Efficacy, Safety and Economic Evaluation of Wolbigachul-Tang for Chronic Cough Due to Upper Airway Cough Syndrome (UACS): A Study Protocol for Randomized, Double-Blind, Active-Comparator Controlled, Parallel, Exploratory Clinical Trial.

Upper airway cough syndrome (UACS) is a common cause of chronic cough characterized by upper airway symptoms, including nasal discharge and throat discomfort. Empirical treatments for UASC-induced chronic cough, such as first-generation antihistamines, have been used; however, the long-term use of these medicines has adverse effects. Therefore, we evaluate the efficacy, safety, and economic feasibility of Wolbigachul-tang (WBGCT), an herbal medication for UASC-induced chronic cough. This is a randomized, double-blind, active-comparator-controlled, parallel, and exploratory clinical trial. Thirty patients with UASC-induced chronic cough will be recruited and randomly allocated to the WBGCT and control groups in a 1:1 allocation ratio. The investigational medicine will be administered three times per day for 2 weeks (3 g of WBGCT at a time). The primary outcome measure is the cough symptom score measured at screening, before starting the trial, and after 2 and 4 weeks. Secondary outcome measures include the cough visual analog scale, nasal discharge score, questionnaire of clinical symptoms of cough and sputum, Leicester cough questionnaire-Korean version, integrative medicine outcome scale, integrative medicine patient satisfaction scale, and 5-level EuroQol 5-dimensional questionnaire, which will be assessed before starting the trial and after 2 and 4 weeks. This study aims to investigate the efficacy, safety, and economic feasibility of WBGCT in the treatment of chronic cough. Therefore, the results of this trial provide evidence for the application of WBGCT in the treatment of UACS-induced chronic cough.

Efficacy and safety of Sanfeng Tongqiao Diwan in the treatment of upper airway cough syndrome: a randomized, double-blind, placebo-controlled clinical study.

Background: Sanfeng Tongqiao Diwan has shown the potential to alleviate acute, recurrent, and chronic rhinitis in adults based on available studies. However, the evidence for its application in upper airway cough syndrome (UACS) is unclear. The purpose of this study was thus to investigate the efficacy and safety of Sanfeng Tongqiao Diwan in the treatment of UACS. Methods: This was a single-center, randomized, double-blind, placebo-controlled clinical trial. A total of 60 patients who satisfied the inclusion criteria were randomly divided into experimental and placebo groups in a 1:1 ratio. The experimental group was given Sanfeng Tongqiao Diwan, and the placebo group was given a simulant for 14 consecutive days. The follow-up period was 15 days. The primary outcome was the total effective rate. The secondary outcomes included clinical efficacy, Visual Analogue Scale (VAS) of related symptoms, and Leicester Cough Questionnaire in Mandarin-Chinese (LCQ-MC) scores before and after the treatment. Additionally, the safety was also evaluated. Results: The total effective rate in the experimental group was 86.6% (26/30), which was significantly higher than the 7.1% (2/28) in the placebo group (difference 79.6; 95% CI: 57.0 to 89.1; P<0.001). Nasal congestion, runny nose, cough, postnasal drip, and overall symptoms in the experimental group were significantly lower than those in the placebo group after treatment (3.7±1.5 vs. 5.0±1.1, 3.6±1.3 vs. 5.9±1.1, 3.8±1.2 vs. 6.8±1.3, 3.5±1.4 vs. 6.1±1.5, 3.8±2.0 vs. 7.3±1.4, respectively; all P values <0.001). After treatment, the LCQ-MC score in the experimental group was significantly higher than that in the placebo group (all P values <0.001). The blood eosinophil count in the placebo group was significantly higher after treatment than before treatment (P=0.037). No abnormalities were found in liver or renal indicators during the treatment period in the 2 groups, and no adverse reactions occurred. Conclusions: Sanfeng Tongqiao Diwan improved the symptoms and living quality of patients with UACS and showed acceptable safety. The results of this trial represent rigorous clinical evidence for the application of Sanfeng Tongqiao Diwan and further support a new option in UACS treatment. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300069302.

A 58-year-Old non-smoking woman with intractable cough and rhinorrhea.

