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Abstract: Cough asthma, or cough variant asthma, is a specific type of asthma. In this case, the patient had cough as the only symptom in the early stage, which lasted for about 3 months, and there was no fundamental improvement after treatment with cough suppression, anti-infection and sputum chemotherapy, and the condition was recurrent. The cough was diagnosed as cough variant asthma by bronchial excitation test after consultation, and after symptomatic treatment with bronchodilators, the cough was relieved and the disease was stably controlled.
Basic information】Female, 27 years old
Type of disease】Cough variant asthma
Hospital】Bazhou People’s Hospital
Date of consultation】October 2021
Treatment plan】Medication (bronchodilator nebulizer inhalation salmeterol ticapone inhalation powder nebulizer + oral compound methocarbamol capsule, montelukast sodium chewable tablet)
[Treatment period] 7 days of hospitalization and six months of regular follow-up
Treatment effect】Stable disease control and significant improvement of cough symptoms
I. Initial consultation
The patient came to the hospital because of obvious cough symptoms, showing that the cough worsened significantly when she spoke, without coughing up sputum. Her medical history is as follows: 3 months ago, she developed a cough and coughing sputum due to a cold. The sputum was initially a small amount of white clear sputum, accompanied by a sore throat and other symptoms. He was given symptomatic treatment such as anti-infective and phlegmolytic drugs, and his cough was intermittently reduced. He also considered coughing after a cold, and was given ketotifen fumarate and suhuang cough capsules to stop coughing, but the cough continued to worsen after stopping the drugs, and his symptoms have been repeatedly recurring for 3 months.
II. Treatment history
The patient had no history of chronic rhinitis or pharyngitis, no cough caused by postnasal drip or other upper airway syndrome, and no gastroesophageal reflux. After this admission, the patient was first actively screened for the possibility of some atypical pathogenic infections, such as the nine respiratory pathogens, all of which were negative, while no abnormalities were seen in the chest CT, ruling out infectious factors causing the cough. The patient’s cough was characterized by paroxysmal irritant dry cough, prominent at night and in the early morning, and easily triggered by talking, inhalation of cold air, dust and smoke. He was immediately given adjusted treatment: oral compound methocarbamol capsules and montelukast sodium chewable tablets to reduce the airway inflammatory response and exudation, and inhalation salmeterol ticapone inhalation powder to diasporate the bronchial tubes for symptomatic treatment.
III. Treatment effect
The patient responded well to the medication, and the cough symptoms were significantly relieved, which was related to the fast onset of bronchodilator and montelukast sodium chewable tablets. The sleep at night improved significantly on the day after taking the medication, and the cough symptoms were significantly controlled after 3 days, and the night rest improved, and the mental status, etc. improved significantly. The patient wanted to stop taking the medication when he saw the improvement of his symptoms, and then he was immediately told repeatedly that he must continue taking the medication for more than 4 weeks and that he should be followed up regularly at the outpatient clinic for six months to adjust the treatment plan according to the actual situation. The patient’s condition was stable and he was discharged after 7 days of hospitalization.
IV. Precautions
The patient’s condition was stable and her symptoms improved, and she was discharged successfully.
1, standardized treatment, do not stop medication: the act of stopping medication on your own may lead to recurrence of the disease, because although the patient’s symptoms improve, but the chronic inflammation and hyperresponsiveness in the airway still exists, and it takes a long period of unremitting efforts to subside, and needs to be controlled continuously by medication. Self-discontinuation of medication may easily lead to aggravation of cough and even development of more severe classical asthma.
2.Regular follow-up and adjustment of medication: outpatient follow-up review is required every 4 weeks to determine whether the dosage can be reduced or discontinued according to the relevant indexes of the review.
3.Examine allergic factors: cough variant asthma, if treatment is not effective, actively improve allergen testing if necessary to further clarify the cause.
4. Lifestyle conditioning: Patients should pay attention to lifestyle conditioning in daily life, avoid spicy and allergy-prone foods, and stay away from allergic substances. In the spring, during the high season of willow and poplar wadding, wear a mask when going out to prevent recurrent coughing.
V. Personal insight
Cough variant asthma is a special airway reactive disease, different from typical asthma, but the pathological mechanism of both is similar, and the clinical distinction is mainly made by symptoms and medical history. The key to treating cough variant asthma is early diagnosis and treatment, which can effectively prevent the exacerbation and progression of the disease. However, if effective intervention is not obtained early, once it develops into typical asthma, lifelong treatment is required and the impact on the patient’s life is relatively high. Therefore, early detection and treatment of cough variant asthma can effectively relieve symptoms, but it is necessary to follow medical advice to review and take medication on time and quantitatively to avoid recurrence of the disease.