만성기침의 진단과 치료를 위한 유용한 접근법
Useful approach to the diagnosis and treatment of chronic cough
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만성기침은 기침을 일으키는 원인 질환을 진단하여 치료가 가능하기 때문에 만성기침을 일으키는 원인 질환을 진단하고 치료하는 접근방법을 잘 알 필요가 있다. 각 원인 질환에 따라 경험적 치료 또는 진단 후 적극적 치료의 접근방법을 언제 시행할 것인지를 알아야 한다. 각 질환에 따라 치료약물에 의해 호전되는 예상기간을 아는 것이 필요하다. 만약 예상되는 기간 동안 반응이 없다면 다른 기침 원인을 찾아보아야 한다. 치료에 대한 기침반응을 평가하는 방법을 마련해 놓으면 환자 관리에 더 편하다. 동일 환자에서 만성기침을 일으키는 원인 질환이나 요인들이 두 가지 이상 있는 경우가 상당수 존재하기 때문에 한 가지 질환에 대한 치료에 대한 기침반응 평가가 만족스럽지 않은 경우에는 다른 원인 질환의 동반 유무를 확인하여, 동시에 치료해 주는 것이 중요하다. 그러나 만성기침의 약 20% 정도에서는 모든 검사를 시행하여도 원인을 알 수 없다. 향후 연구를 통하여 진단과 치료를 위한 접근법의 수정 또는 변화가 필요하다고 생각되며, 기침반사 항진의 기전 연구와 새로운 진해제 개발도 필요하다고 생각된다.
Abstract
It is necessary to recognize how to approach patients with chronic cough to diagnosis and treat the causes, because cough may resolve only after the management of the causative disease. There are many reports of successful management of cohorts of patients with chronic cough, by use of variants of anatomic, diagnostic approach to investigation. It should be recognized whether initial empiric treatment or specific treatment following diagnostic investigations is begun and when cough improves since the treatment for each disease. The resolution of cough in response to the empiric or specific treatment should be assessed to confirm the diagnosis of the diseases as a cause of cough. The treatment should be given in sequential and additive steps because more than one cause of cough may be present in some patients. However, in up to 20% of referrals to cough clinics, the cause of cough remains unclear even after extensive investigations and treatment trials, suggesting that aspects of the anatomic, diagnostic investigation protocol need to be modified. Hence, more research and better treatments for chronic cough are needed.
참고문헌 (19)
- Irwin RS, "Chronic persistent cough in the adult: the spectrum and frequency of causes and successful outcome of specific therapy", Am Rev Respir Dis, 123, pp.413~417 (1981)
- Irwin RS, "Managing cough as a defense mechanism and as a symptom. A consensus panel report of the American College of Chest Physicians", Chest, 114, pp.133S~181S (1998)
- Irwin RS, "Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines", Chest, 129, pp.1S~23S (2006)
- Morice AH, "The diagnosis and management of chronic cough", Eur Respir J, 24, pp.481~492 (2004)
- Morice AH, "Recommendations for the management of cough in adults", Thorax, 61(Suppl 1), pp.i1~24 (2006)
- Chung KF, "Prevalence, pathogenesis, and causes of chronic cough", Lancet, 371, pp.1364~1374 (2008)
- McGarvey LP, "Does idiopathic cough exist?", Lung, 186(Suppl 1), pp.S78~81 (2008)
- 지영구, "만성기침으로 내원한 환자에서 원인 질환 및 빈도에 관한 전향적연구", 천식 및 알레르기, 18, pp.222~231 (1998)
- Dicpinigaitis PV, "Cough reflex sensitivity in cigarette smokers", Chest, 123, pp.685~688 (2003)
- Belafsky PC, "Symptoms and findings of laryngopharyngeal reflux", Ear Nose Throat J, 81, pp.10~13 (2002)
- Belafsky PC, "The validity and reliability of the reflux finding score (RFS)", Laryngoscope, 111, pp.1313~1317 (2001)
- Irwin RS, "Cough and gastroesophageal reflux: identifying cough and assessing the efficacy of cough-modifying agents", Am J Med, 111(Suppl 8A), pp.45S~50S (2001)
- Vela MF, "Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux: effect of omeprazole", Gastroenterology, 120, pp.1599~1606 (2001)
- Irwin RS, "Chronic cough due to gastroesophageal reflux disease: ACCP evidence-based clinical practice guidelines", Chest, 129, pp.80S~94S (2006)
- Pavord ID, "Management of chronic cough", Lancet, 371, pp.1375~1384 (2008)
- Chatkin JM, "Exhaled nitric oxide as a noninvasive assessment of chronic cough", Am J Respir Crit Care Med, 159, pp.1810~1813 (1999)
- Oh MJ, "Exhaled nitric oxide measurement is useful for the exclusion of nonasthmatic eosinophilic bronchitis in patients with chronic cough", Chest, 134, pp.990~995 (2008)
- Prieto L, "Exhaled nitric oxide measurement is not useful for predicting the response to inhaled corticosteroids in subjects with chronic cough", Chest, 136, pp.816~822 (2009)
- Kraft M, "Approach to the patient with respiratory disease. In: Cecil Medicine 23th edition", pp.591~595 (2008), Saunders