Our case highlights an uncommon cause of CSF rhinorrhea. The patient was diagnosed with bacterial meningitis and appropriately treated after which, she developed unilateral rhinorrhea followed by non-productive cough. These symptoms were not responsive to multiple treatment regimens, and eventually imaging revealed a dehiscence in the ethmoid air sinus which was surgically repaired. We also performed a literature review on CSF rhinorrhea and provide insights into its evaluation.

Aerodigestive Approach to Pediatric Chronic Cough.

Chronic cough is defined as cough lasting more than 4 weeks in children aged 14 years or older. Normal children, without pathophysiology, can cough up to more than 30 times a day. When cough occurs pathologically, it is often more often and can be divided into specific and nonspecific cough types. Inputs from otolaryngology, pulmonary medicine, and gastroenterology, along with other specialties in an aerodigestive team setting, allow a team approach to consider a wide variety of causes of cough and coordinate diagnostic procedures with treatment.

WAO-ARIA consensus on chronic cough - Part III: Management strategies in primary and cough-specialty care. Updates in COVID-19.

Background: Chronic cough management necessitates a clear integrated care pathway approach. Primary care physicians initially encounter the majority of chronic cough patients, yet their role in proper management can prove challenging due to limited access to advanced diagnostic testing. A multidisciplinary approach involving otolaryngologists and chest physicians, allergists, and gastroenterologists, among others, is central to the optimal diagnosis and treatment of conditions which underly or worsen cough. These include infectious and inflammatory, upper and lower airway pathologies, or gastro-esophageal reflux. Despite the wide armamentarium of ancillary testing conducted in cough multidisciplinary care, such management can improve cough but seldom resolves it completely. This can be due partly to the limited data on the role of tests (eg, spirometry, exhaled nitric oxide), as well as classical pharmacotherapy conducted in multidisciplinary specialties for chronic cough. Other important factors include presence of multiple concomitant cough trigger mechanisms and the central neuronal complexity of chronic cough. Subsequent management conducted by cough specialists aims at control of cough refractory to prior interventions and includes cough-specific behavioral counseling and pharmacotherapy with neuromodulators, among others. Preliminary data on the role of neuromodulators in a proof-of-concept manner are encouraging but lack strong evidence on efficacy and safety. Objectives: The World Allergy Organization (WAO)/Allergic Rhinitis and its Impact on Asthma (ARIA) Joint Committee on Chronic Cough reviewed the recent literature on management of chronic cough in primary, multidisciplinary, and cough-specialty care. Knowledge gaps in diagnostic testing, classical and neuromodulator pharmacotherapy, in addition to behavioral therapy of chronic cough were also analyzed. Outcomes: This third part of the WAO/ARIA consensus on chronic cough suggests a management algorithm of chronic cough in an integrated care pathway approach. Insights into the inherent limitations of multidisciplinary cough diagnostic testing, efficacy and safety of currently available antitussive pharmacotherapy, or the recently recognized behavioral therapy, can significantly improve the standards of care in patients with chronic cough.

Cough in the Elderly During the COVID-19 Pandemic.

INTRODUCTION: The prevalence of chronic cough increases with age. However, data on the prevalence and background disorders of cough subtypes in the elderly are scarce. The objective of this study was to identify the point prevalence and risk factors of acute, subacute, and chronic cough in an elderly community-based population. METHODS: This was a cross-sectional email survey amongst 26,205 members of the Finnish Pensioners' Federation during the COVID-19 pandemic in spring 2021. RESULTS: The response rate was 23.6% (6189). 5983 subjects aged at least 64 years were included in the analyses (mean 72.6 years, 66.3% female). The point prevalence of daily acute, subacute, and chronic cough were 1.4%, 0.7%, and 9.6%, respectively. Only 0.4% of the subjects had a COVID-19 infection. In the multivariate analyses, chronic rhinosinusitis, and obstructive sleep apnoea were common risk factors for all cough subtypes. Chronic cough had several risk factors; Bronchiectasis (OR 5.79 (CI95% 2.70-12.41)), current asthma (2.67 (2.02-3.54)), chronic rhinosinusitis (2.51 (1.94-3.24)), somatic symptom score (1.13 per symptom (1.07-1.19)), family history of chronic cough (1.88 (1.54-2.30)), gastro-oesophageal reflux disease (1.86 (1.50-2.32)), advanced age (1.20 per decade (1.02-1.40)), chronic obstructive pulmonary disease (1.74 (0.99-3.05)), dog ownership (1.42 (1.07-1.89)), and obstructive sleep apnoea (1.41 (1.16-1.73)). CONCLUSION: Acute and subacute cough, as well as previous COVID-19 infection, were uncommon in this Finnish elderly population. The prevalence of chronic cough was higher than that previously found in younger adults. Chronic cough is a multifactorial disorder in the elderly.

