诱导痰(Is)是以高渗盐水或其他诱导物雾化吸入诱导无痰或少痰受检者产生足量痰液，以对气道分泌物的细胞及其他液相成分进行分析研究的一种检测方法，具有经济、无创、准确、重复性较好等优点，能客观地反映气道状态，而且与气道活检的病理改变基本一致，能早期敏感地发现病情变化，并可借此深入研究呼吸系统疾病发病机制及治疗干预。目前，这种检测技术已较成熟，并被广泛应用。 1958年Bickerman等首次建立了诱导痰检测方法，对不能自然咳痰的患者进行高渗盐水雾化获得痰液，利用二硫苏糖醇(DTr)等黏液裂解剂对痰进行处理，消除黏液的影响，提高了肺部肿瘤患者癌细胞的检出率。随后又应用于结核和条件致病菌引发的肺部炎症的诊断。1992年，Pin等首次将诱导痰技术应用于哮喘气道炎症的研究，随后该技术在 COPD、慢性咳嗽、肺间质纤维化等临床研究中得到进一步应用，分析项目也从单一的细胞和病原体等有型成分的检测发展为对痰液液相成分的检测。近年来，越来越多的研究利用诱导痰技术对多种呼吸道疾病的发病机制、诊断与治疗进行研究，逐渐扩大了该技术的应用范围。本文主要阐述诱导痰细胞学检查技术的方法学及临床应用。
Objective Chronic cough is often present as increasing cough reaction to various physical and chemical stimulating factors. This study is aimed to investigate the difference of cough sensitivity and its mechanisms which are not clear among different causes of chronic cough. Methods Patients with chronic cough were recruited from cough clinic of Guangzhou Institute of Respiratory Diseases between 2005 to 2010. Using a modified diagnostic algorithm of chronic cough, common causes were identified. Capsaicin cough provocation test was also performed in these patients to assess the cough threshold. The relations between cough reflex sensitivity and duration of cough, cough severity, pulmonary function, induced sputum cell counts were then investigated. Results Through the diagnostic algorithm of chronic cough, the current study evaluated 133 adult patients, including 24 cases with upper airway cough syndrome (UACS) , 26 patients with cough variant asthma (CVA) , 31 cases with eosinophilic bronchitis (EB) , 30 patients with atopic cough (AC) , 22 cases with gastroesophageal reflux induced cough (GERC) . There were 30 healthy volunteers recruited as normal control. The cough threshold of LgC5 in AC, CVA, EB, GERC and UACS was 1.70 ±0.70, 2.12 ±0.67, 2.13 ±0.69, 1.69 ±0.73, 2.16 ±0.66, respectively. The LgC5 of the normal group ( 2.63 ±0.39) was higher than those in chronic cough groups( All P lt; 0.05) . The LgC5 of AC and GERC were lower than CVA, EB and UACS ( all Plt;0.05) . Duration and daytime score of cough showed positive correlations with LgC5( r =-0. 280, -0. 168, all P lt;0.05) . Pulmonary function and differential cell count of induced sputumwere not associated with LgC5 ( all Pgt;0.05) . Conclusions Different cause of chronic cough exhbit high cough reflex sensitivity to different extent. The difference of cough sensitivity may reflect the different pathogenesis among different causes, and may be related to the type of nerve fiber dominating the cough reflex.
ObjectivesTo assess the quality of clinical practice guidelines (CPGs) for diagnosis and management of cough in China, and to provide methodological experiences for updating and developing the evidence-based guideline in this field in future. MethodsWe searched CBM, WanFang Data, VIP and CNKI databases, and Chinese clinical guidelines' website to identify and select CPGs related to cough in China. Four reviewers independently evaluated the quality of eligible guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) Ⅱ instrument. ResultsSix guidelines were included. The mean scores for six AGREE Ⅱ domains were low:scope and purpose 61.1%, stakeholder involvement 26.6%, rigor of development 16.7%, clarity and presentation 58.3%, applicability 11.1%, and editorial independence 0.0%. ConclusionThe quality of guidelines for cough in China is low. More efforts are urgently needed to develop high quality Chinese guidelines using methodologically rigorous development frameworks and strengthen guideline reporting.
Objective To investigate the etiological diagnosis of chronic cough with pharyngitis-like manifestations. Methods Patients with chronic cough and pharyngitis-like manifestations were recruited from Outpatient Department of Guangzhou Institute of Respiratory Diseases between December 2002 to March 2010. The causes of chronic cough were investigated using a well-established diagnostic protocol, including history taking and physical examination, pulmonary function tests, induced sputum cytology, 24-h esophageal pH monitoring, etc. The final diagnosis depended on clinical manifestations, examination findings, and a successful response to therapy. Results 326 patients with chronic cough and pharyngitislike manifestations were included in the study with amedian duration of 24 ( 2 ～480) months, amean age of 41 ±13 years. The causes of chronic cough were identified as follows: post nasal drip syndrome or upper airway cough syndrome in 73 cases ( 23. 31% ) , cough variant asthma in 61 cases( 18. 71% ) , eosinophilic bronchitis in 70 cases( 22. 47% ) , gastroesophageal reflux-induced cough in 54 cases ( 16. 56% ) , atopiccough in 48 cases ( 14. 72% ) , and others in 40 cases ( 12. 27% ) . There is no significant difference in percentage of common causes of chronic cough ( P gt; 0. 05) . Conclusion The proportions of upper airway syndrome and other common causes are similar in chronic cough with pharyngitis-like manifestatioins, whichsuggest pharyngitis-like manifestations are not specific for diagnosis of upper airway cough syndrome.
ObjectiveTo explore the spectrum and frequency of respiratory symptoms in outpatients clinics.MethodsPatients were enrolled from outpatient clinic of Guangzhou Institute of Respiratory Disease. Information about respiratory symptoms especially cough was obtained from the survey questionnaire from July 2013 to August 2013 .ResultsA total of 900 were eligible out of 939 questionnaires. The mean age of the patients was (48.9±18.3) years, 453 (50.3%) were males, 447 (49.7%) were females. The cases of cough, wheeze, polypnea, chest distress, pharyngalgia, catarrh, chest pain, throat itching, fever, hemoptysis and other symptom was 687 (76.3%), 310 (34.4%), 307 (34.1%), 173 (19.2%), 107 (11.9%), 101 (11.2%), 82 (9.1%), 59 (6.6%), 36 (4.0%), 10 (1.1%) and 129 (14.3%) out of the patients, respectively. In patients with cough, 69.5% of them considered cough as their predominant symptom, and 22.1% of them reported that cough was the only symptom. 56.3% of cases were chronic cough, while acute and subacute cough accounted for 29.7% and 14.0%, separately. The proportion of female in acute cough was significantly higher than that of males (60.3%vs. 39.7%, P<0.01).ConclusionsCough, especially the chronic cough is the most common reason for patients who seeking health care in outpatient clinic of respirologist. There are more females suffered from acute cough than males.