• 보건세계
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• v.43 no.12 s.484
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• pp.4-9
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• 1996

기도가 협착되어서 증상을 일으키는 질환으로 만성기관지염, 폐기종, 만성폐쇄성질환, 기관지천식 등이 있으며, 기침, 가래, 호흡곤란(숨참)등이 주요 증상인데 비의료인에게는 해소천식으로 더 잘 알려져 있다. 일반적으로 기침 가래가 나오고 숨이차면 해소천식이라고 하는데 실제로 이 만큼 오용되고 남용되는 단어는 드물 것이다. 동의보감에 의하면 해수(해소의 원명)는 기침을 말하는데 해는 가래가 없이 소리가 심한 경우이고 수는 가래를 주로하는 기침을 말하며 16가지 종류로 구분된다. 천식은 숨이 찬 증상을 말하는 것으로 8가지 종류로 구분되어 있다. 따라서 해소천식은 기침가래가 나오고 숨이 찬 증상을 말하는 것으로 특정질환을 말하는 병명이 아니다. 비의료인이 말하는 천식의 경우에는 숨이 찬 증상을 말하는 것이고 의료인이 천식이라고 할 경우에는 특정 기도질환인 기관지 천식을 말하는 것이므로 서로 오해하기가 쉽다. 실제로 일간지 건강상식란에 천식을 소개하였는데 의사는 병명으로서의 기관지천식을 설명하였고 동참한 한의사는 증상으로서의 천식을 설명하여 혼란을 일으켰던 예가 있었다. 한의학에서는 예전에 기관지천식은 효천(孝喘)이라고 부르고 천식의 증상이 심하고 위중한 상황일 때에는 천급(喘急)이라고 하여 한의학에서도 구별하였는데 도리어 현대에 와서 정확성이 없어지고 모호해진 이유는 무엇일지 궁금하다. 폐쇄성기도질환은 기도가 좁아지는 기전과 기도폐쇄의 가역성(기도가 정상으로 회복되는지)여부에 다라서 가역성폐쇄질환인 기관지천식과 비가역적인 만성폐쇄성기도질환으로 구분하고 있다.

• Tuberculosis and Respiratory Diseases
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• v.44 no.1
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• pp.146-153
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• 1997

Background : Chronic cough is commomly defined as a persistent or recurrent cough exceeding 3 week's duration. The prevalence of chroinc cough is reported to range from 14% to 23 % for nonsmoking adults. The post nasal drip syndrome has been determined to be the most common cause of chronic cough, followed by asthma, chronic bronchitis, gastroesophageal reflux and bronchiectasis. Cough can be the only manifestation of asthma. Bronchial provocation tests are useful in diagnosing cough variant asthma. We investigated the clinical or laboratory findings and the incidence of airway hyperresponsiveness and evaluated the etiology in patients with chronic cough. Method : We evaluated 46 patients with chronic cough. Methacholine challenge test were done. Results : The results were as follows : 1) Thirty - five percent(16/46) of the chronic cough patients and 44% of the post nasal drip syndrom(7/16) showed the positive responses to methacholine challenge test 2) The underlying causes of chronic cough were post nasal drip syndrome in 35%, bronchitis in 21.7%, cough-variant asthma in 17.4%, and unknown condition in 25.9%. 3) Airway hyperresponsiveness in chronic cough was not related to respiratory symptom, nasal symptom, post nasal drip, smoking, derangement of ventilatory function, atopy, or sinusitis. Conclusion : Airway hyperresponsivenss in patients with chronic cough increased in frequency when compaired with normal control, allergic rhinitis. Cough-variant asthma account for 17.4% of patients with chronic cough.

