Tip: If chronic cough occurs more than 4 weeks later, and the cough mainly occurs in the middle of the night and early morning, be aware that it may be caused by cough and variant asthma.

◇ New syntax (www.xys.org) (xys4.  Dxiong.com) (Www.xinyusi.info )(  Xys2.dropin.org) ◇ Asthma -- A common but easily missed-diagnosed respiratory disease Author: ShuangFeng matchup yesterday four o'clock P.M. from the local suburbs an old mother-in-law, her daughter,  As soon as they sat down, they looked anxious,  My daughter told me that a doctor at a local second-level hospital diagnosed her mother with pneumonia and was about to be hospitalized immediately. They were not at ease and immediately transferred to my big hospital.  I first read the lung CT just taken this morning and did not find any problems. So I looked at the outpatient medical records,  The complaint is "coughing for two months ." I am confused: This medical history is not in line with the diagnosis,  So I went on to understand the situation. My mother-in-law had no fever or sputum, and the blood routine and C-reactive protein were normal,  How can this be pneumonia? So I asked in detail about the medical history. The patient had a cough for two months,  It is obvious at night, especially in the middle of the night, and it is anxious after the recent event. Now I have some points in my heart. Next I will have a lung auscultation,  You can hear two lungs in a symmetric and low-profile breath. Okay, it seems Asthma The diagnosis should be clear,  However, to confirm that I took her to the lung function room for lung function testing, we can see that fe1 is only 0.69l,  She was sprayed with vanetine and then rose to 1.07l to diagnose the bronchial tube. Asthma Clear.  After giving her some medicine, I asked the patient how to use it. It was time to finish work. It should be said that in the respiratory clinic of a large hospital, we usually encounter Asthma Patient,  This is a disease that is not difficult to diagnose but missed and diagnosed by medical workers,  It also leads many patients to have a wrong understanding of the disease. For example, I often hear patients say that I have bronchitis in the clinic,  In the past, an attack occurred for a period of time every year. It often takes a long time to take cough medicine and antibiotics;  Some patients will say that infusion is good, and so on. So Asthma What is it like? How do we identify it? Bronchial tube Asthma It is defined as a chronic airway inflammation involving multiple cell and cell components.  Disease, this chronic inflammation leads to increased airway responsiveness,  There will be a wide range of reversible airflow restrictions, and cause recurrence of breathing, shortness of breath, chest tightness, cough, often at night or early morning attacks,  Most patients are able to mitigate independently. (Referenced in the sixth edition of internal medicine ).  This section summarizes the core and essence of the disease, and also reflects the deepening process of people's understanding of the disease.  In fact, when I was studying, we calledAsthma Mostly allergic Asthma ", With greater emphasis on allergens,  Typical or serious manifestations of allergic processes and breathing and shortness of breath,  At that time, the pathological physiological process was considered to be the secondary intensification of Immunoglobulin E, resulting in airway spasm.  Therefore, in my later work, there was no problem with the diagnosis of such typical patients. However, due to my lack of deep understanding of the nature of the disease, I also experienced a possible misdiagnosis,  So as to deepen my understanding of this disease. In my second year of work, the patients transferred from other places, the local hospital (  Is also the top three hospitals) discharged from the hospital with a summary of chronic bronchitis, but the patient complained to me about the unsatisfactory effect,  Coughing is still very frequent, especially at night, but besides antibiotics and cough drops,  Not Considered Asthma And naturally, they are not treated with inhaled hormones and antiasthma drugs.  The result is naturally that the patient's treatment effect is not satisfactory, and the consequences are very serious. The patient directly complained to me from the Director, saying that I am not good enough and asked to change doctors,  The director was able to placate the patient after learning about the disease, and at the same time, combined with inhalation and oral hormones,  So that the disease can be controlled on the day. Here I want to explain Asthma In addition to breathing and shortness of breath,  Chronic Cough is also one of its manifestations, in chronic cough (more than 6 weeks of cough,  Asthma Yes, the top three. So why do some patients suffer from cough?  Because this is mainly determined by the location where the patient's airway inflammation occurs, for example, where the small airway (diameter less than 2mm) occurs,  Because the small airway does not have cartilage, inflammation occurs in these places airway mucosal edema canal stenosis,  The airway is trapped during breath, so breathing occurs. You can also hear an obvious beep.  