慢性咳の管理について
1Institute for Lung Health, Department of Respiratory Medicine, Allergy and Thoracic Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.
Lancet (London, England)
|April 22, 2008
まとめ
慢性的な咳は,しばしば二次的なケアを必要とします. 新しいアプローチでは,エオシノフィルの咳と非エオシノフィルの咳を区別し,より良い治療開発のために高まる咳の反射を強調しています.
科学分野:
- 肺内科 肺内科 肺内科
- クリニカル・メディシン 臨床医学
- 病理生理学 病理生理学とは
背景:
- 説明がつかない慢性咳は,二次医療への紹介の頻繁な理由です.
- 現在の管理は,多くの場合,症例シリーズに依存し,咳を喘息,逆流,または上部呼吸道状態に起因します.
- 2次治療中の患者の有意な部分は,満足のいく咳のコントロールを達成できません.
研究 の 目的:
- 慢性咳の管理におけるパラダイムシフトを提唱する.
- コルチコステロイドに反応するエオシノフィルの呼吸道疾患と,コルチコステロイドに抵抗する非エオシノフィルの咳を区別する.
- 加強した咳反射の病理生理学的研究と新種の咳抑制治療の研究を奨励する.
主な方法:
- 慢性咳の管理に関する既存の証拠のレビュー.
- 呼吸道炎症と反射感受性に基づく咳の再分類の提案.
- 悪化要因と内在の反射異常を評価するための勧告.
主要な成果:
- 喘息,逆流,上部呼吸道疾患に対する伝統的な治療法は,慢性咳に対して普遍的に効果的ではありません.
- 標準的なケアに耐性のない慢性咳を患っている患者の数も多い.
- 併発性疾患だけが咳の原因であるという信念は,反射病理生理学の研究を妨げることがあります.
結論:
- エオシノフィルの咳と非エオシノフィルの咳を明確に区別することが必要である.
- 証拠が弱い要因は,咳反射異常の原因ではなく,悪化要因とみなされるべきである.
- 加速した咳反射のメカニズムと薬理学的制御に関するさらなる研究は,改善された治療法の開発に不可欠です.
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