WAO-ARIA consensus on chronic cough - Part II: Phenotypes and mechanisms of abnormal cough presentation - Updates in COVID-19.

BACKGROUND: Chronic cough can be triggered by respiratory and non-respiratory tract illnesses originating mainly from the upper and lower airways, and the GI tract (ie, reflux). Recent findings suggest it can also be a prominent feature in obstructive sleep apnea (OSA), laryngeal hyperresponsiveness, and COVID-19. The classification of chronic cough is constantly updated but lacks clear definition. Epidemiological data on the prevalence of chronic cough are informative but highly variable. The underlying mechanism of chronic cough is a neurogenic inflammation of the cough reflex which becomes hypersensitive, thus the term hypersensitive cough reflex (HCR). A current challenge is to decipher how various infectious and inflammatory airway diseases and esophageal reflux, among others, modulate HCR. OBJECTIVES: The World Allergy Organization/Allergic Rhinitis and its Impact on Asthma (WAO/ARIA) Joint Committee on Chronic Cough reviewed the current literature on classification, epidemiology, presenting features, and mechanistic pathways of chronic cough in airway- and reflux-related cough phenotypes, OSA, and COVID-19. The interplay of cough reflex sensitivity with other pathogenic mechanisms inherent to airway and reflux-related inflammatory conditions was also analyzed. OUTCOMES: Currently, it is difficult to clearly ascertain true prevalence rates in epidemiological studies of chronic cough phenotypes. This is likely due to lack of standardized objective measures needed for cough classification and frequent coexistence of multi-organ cough origins. Notwithstanding, we emphasize the important role of HCR as a mechanistic trigger in airway- and reflux-related cough phenotypes. Other concomitant mechanisms can also modulate HCR, including type2/Th1/Th2 inflammation, presence or absence of deep inspiration-bronchoprotective reflex (lower airways), tissue remodeling, and likely cough plasticity, among others.

Upper airway cough syndrome may be the main cause of chronic cough in Japan: a cohort study.

BACKGROUND: Upper airway cough syndrome (UACS) is generally considered a common cause of chronic cough but remains poorly recognised in Japan. OBJECTIVE: This study aimed to assess whether UACS was a common cause of chronic cough in Japan, as is true in other countries. Interview and examination items were evaluated for their potential use in UACS diagnosis. METHODS: All patients with chronic cough were preliminarily diagnosed with bronchial asthma, UACS, gastroesophageal reflux disease, or postinfectious prolonged cough, based on interviews and examinations. Treatment centred on nasal steroids was administered to the UACS group and standard treatment to the other groups. The observation period lasted 4 weeks. The subjective cough score at first diagnosis was set at 10, and the final diagnosis was made based on the treatment administered at the time the cough score had decreased to ≤2. The associations between the presence or absence of UACS and interview and examination items were statistically evaluated. RESULTS: Among 230 patients with chronic cough, 146 were diagnosed with UACS-only. Multivariate logistic regression revealed that the assessment items 'awareness of mucus accumulating in the back of the throat', 'presence of abnormal echography findings', 'absence of associated coughing when exercising' and 'presence of coughing persisting after onset' were significantly correlated with the presence or absence of UACS (p < 0.05). CONCLUSIONS: UACS may be the most common cause of chronic cough in Japan and may be effectively treated with nasal corticosteroids. Diagnosing UACS might be possible by selecting appropriate interview and examination items.