However, if the airway is located in the trachea and the main bronchial duct, airway traps are not possible due to the support of the trachea cartilage, so breathing is not obvious;  However, due to the slightly richer atmospheric nerve ends, the main manifestation of the inflammatory reaction is cough.  Why are nighttime symptoms more obvious? This is because at night, especially in the middle of the night, we have the highest nerve tension,  At this time, the airway is in the most tight and the most narrow moment of the airway cavity in a day, so the degree of airflow restriction is the most obvious. Due to bronchial Interfaces Asthma Is a chronic airway inflammation disease,  It varies with the situation of each patient. For example, there is a seasonal phenomenon, and some patients may suffer from sweet-scented osmanthus activation in autumn,  Some patients suffer from cold air in winter. However, if the stimulus decreases or disappears,  Its symptoms may also be mitigated, so some patients may improve after a month or two after taking cough medicine and antibiotics,  Therefore, we mistakenly believe that the drug is slow. Unfortunately, our doctors do not have a deep understanding of chronic cough,  In particular, cough-variant asthma (CVA) many doctors simply think it is chronic bronchitis,  Given a large number of antibiotics and a variety of cough pills, the result was that the patient spent a lot of money,  Sometimes lucky patients take relief and take credit for themselves. Of course, this disease clearly requires lung function tests,  However, currently, only large hospitals in China have these devices, while many secondary hospitals and Community The reason why the hospital does not have relevant supporting facilities also leads to low diagnostic rate.  I strongly urge the country to list lung function as a regular health check item for men over 40 years of age who smoke,  And routine examination content of patients with chest tightness and shortness of breath. Then what kind of cough patients need lung function tests,  Because if appropriate clinical selection is not performed, the lung function should not be too much. According Asthma Pathological and physiological characteristics and clinical manifestations,  There are also situations observed at the clinic, I think the following situations indicate that patients may suffer from CVA:  There is a history of allergic rhinitis or someone in the family has suffered Asthma Disease;  Chronic Cough is more than 4 weeks and cough mainly occurs in the middle of the night and early morning; chest tightness or shortness of breath for unknown reasons, chest x-ray and ECG examination normal.  Therefore, lung function and bronchial Relaxation Test are feasible, and the test is feasible when necessary. Next let's talk about Asthma It should be said that the current treatmentAsthma Method is very mature,  It is also good. The main problem lies in the problem of treatment strategies. Many doctors have insufficient understanding about the long-term treatment of the disease,  In addition, insufficient publicity and education are also common problems.  Many patients are using Asthma After drug treatment, it can be significantly improved within one or two weeks, and there is no difference with ordinary people, so it is easy to relax,  Some will stop the drug on their own, and some will use it when they feel uncomfortable,  If you feel good, you can either forget or worry about the so-called adverse reactions or be afraid of dependency.  These misunderstandings lead Asthma The good control rate has been hovering below 10%. Some people believe that some small advertisements are used to buy the so-called special medicine,  As a result, the disease is repeated and serious complications occur.  Some young women are afraid of adverse reactions to the fetus before pregnancy,  As a result, after several months of pregnancy, the system experienced a cough and shortness of breath, which made itself and the fetus at risk. In clinical practice, patients often ask the same question: is this disease not good,  Is the drug dependent. I often ask patients a question: Will high blood pressure and diabetes be good?  If your blood pressure is stable and your blood sugar is stable, do you dare not stop using the medicine?  Then I will say Asthma As high blood pressure and diabetes are both chronic diseases, a "long-term stability" strategy is required,  Long-term Control to obtain a good living status and lung function status, because of the strong lung compensation function, so although the Self feeling good,  However, pulmonary function tests are often unsatisfactory,  Therefore, it is necessary to tell the patient to determine whether your condition is improving based on the state of lung function. As for treatment Asthma Is one of the main drugs,  Because it is currently through inhalation treatment, the side effects are very small, the most important is the hoarse voice, as long as the mouth after taking the medicine.  However, no adverse effect on the fetus was observed during the treatment of sex hormones inhaled in pregnant women. (Xys20091228) ◇ (www.xys.org) (xys4.  Dxiong.com) (Www.xinyusi.info )(  Xys2.dropin.org) ◇