Many people think that coughing is just a minor problem, that it is probably a cold, and that they will get over it with extra clothes and medicine.
According to a survey conducted by the Guangzhou Institute of Respiratory Diseases, 64% of patients with chronic cough have been misdiagnosed as “chronic bronchitis or bronchiectasis”, with an average misdiagnosis time of 5 years and a maximum of 20 years. Many patients suffer from chronic cough for years, repeatedly using various tests and exhausting antibiotics, but the treatment is still ineffective, resulting in a great waste of medical resources, as well as physical pain and financial pressure.
The large number of patients with incurable coughs has also long confused clinicians. The dangers associated with cough and the complex causes of cough are gaining attention. After the United States, Europe and Japan, the first “Draft Guidelines for the Diagnosis and Treatment of Cough” developed in China was officially released in November 2005. The guidelines reflect both the latest advances in current research on the diagnosis and treatment of cough and have relatively distinctive Chinese characteristics, and they have received widespread attention from domestic experts and colleagues upon release.
In fact, cough involves different parts of the respiratory system: e.g., nose, trachea, lungs, and stomach, as well as different systems, such as: respiratory, digestive, cardiovascular, and neurological. Therefore, the diagnosis and management of cough is encountered in various clinical departments, especially in respiratory medicine, gastroenterology, otorhinolaryngology, and emergency medicine. The causes of cough are also very complex. In addition to the common infectious and inflammatory factors, allergy, reflux, and medications are also important and not negligible factors. Because of these complexities, treatment should be multidimensional and multifaceted, and it is difficult to achieve good results simply by using antibiotics.
I. Cough variant asthma (CVA) is a special type of asthma, accounting for 29% of the incidence of chronic cough. It is mainly due to the presence of airway hyperresponsiveness in patients, and when allergens stimulate the airways, it causes local hypersensitivity reactions, resulting in reflex coughing from tracheal and bronchial spasms, and is prone to develop into asthma. The typical clinical manifestations of this group of patients are as follows.
1. Usually an irritating dry cough, mainly at night or in the early hours of the morning, often accompanied by chest tightness, without dyspnea, usually without sputum and without fever;
2. It lasts for more than two weeks and is often triggered by breathing irritants such as cold air, dust, fumes and laughter, or sometimes caused by excessive fatigue or mental stress;
3. Have a family or personal history of allergy;
4. There are obvious seasonality, with frequent attacks in spring and autumn;
5.Treatment with general cough medicine or antibiotics is not effective;
6. Positive airway reactivity test for asthma. The treatment of cough variant asthma is the same as that of typical bronchial asthma. The most effective method is the combined application of glucocorticoids and inhaled β2 agonists, and most patients need inhaled small doses of glucocorticoids. TCM has good efficacy in treating this disease. According to the clinical characteristics, TCM identifies the deficiency of Yin and Blood in the liver, the dryness of blood generates wind, Yin deficiency and wind movement, internal wind disturbance, shaking the bell and sounding.
The treatment is to soften the liver to quench the wind and purge the lung to subdue the rebellion. The formula is based on the addition of allergy decoction with medicines such as wu mei, bai shao, bai hu, fang feng, wu wei zi, hook vine, di dragon, mulberry bark, almond and roasted licorice. In some CVA patients, cough attacks or exacerbations are often related to emotional fluctuations, and in female patients, they are closely related to the menstrual cycle. The symptoms include choking cough with little sputum, worsening in bouts, chest fullness, irritability, bitter mouth and dry throat, thin white or thin yellow coating, and string pulse. The evidence belongs to liver depression and qi reversal, wood knocking and gold sounding. The treatment is to dredge the liver and regulate qi, lower the rebellion and stop the cough.
The formula is based on Xiao Chai Hu Tang combined with Yi Yao San, with medicines such as Chai Hu, Scutellaria, Qing Han Xia, Angelica, Bai Shao, Peppermint, Xiang Shen, Citrus aurantium, Sang Bai Pi, Roasted Licorice, etc. Liver depression and fire, wood and fire Xingjin, guard the above plus Danpi, Gardenia, Dai Clam San to clear the liver fire and phlegm; fire and yin injury obviously, guard the above plus Zhi Mu, Bayberry, Sha Shen nourishing yin moisten the lungs to stop cough.
Second, postnasal drip syndrome refers to allergic or non-allergic rhinitis, causing secretions to backflow to the postnasal and posterior pharynx, and even reflux to the vocal cords or trachea, resulting in chronic cough, pharyngeal foreign body sensation and a series of symptoms. It accounts for nearly 20% of the incidence of chronic cough. The typical clinical manifestations of this group of patients are.