Chronic cough that lasts more than 8 weeks is often a symptom that plagues the patient and the physician. In general, postnasal drip [now defined as upper airway cough syndrome (UACS)] associated with rhinosinusitis, cough variant asthma and gastroesophageal reflux are known causes of chronic cough. The cough guidelines by the Japanese Respiratory Society state sinusitis as the cause of cough, and it is categorised as a sino-bronchial syndrome. Thus, the recognition of UACS is extremely low. UACS is not considered a cause of cough in Japan, but it is unlikely that Japan is the only exception. Based on these findings, I investigated the causes of chronic cough in patients who visited my clinic. As a result, UACS accounted for at least 60% of chronic cough cases. This study showed that UACS might be the most common cause of chronic cough in Japan. This study also showed that the treatment centred on nasal steroids was highly effective against UACS and that some interview and examination items might be useful in the diagnosis of UACS. This is an unprecedented finding and may contribute to the diagnosis of chronic cough.

Chronic cough related to the upper airway cough syndrome: one entity but not always the same.

PURPOSE: Upper airway cough syndrome (UACS), described as chronic cough (CC) associated with allergic (AR), non-allergic rhinitis (NAR) or chronic rhinosinusitis (CRS), is one of the major causes of CC. We aimed to characterize a cohort of UACS patients with special attention to differences between patients with AR and NAR. METHODS: A prospective analysis of clinical data of patients, diagnosed with UACS between 2015 and 2018. RESULTS: There were 143 patients diagnosed with UACS, median age 52 years, women predominance (68.5%), The group comprised of 59 (41%) AR and 84 (59%) NAR subjects, CRS diagnosed in 17 (12%). Median cough duration: 48 months (IQR 24-120), median cough severity (VAS)-60 mm (IQR 42-78), median Leicester Cough Questionnaire (LCQ) score-11.3 (IQR 8.7-13.7), never-smokers: 70%. The most common symptoms: PND (62%), rhinorrhea (59%), nasal congestion (54%), abnormalities of sinus CT: septum deviation (62%), turbinates hypertrophy (53%), mucosal thickening (53%). UACS as the only cause of CC, was presented in 20 patients (14%). We found no differences between patients with AR and NAR in terms of age, gender, duration and severity of cough, BMI, blood eosinophil count, total IgE and FeNO. AR was associated with higher comorbidity of asthma than NAR (54% vs 35%, p = 0.019). Abnormalities in sinus CT scan were more frequently found in patients with NAR than AR (p = 0.018). CONCLUSION: NAR is the most common upper airway disease associated with UACS. Clinical characteristics of UACS patients with AR and NAR are similar with only minor differences between these groups. It seems reasonable to plan further studies concerning relationship of NAR and cough sensitivity, also in terms of potential similar neurogenic mechanism.

[The Mysterious Cough - a Case-Based Proposal of Differential Diagnosis]. / Der rätselhafte Husten ­ ein fallbasierter Vorschlag einer Abklärungsstrategie.

The Mysterious Cough - a Case-Based Proposal of Differential Diagnosis Abstract. Cough is a frequent complaint in the general practice. Avoidance of overdiagnosis and underdiagnosis is essential. In case of acute cough or subacute (<8 week duration), red flags indicate the need for further evaluation, otherwise it is mostly self-limiting. In case of chronic cough (>8 week duration) and normal baseline examination and after cessation of smoking and medication with ACE-I, cough-variant asthma, gastro-esophageal reflux disease and upper airway cough syndrome are the main causes and should be assessed and empirically treated in a systematic manner.

Changing etiological frequency of chronic cough in a tertiary hospital in Shanghai, China.