• Tuberculosis and Respiratory Diseases
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• v.46 no.4
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• pp.555-563
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• 1999

Background: Chronic cough is a common symptom that requires the systematic diagnostic approach for proper evaluation. Postnasal drip syndrome(PNDS), bronchial asthma, gastroesophageal reflux disease(GERD), and chronic bronchitis are among the common causes. This study was conducted to evaluate the spectrum and the frequency of the causes of chronic cough. Methods: We prospectively evaluated 93 patients who had chronic cough despite normal chest radiographic finding. History and physical examination were done along with paranasal sinus radiograph, spirometry, bronchoprovocation test and 24-hours' ambulatory aesophageal pH monitoring as necessary. Results: Forty-nine(52%) of the 93 patients had PNDS, 15 patients(16%) bronchitis, 10 patients(11%) asthma, 4 patients (4%) GERD, 7 patients (8%) both PNDS and asthma, 4 patients (4%) undiagnosed condition and 4 patients(4%) were taking ACE inhibitor. Sixty-nine percent of the patients with PNDS improved after follow up, 73% patients with bronchitis, 80% patients with asthma, 50% patients with GERD, 100% patients with both PNDS and asthma, and 100% patients with ACE inhibitor. Conclusion: PNDS was the most common causes of chronic cough. Bronchitis was the second and asthma the third in frequency. The etiology of chronic cough can be determined easily by history and physical examination, successful therapy initiated in most patients. The response to specific therapy also was important in evaluation of chronic cough.

• Tuberculosis and Respiratory Diseases
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• v.46 no.5
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• pp.654-661
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• 1999

Background : The upper respiratory tract is the primary target organ of various airborne pollutants and is easily accessible part of the respiratory tract, and also is the predominant structure where chronic cough originates. The nasal peak inspiratory flow(PIFn), which is the peak inspiratory flow via nose with nasal mask and spirometry, could be a reliable parameter of nasal obstruction. The validity of PIFn has been evaluated in several studies by assessing the correlation between PIFn measurements and other parameters of nasal air flow. This study was designed to show the reproducibility of PIFn, the difference of PIFn between patients with chronic cough and normal subjects, and the usefulness of PIFn in the evaluation of nasal obstruction in patients with chronic cough. Methods : PIFn was measured by spirometry with nasal mask, twice a day for 3 consecutive days in 7 young normal subjects to evaluate validity of the test. In 32 patients with chronic cough and 25 age-matched normal subjects, PIFn and pulmonary function test($FEV_1$, $FEV_1%$ pred, FVC, and FVC% pred) were measured at first visiting. Results : Values of PIFn, $FEV_1$, and FVC were nearly constant in 7 young normal adults. Patients with chronic cough were 32 (14 males and 18 females) and the mean age was $41.4{\pm}15.9$ years. Normal subjects were 32(22 males and 10 females) and the mean age was $39.8{\pm}18.6$ years. There was no significant difference of age and pulmonary function test between patients with chronic cough and normal subjects(p<0.05). The PIFn values in patients with chronic cough was significantly lower than those of normal subjects($2.25{\pm}0.68\;L/sec$ vs. $2.75{\pm}1.00\;L/sec$ ; p=0.02). The postnasal drip syndrome(PNDS) comprised the majority of patients with chronic cough(27). The PIFn in patients with PNDS was significantly lower than that of normal subjects (mean$\pm$SD ; $2.18{\pm}0.66$ vs. $2.75{\pm}1.00\;L/sec$, p=0.006). Conclusion : There was a significant difference of PIFn between patients with chronic cough and normal subjects. Among the patients with chronic cough, patients with PNDS showed the most significant difference with normal subjects in PIFn. The PIFn could be a useful parameter of nasal obstruction in patients with chronic cough, especially in patients with PNDS.

• Tuberculosis and Respiratory Diseases
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• v.61 no.2
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• pp.137-142
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• 2006

Background: Recent studies have suggested an association between chronic cough and gastroesophageal reflux. Our study aimed to assess the utility of a proton-pump inhibitor in unexplained chronic cough patients. Methods: Patients with chronic cough of unknown etiology were evaluated using a chest x-ray, methacholine challenge test, and an empirical trial of postnasal drip therapy. After excluding other potential causes of the cough, forty patients were included in the study and treated for 8 weeks with a proton-pump inhibitor. Results: Eleven and three patients in the first and second 4 weeks were lost to follow-up, leaving twenty-six patients finally included in the study. Of these patients, two were unimproved, eight partially responded to the proton-pump inhibitor and sixteen responded completely after the 8 week treatment. Conclusion: We suggest that empirical treatment with a proton pump inhibitor in all patients with persistent cough, which is not secondary to asthma or postnasal drip syndrome, represents a practical and simple approach to this ailment.

