the experimental group, including 46 males and 48 females, and 432 cases (82.1%) in the control group, including 171 males and 261 females. The median and quartile interval of cough severity score in the experimental group was significantly greater than those of control group (4 [2, 5] vs 3 [2, 5], Z=3.648, P=0.000). The ratio of increased FeNO (≥25 ppb) in the experimental group was significantly higher than that of control group (35.5% vs 23.6%, χ²=5.647, P=0.017). The positive rate of nocturnal cough and throat itching in the experimental group was significantly higher than that of control group (48.4% vs 36.1%, χ²=4.887, P=0.027). After one week of treatment, the cough relief rate of subgroup C was significantly lower than that of other groups, which was relatively high in subgroup A, B and D. Conclusion Allergic rhinitis patients combined with subacute cough have severer cough, eosinophilic airway inflammation or mixed airway inflammation, which is better responsive to the combination of antiallergic or inhaled corticosteroids.

Key words: cough, allergic rhinitis, fractional exhaled nitric oxide, nocturnal cough, throat itching

CLC Number:

R256.11

Li Yuanpeng, Chen Liang, Liu Junan, Li Tianlin. Clinical analysis of subacute cough in patients with allergic rhinitis[J]. Clinical Focus, 2023, 38(10): 904-906.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.10.007

https://huicui.hebmu.edu.cn/EN/Y2023/V38/I10/904

Figures/Tables 2

Tab. 1 Comparison of cough score, FeNO, nocturnal cough and throat itching between groups

组别	例数	咳嗽严重程度评分 [M(P25, P75)]	FeNO增高比例 [例(%)]	夜间咳嗽+咽喉瘙痒比例 [例(%)]
试验组	94	4(2, 5)	35.5	48.4
对照组	432	3(2, 5)	23.6	36.1
$Z$ /χ²值		3.648	5.647	4.887
P值		0.000	0.017	0.027

Tab. 1 Comparison of cough score, FeNO, nocturnal cough and throat itching between groups

组别	例数	咳嗽严重程度评分 [M(P25, P75)]	FeNO增高比例 [例(%)]	夜间咳嗽+咽喉瘙痒比例 [例(%)]
试验组	94	4(2, 5)	35.5	48.4
对照组	432	3(2, 5)	23.6	36.1
$Z$ /χ²值		3.648	5.647	4.887
P值		0.000	0.017	0.027

Tab. 2 Comparison of cough relief rates among four subgroups

组别	例数	咳嗽缓解率
试验组
A组	61	52(85.2)^*
B组	33	30(90.9)^*
对照组
C组	357	258(72.3)
D组	75	63(84.0)^*
χ²值		12.347
P值		0.006

References 18

[1]	中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 咳嗽基层诊疗指南(2018年)[J]. 中华全科医师杂志, 2019, 18(3):220-227.
[2]	程雷, 董震, 孔维佳. 变应性鼻炎诊断和治疗指南(2015年, 天津)[J]. 中华耳鼻咽喉头颈外科杂志, 2016, 51(1):6-24.
[3]	Dweik RA, Boggs PB, Erzurum SC, et al. An official ATS clinical practice guideline: Interpretation of exhaled nitric oxide levels (FENO) for clinical applications[J]. Am J Respir Crit Care Med, 2011, 184(5): 602-615. doi: 10.1164/rccm.9120-11ST URL
[4]	Hsu JY, Stone RA, Logan-Sinclair RB, et al. Coughing frequency in patients with persistent cough: Assessment using a 24 hour ambulatory recorder[J]. Eur Respir J, 1994, 7(7): 1246-1253. pmid: 7925902
[5]	陈如冲, 赖克方, 刘春丽, 等. 辣椒素咳嗽激发试验方法的建立及其安全性评价[J]. 中华结核和呼吸杂志, 2005, 28(11):751-754.
[6]	Ishida T, Yokoyama T, Iwasaku M, et al. Clinical investigation of postinfectious cough among adult patients with prolonged cough[J]. Nihon Kokyuki Gakkai Zasshi, 2010, 48:179-185.
[7]	杨艳娟, 郑西卫, 李芳, 等. 布地奈德福莫特罗吸入治疗咳嗽变异性哮喘疗效观察[J]. 临床荟萃, 2010, 25(19):1715-1717.
[8]	Diver S, Russell RJ, Brightling CE. Cough and Eosinophilia[J]. J Allergy Clin Immunol Pract, 2019, 7(6): 1740-1747. doi: S2213-2198(19)30457-X pmid: 31279462
[9]	李远鹏, 李天林, 陈亮, 等. 582例亚急性咳嗽患者的临床特点分析[J]. 中外医疗, 2022, 41(33):61-64.
[10]	Ambrosino P, Accardo M, Mosella M, et al. Performance of fractional exhaled nitric oxide in predicting response to inhaled corticosteroids in chronic cough: A meta-analysis[J]. Ann Med, 2021, 53(1): 1659-1672. doi: 10.1080/07853890.2021.1979242 pmid: 34528479
[11]	中华医学会呼吸病学分会哮喘学组, 中国哮喘联盟. 支气管哮喘急性发作评估及处理中国专家共识[J]. 中华内科杂志, 2018, 57(1):4-14.
[12]	Butler CA, Heaney LG. Fractional exhaled nitric oxide and asthma treatment adherence[J]. Curr Opin Allergy Clin Immunol, 2021, 21(1): 59-64. doi: 10.1097/ACI.0000000000000704 URL
[13]	李远鹏, 李天林, 陈亮, 等. 呼出气一氧化氮在门诊慢性咳嗽诊治中的意义[J]. 中外医学研究, 2019, 17(5):9-11.
[14]	Liu X, Zhang H, Wang Y, et al. Fractional exhaled nitric oxide is associated with the severity of stable COPD[J]. COPD, 2020, 17:121-127. doi: 10.1080/15412555.2019.1704231 pmid: 32116037
[15]	Jiang M, Liu M, Wang Y, et al. Association between fractional exhaled nitric oxide and clinical characteristics and outcomes in patients with subacute cough[J]. Clin Respir J, 2018, 12(3): 1068-1075. doi: 10.1111/crj.12629 pmid: 28296234
[16]	万滢. 气道高反应及其相关危险因素在亚急性咳嗽中的临床应用研究[D]. 甘肃中医药大学, 2020.
[17]	Lai K, Lin L, Liu B, et al. Eosinophilic airway inflammation is common in subacute cough following acute upper respiratory tract infection[J]. Respirology, 2016, 21(4): 683-688. doi: 10.1111/resp.12748 pmid: 26969485
[18]	Folkerts G, Nijkamp FP. Virus-induced airway hyperresponsiveness. Role of inflammatory cells and mediators[J]. Am J Respir Crit Care Med, 1995, 151(5): 1666-1673, 1673-1674. doi: 10.1164/ajrccm/151.5_Pt_1.1666 URL