BACKGROUND: The frequency distributions of the etiologies of chronic cough have changed over time. This study aimed to investigate the changing etiological frequency of chronic cough in a tertiary hospital in Shanghai, China, and to explore the clinical significance. METHODS: Medical records of 1,311 patients with chronic cough who visit our hospital between January 2009 and December 2016 were retrospectively reviewed. The etiologies of chronic cough were identified according to a standardized step-by-step diagnostic protocol and the changes in the etiological frequency of chronic cough over the years were using the Chi-squared (χ2) test. RESULTS: Cough variant asthma (CVA) (449/1,311, 34.2%), gastroesophageal reflux-related chronic cough (GERC) (374/1,311, 28.5%), upper airway cough syndrome/postnasal drip syndrome (UACS/PNDs) (241/1,311, 18.4%), atopic cough (AC) (188/1,311, 14.3%), and non-asthmatic eosinophilic bronchitis (NAEB) (147/1,311, 11.2%) were the common causes of chronic cough in descending order. The post-infectious cough (PIC) (39/1,311, 3.0%) and angiotensin-converting enzyme inhibitor (ACEI)-induced cough (25/1,311, 1.9%) were less common. During the 8-year period, the proportion of CVA (χ2=72.86, P<0.0001) and UACS/PNDs (χ2=68.80, P<0.0001) decreased, while those of NAEB (χ2=51.38, P<0.0001), GERC (χ2=55.95, P<0.0001) and AC (χ2=39.09, P<0.0001) increased. CONCLUSIONS: The etiological frequency of chronic cough varies over time, and it may encourage the adjustment of the current diagnostic and therapeutic strategies for chronic cough.

Etiologies associated with chronic cough and its clinical characteristics in school-age children.

BACKGROUND: To comprehensively evaluate the etiology of chronic cough and the value of clinical feature in school age children in Suzhou, China. METHODS: School-age (6-14 years) children newly referred with chronic cough (>4 weeks) were prospectively evaluated by utilizing a diagnostic algorithm in this study. Clinical features of different etiologies of chronic cough were also investigated. RESULTS: In total, 118 patients were enrolled in the study. The cough duration ranged from 1 to 76 months. Upper airway cough syndrome (UACS) was found in 77 (65.3%) patients with chronic cough, cough-variant asthma (CVA) in 57 (48.3%) patients, protracted bronchitis (PB) in 15 (12.7%) patients, gastroesophageal reflux disease (GERD) in 7 (5.9%) patients, tic disorders (TD) in 3 (2.5%) patients and eosinophilic bronchitis (EB) in 2 (1.7%) patients. A single etiology was present in 75 patients and multiple etiologies were present in 43 patients. The three most common single etiologies were UACS (31.4%), CVA (14.4%), and PB (10.2%), followed by GERD (5.9%), and EB (1.7%). The most common multiple etiology was CVA + UACS (31.4%), followed by CVA + PB (2.5%), and TD + UACS (2.5%). CONCLUSIONS: The common etiologies of chronic cough in school-age children were UACS, CVA, and PB, while EB and GERD were rare.

Cough and Eosinophilia.

Eosinophilic airway inflammation is observed in 30% to 50% of chronic cough sufferers. It is a common feature of asthma and upper airway cough syndrome, and it is required in the diagnosis of nonasthmatic eosinophilic bronchitis. Our understanding of the mechanisms underlying allergic and nonallergic eosinophilic inflammation have evolved tremendously in the last 2 decades, but the cause of this inflammation in any individual is often uncertain. Inhaled corticosteroids are the mainstay therapy for cough due to asthma or nonasthmatic eosinophilic bronchitis, and response is related to the presence of biomarkers of eosinophilic airway inflammation. In upper airway cough syndrome, nasal topical corticosteroids are beneficial in allergic rhinitis and chronic rhinosinusitis with polyposis. This review will describe the diagnosis, current and possible future treatments, and prognosis of chronic cough in adults with eosinophilic inflammation.

Wet Cough and Nasal Symptoms in Children: Can We Do Better?

