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咳嗽变异型哮喘又称隐匿型哮喘或咳嗽型哮喘,由于这类疾病的患儿临床表现仅为慢性咳嗽,故常易被误诊为急性或慢性支气管炎、肺部淋巴结核等。现将我科近年来收治的5例病例临床分析如下。 1.临床资料 年龄2～4岁2例,5～7岁3例,男性4例,女性1例。症状以慢性咳嗽为主,最短39天,最长6个月。都为阵发性干咳,发生在入睡一小时左右,持续1～3小时,剧咳后呕吐出胃液及白色泡沫状痰液后缓解。一般每晚或隔晚发作一次,有一例夜间多次发作,影响睡眠。诱因:1例因搬入新居而发病,4例无明显诱因。家族史:2例家族中有哮喘史,3例家族中否认有哮喘史。体检:除2例肺部听诊呼吸音较粗糙,余均无阳性体征。血常规:白细胞计数正常或略升高,分类中嗜酸性白细胞有不同程度的升高。胸片:1例两下肺纹理略增深,2例肺部疑有淋巴结肿大。治疗过程,全部病例均曾使用抗菌素2种以上,1例多达近10种。2例曾使用抗痨治疗(异烟肼)1～2个月。以上治疗均不能奏效。而改用支气管扩张剂及肾上腺皮质激素使病情及时缓解。随访一年后,4例表现为典型哮喘,1例仍为慢性咳嗽。
Cough variant asthma, also known as occult asthma or cough type asthma, because these clinical manifestations of children with chronic cough, it is often misdiagnosed as acute or chronic bronchitis, pulmonary nodules and so on. Now my department admitted in recent years, five cases of clinical analysis is as follows. 1 clinical data of 2 to 4 years old in 2 cases, 5 to 7 years old in 3 cases, 4 males and 1 female. The main symptoms of chronic cough, the shortest 39 days, up to 6 months. Are paroxysmal dry cough, occurred in an hour or so to sleep for 1 to 3 hours after the cough and vomiting gastric juice and white foam-like sputum relief. Generally every night or night attack once, there is a case of multiple attacks at night, affecting sleep. Incentives: 1 case due to move into a new home and onset, 4 cases no obvious incentive. Family history: There was a history of asthma in two families and a history of asthma in three families. Physical examination: In addition to 2 cases of auscultatory lung sounds more rough, I have no positive signs. Blood: normal or slightly elevated white blood cell count, classification of eosinophils have varying degrees of elevation. X-ray: a case of lung texture slightly deeper in two cases, two cases of suspected lung lymph nodes. The course of treatment, all cases have used more than two kinds of antibiotics, 1 up to nearly 10 species. 2 cases had used anti-tuberculosis treatment (isoniazid) for 1 to 2 months. None of the above treatments worked. The switch to bronchodilators and adrenal hormones to alleviate the disease in time. One year after follow-up, 4 cases showed typical asthma and 1 case was still chronic cough.