Pay attention to standardized diagnosis and treatment of corticosteroid-responsive cough

Abstract

The global prevalence of chronic cough in adults is 9.6%.In 2008, the cough special issue of Lancet published a diagnosis and treatment plan to distinguish the causes of chronic cough based on eosinophilic airway inflammation or sensitivity to glucocorticoids therapy. In 2014, Professor Lai Kefang of China first proposed the Chinese name “corticosteroid-responsive cough” (CRC). CRC refers to chronic cough that is effectively treated with glucocorticoids, accounting for 63% of the causes of chronic cough in China, including cough variant asthma, eosinophilic bronchitis, and atopic cough. Cough variant asthma is the most common cause of chronic cough in China, accounting for 30% to 50% Chronic cough has a complex etiology and involves numerous examinations, especially bronchial provocation tests, induced sputum cell analysis, multi-channel esophageal impedance pH monitoring, etc., which have not been carried out in many tertiary hospitals, and not all chronic patients can undergo relevant examinations to confirm diagnosis and receive treatment. The concept of corticosteroid-responsive cough has important guiding significance for the empirical treatment of chronic cough, and is suitable for promotion in grassroots hospitals. In clinical practice, it is only necessary to determine whether it is a CRC based on the clinical characteristics of the patient without the need for further tests, such as induced sputum cell analysis and bronchial provocation tests to distinguish cough variant asthma, eosinophilic bronchitis, and allergic cough, and then empirical treatment can be given. However, there is currently insufficient understanding of the standardized diagnosis and treatment of CRC. For example, there is still a lack of consensus on determining whether it is CRC, how to select hormone treatment and the duration of hormone treatment. It is necessary to further emphasize and promote the relevant concepts and diagnosis and treatment plans of corticosteroid-responsive cough