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Abstract: The patient was a 14-year-old girl who was brought to the hospital by her family because of paroxysmal dry cough, waking up at night and affecting her studies during the day. The patient’s condition has been stabilized by medication (budesonide formoterol powder inhaler, loratadine tablets, montelukast sodium tablets, mometasone furoate nasal spray) and has not had any further attacks for more than one year.
Basic information】Female, 14 years old
Type of disease】Cough variant asthma
Hospital】Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
Time of consultation】August 2020
Treatment plan】Medication (budesonide formoterol powder inhaler, loratadine tablets, montelukast sodium tablets, mometasone furoate nasal spray)
[Treatment period] Outpatient medication self-administration, regular outpatient follow-up
Treatment effect】The patient’s condition is stable and has not reoccurred for more than one year.
I. Initial consultation
The patient had a paroxysmal dry cough, and the family complained of anxiety: the patient had a pronounced cough at night and often woke up with a cough during sleep at night. He had been thought to have a cold, no fever, no obvious cough, runny nose, or difficulty breathing, and was given cough suppressants for a long time. The patient was aggravated by cold and exercise, and was forced to stop exercising during physical education class several times due to severe cough. General lung function and bronchial excitation test were given to clarify that the patient had cough variant asthma. Further allergen tests were performed to identify allergens: cat hair, house dust mite, dust mite, and significantly elevated SlgE.
(Bronchial excitation test)
II. Treatment history
In response to the patient’s condition, it was initially clarified that the patient generally had a dry cough, with severe attacks at night and in the early morning, and often woke up with coughing during sleep, which seriously affected physical and mental health, without obvious discomfort such as coughing sputum and dyspnea. On auscultation: the breath sounds of both lungs were acceptable, and no obvious rales were heard. Based on the above, it was clear that the patient had cough variant asthma, cat hair and mite allergy. Previous history of rhinitis, recurrent nasal itching and sneezing were evident throughout the year. According to the characteristics of the patient’s condition, budesonide formoterol powder inhaler, oral loratadine tablets and montelukast sodium tablets were given as symptomatic treatment; at the same time, mometasone furoate nasal spray was applied to effectively avoid known allergens, and the medication was adjusted according to the changes of the condition.
III. Treatment effect
The patient’s condition gradually improved according to the doctor’s treatment plan, regular treatment, while paying attention to avoiding allergens as much as possible and other recommendations, and gradually discontinued oral anti-allergic drugs and leukotriene receptor antagonists, and reduced inhaled hormones and β2 agonists and nasal hormones, and the patient’s condition is now stable. In the past 1 year, the patient has not had any further attacks of cough variant asthma, and the rhinitis has occasionally attacked after cold, with intermittent nasal hormone treatment. After systematic and effective treatment, the patient’s condition is stable and has not reoccurred for more than one year.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but since the patient’s main allergens are cat hair, house dust mites, dust mites, cat hair decomposition products, cat dander and cat urine and saliva, which contain a large amount of allergens, and cat hair and dander are prone to mites, the patient must not keep pets with hair such as cats at home. Mites are common indoor allergens, mites and their bodies, excrement can cause allergic reactions in the body, bed usually pay attention to the use of mite removal device to remove. Pay attention to try to avoid food containing cross allergens similar to mites, such as shrimp, crab, snails, shellfish.
V. Personal insight
Cough variant asthma is a special type of asthma, with clinical symptoms mainly of long-term recurrent dry cough, a common cause of chronic cough, characterized by, as in the patient in this case, dry cough performance, nighttime or early morning attacks, cough aggravation after a cold, and no clinical symptoms of infection or long-term ineffectiveness of antibacterial drugs. In addition, cough variant asthma is also a persistent allergic disease with a high recurrence rate, low cure rate and a greater risk of developing into typical asthma. Since reducing airway hyperresponsiveness is particularly critical, early and effective treatment is important to improve the patient’s prognosis. For patients with combined allergic rhinitis, attention should be paid to the simultaneous treatment of the upper and lower airways in order to effectively control airway inflammation, and desensitization therapy is important for allergic asthma and rhinitis, although the course of treatment is relatively long, and symptomatic supportive treatment should be carried out at the same time in the early stage. Patients and their families adhere to desensitization therapy, and their condition is well improved.