• Tuberculosis and Respiratory Diseases
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• v.48 no.4
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• pp.471-477
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• 2000

Background : Coughing is the most common complaint for which patients seek medical service. When caughing continues over 3 weeks in non-smokers who do not take cough-provoking drugs, they are classified as patients with chronic cough. Three well known main causes of chronic caugh are postnasal drip syndrome, bronchial asthma and gastroesophaseal reflux disease. Among them, postnasal drip syndrome is reported to be the most common cause of all in chronic cough diseases, and allergic inflammation plays an important role in the pathogenesis of postnasal drip syndrome. CD23 and CD25 which are low affinity receptor for IgE and IL-2 receptor alpha, respectively, are closely related to allergic inflammation and their roles were evaluated in chronic cough patients. Methods : We evaluated 105 patients with chronic cough and selected 56 patients for measurement of serum CD23 & CD25 levels. We selected 10 normal, medical students for comparison of serum CD23 & CD25 levels. Result : The postnasal drip syndrome was found to be the most common cause of chronic cough. Serum CD23 and CD25 did not increase in chronic cough patient compared to normal controls. However in bronchial asthma patient, serum CD23 level was increased relative to normal control (p<0.05). Conclusion : In bronchial asthma presented as chronic cough, lymphocyte mediated allergic inflammation may related with the pathogenesis of the disease.

• 보건세계
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• v.46 no.3 s.511
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• pp.8-11
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• 1999

• Tuberculosis and Respiratory Diseases
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• v.44 no.4
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• pp.853-860
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• 1997

Background : Chronic cough, defined as a cough persisting for three weeks or longer, is a common symptom for which outpatient care is sought. The most common etiologies of chronic cough are postnasal drip, asthma, and gastroesophageal reflux. Methacholine challenge is a useful diagnostic study in the evaulation of chronic cough, particularly useful in chronic cough patients with asthmatic symptom. Patients with chronic cough may have dysfunction of bronchial and extrathoracic airways. To evaluate if dysfunction of the bronchial and extrathoracic airways causes chronic cough, we assessed bronchial (BHR) and extrathoracic airway (EAHR) responsiveness to inhaled methacholine in patients with chronic cough. Method : 111 patients with chronic cough were enrolled in our study. Enrolled patients had no recorded diagnosis of asthma, bronchopulmonary disease, hypertension, heart disease or systemic disease and no current treatment with bronchodilator or corticosteroid. Enrolled patients consisted of 46 patients with cough alone, 24 patients with wheeze, 22 patients with dyspnea, 19 patients with wheeze and dyspnea. The inhaled methacholine concentrations causing a 20% fall in forced expiratory volume in 1s($PC_{20}FEV_1$) and 25% fall in maximal mid-inspiratory flow ($PC_{25}MIF_{50}$) were used as bronchial and extra thoracic hyperresponsiveness. Results : There were four response patterns to methacholine challenge study : BHR in 27 patients, EAHR in 16 patients, combined BHR and EAHR in 8 patients, and no hyperresponsiveness in 60 patients. In patients with cough alone, there were BHR in 3 patients, EAHR in 9 patients, and combined BHR and EAHR in 2 patients. In patients with wheeze and/or dyspnea, there were BHR in 24 patients, EAHR in 7 patients, and BHR and EAHR in 6 patients. Compared with patients with wheeze and/or dyspnea, patients with cough alone had more common EAHR than BHR. In patients with wheeze and/or dyspnea, BHR was more common than EAHR. Conclusion : These results show that among patients with hyperresponsiveness to methacholine, those with dyspnea and/or wheezing had mainly bronchial hyperresponsiveness, whereas those with chronic cough alone had mainly extrathoracic airway hyperresponsiveness.

• 보건세계
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• v.53 no.2 s.594
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• pp.22-24
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• 2006

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.27 no.2
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• pp.87-90
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• 2016

Cough, the most common symptom, encountered in the outpatient clinic can be caused by various underlying diseases. It defines as chronic cough that the duration of cough is more than 8 weeks with a normal chest X-ray findings. The cause of cough can be found out for more than 90% through the appropriate diagnostic approach and Upper airway cough syndrome, Asthma and Gastroesophageal reflex disease are the most common causes of disease to non-smokers. Chronic cough can be due to not one reason but various reasons and achieve good results by a systematic approach to diagnosis and a concrete treatment on the basis of the sufficient understanding of the underlying disease.