1. paroxysmal or persistent cough, mainly during the day and less often after sleep;
2. Most patients have a backflow of nasal secretions, oral mucus, itching in the throat, a feeling of foreign bodies or “paste sticking to the throat”, and frequent throat clearing, which, in layman’s terms, is a reflexive cough due to the discomfort in the throat caused by the backflow of nasal mucus;
3. There are symptoms such as nasal itching, nasal congestion, runny nose and sneezing;
4. Some patients also have hoarse voices, and even speech can trigger coughing;
5.History of rhinitis, sinusitis, nasal polyps or chronic laryngitis. The main causes of postnasal drip syndrome are seasonal allergic rhinitis, perennial non-allergic rhinitis, vasodilatory rhinitis, infectious rhinitis, fungal rhinitis, common cold and paranasal sinusitis. Those with large amounts of sputum are mostly due to chronic sinusitis; vasodilatory rhinitis is characterized by large amounts of thin, watery nasal discharge sometimes produced with temperature changes.
For cough caused by non-allergic rhinitis, vasodilatory rhinitis and the common cold, first-generation antihistamines (chlorpheniramine maleate) and decongestants (pseudoephedrine hydrochloride) can be used; for cough caused by allergic rhinitis, second-generation antihistamines (loratadine, astemizole, etc.) should be used, along with intranasal sprays of glucocorticoids, such as beclomethasone propionate, budesonide and mometasone furoate, etc.
Chinese medicine identifies most of the evidence as qi deficiency and lack of consolidation, and the loss of harmony between Ying and Wei, and unfavorable clearing of the orifices. The treatment is to benefit the qi and consolidate the surface, harmonize the ying and gui, and clear the pharynx and orifices. The formula is Yu Ping Feng San combined with Gui Zhi plus Hou Pu apricot seed soup plus reduction, such as Astragalus, Atractylodes, Fang Feng, Gui Zhi, Bai Shao, Hou Pu, Almond, Cicada, Xin Yi, Cang Er Zi, etc. If the patient nasal congestion, headache is obvious, guard the above plus Su Ye, Angelica dahurica, pungent warmth through; if the cough sputum thin amount of people, can be added at your discretion atractylodes, half summer, Chen Pi dry dampness and resolve phlegm; if accompanied by tiredness and weakness, cold limbs cold people, can guard the above at your discretion plus party ginseng, Xian Mao, Xian Ling spleen benefit Qi and warm Yang. If patients with recurrent sinusitis, flowing yellow thick turbid mucus obvious, guard the above plus scutellaria, fishy grass, sorrel to clear heat and detoxify dampness.
Third, gastroesophageal reflux cough is usually caused by reflux of stomach acid and other gastric contents into the esophagus, resulting in cough. It accounts for 10-20% of the incidence of chronic cough. Typical clinical manifestations of this group of patients are.
1. A burning sensation behind the sternum, which is commonly referred to as heartburn symptoms, accompanied by acid reflux, belching, chest tightness, and some atypical symptoms such as chronic cough, asthma, hoarseness, etc. ;
2. Cough mostly occurs during the day and in the upright position;
3. The cough is mostly dry and lasts for a long time;
4. In mild cases, a small amount of white mucous sputum is coughed up, while in severe cases, symptoms such as dyspnea, pus sputum, coughing up blood, chest pain, or nighttime fever and night sweats without clear reasons appear;
5. The cough is often associated with eating, and is aggravated after consuming high-fat foods and coffee.
Treatment for these patients should start with lifestyle adjustments. Obese people should preferably lose weight, avoid overeating, eat less and more meals, avoid eating before bedtime, eat less acidic and greasy food, drink less coffee and other beverages, and also quit smoking, and sleep with the head of the bed elevated or with a higher pillow. From the perspective of Chinese medicine, the cause and mechanism of the disease is due to prolonged gastric disease, soil congestion and wood depression, wood gas produces acid, liver and stomach disharmony, Qi elevation and declination is out of balance, and lung gas reverses and makes cough; analyzing the location and transmission pattern of the disease, it originates in the stomach, involves the liver, and then spreads to the lung.
The evidence is that the liver and stomach are not in harmony, and the lung is not clear and purified. Therefore, in the treatment of this disease, the lung should be the target and the liver and stomach the root; stopping the cough is the target and lowering the rebellion is the root. The method is to dredge the liver and stomach to control acidity, and to purge the lung to lower the rebellion to stop cough. The formula is based on the combination of Zuojin Wan with Zhuangyu Dianchao Tang, with medicines such as Chai Hu, Bai Shao, Huang Lian, Wu Ju Ju, Zhuangyu Hua, Dianchao Shi, Hou Pu, Yu Jin, Citrus Aurantium, Su Zi, and Roasted loosestrife.
In addition to the above-mentioned types of cough, there are many other causes of cough, such as post-infectious cough, allergic cough, drug-induced cough, and so on.
Etiological diagnosis is the key to the diagnosis and treatment of chronic cough. Its diagnosis should emphasize the medical history, and relevant tests should be selected based on the medical history, with the tests progressing from simple to complex, with common diseases first, followed by rare diseases, to reduce the diagnostic cost for patients. Both diagnosis and treatment should be carried out simultaneously or sequentially. Combined Chinese and Western medicine treatment is the best choice for patients with chronic cough.