The causes of chronic cough in children are mainly dependent on the setting and age of the child. Protracted bacterial bronchitis is a frequent cause of morbidity in childhood, and antibiotic treatment is beneficial. Prompt recognition and early treatment is important both to prevent inappropriate use of asthma medications and also progression to bronchiectasis, but the diagnosis should not be made uncritically, because chronic wet cough is not necessarily due to lower airway disease. Upper Airway Cough Syndrome (UACS) is considered by some to cause chronic cough in childhood. Underlying UACS are many common conditions, including allergic rhinitis, adenoiditis and rhinosinusitis. Diagnosis relies on a combination of clinical criteria that are relatively sensitive but non-specific. The role of nasal endoscopy in children with chronic cough and signs suggesting UACS is unclear. Nasal saline solution irrigation is commonly used in UACS, but most studies have methodological biases, and efficacy data are scanty. Randomized controlled trials are urgently required. However, if saline washes, rather than oral antibiotics, can effectively treat some children with wet cough associated with upper airway conditions, antibiotic resistance could potentially be reduced. There is a need to further study wet cough and not to assume it to be equivalent to lower airway infection in all children.

The efficacy of modified Quyuan decoction in treating children upper airway cough symptom complex with syndrome of phlegm and heat accumulated in lung / 国际中医中药杂志

Objective@#To investigate the efficacy of modified Quyuan decoction in the treatment of Children upper airway cough symptom complex with syndrome of phlegm and heat accumulated in lung.@*Methods@#Eighty-two Children with upper airway cough symptom complex who met the inclusion criteria were randomly divided into 2 groups with 41 in each group. In the control group, monteluster sodium chewing tablets were taken orally and budesonide suspension was inhaled. The observation group took modified Quyuan decoction on the basis of the control group. Both groups were treated continuously for 2 weeks and followed up for 6 months. The levels of interleukin (IL)-8 and IL-13 were detected by double-antibody-sandwich ELISA, and the symptoms and signs were scored before and after treatment, as well as the symptoms of phlegm, heat and stagnation of lung, cough and pharynx. The efficacy was evaluated and recurrence rate was recorded.@*Results@#The total effective rate 95.12% (39/41) in the observation group was obviously higher than 75.61% (31/41) in the control group (χ2=4.783, P=0.029). After treatment, the serum level of IL-8 (51.61 ± 5.94 ng/L vs. 71.25 ± 7.99 ng/L, t=12.631) and IL-13 (27.62 ± 3.20 ng/L vs. 34.91 ± 4.01 ng/L, t=9.099) in the observation group were significantly lower than those in the control group (P<0.01). After treatment, the scores of cough, nasal obstruction, runny nose, nasal itching, expectoration, sneezing, secretion of posterior pharyngeal wall and pharyngeal mucosa in the observation group were all significantly lower than those in the control group (t values were 7.762, 6.831, 6.217, 6.944, 6.408, 6.212, 7.268, 7.109, all Ps<0.01). The scores of cough, expectoration, blood in sputum, chest pain, dry mouth and fever were significantly lower than those of the control group (t values were 9.439, 6.831, 6.982, 10.115, 12.031 and 10.443, all Ps<0.01). Scores of daytime and nighttime cough symptoms were significantly lower than those of the control group (t values were 7.012, 7.241, respectively, all Ps<0.01). The scores of pharyngeal pain, pharyngeal dryness and pharyngeal foreign body sensation were significantly lower than those of the control group (t values were 6.003, 6.106, 6.318, respectively, all Ps<0.01). In the 6 months' follow-up observation, the recurrence rate was 17.7% (3/17) in the observation group and 53.9% (7/13) in the control group, and the difference between the two groups was statistically significant (χ2=4.344, P=0.037).@*Conclusions@#The modified Quyuan decoction combined with conventional western medicine can improve the symptoms and signs of upper airway cough symptom complex of children with syndrome of phlegm and heat accumulated in lung.

Managing patients with chronic cough: challenges and solutions.

Chronic cough is a common complaint and a frequent cause of medical consultation. Its management can be difficult. We present here an overview of the current guidelines for the management of chronic cough. Different steps are detailed, including the initial research of an obvious etiology and alert signs that should lead to further investigation of underlying condition. The diagnosis of the most frequent causes: asthma, non-asthmatic eosinophilic bronchitis, gastroesophageal reflux disease and upper airway cough syndrome should be considered, assessed and treated accordingly. Recent advances have been made in the comprehension of refractory chronic cough pathophysiology as well as its pharmacologic and non-pharmacologic treatment, especially speech pathology therapy.

Curative Effect of Shufeng Jiedu Capsules Combined with Conventional Treatment on Upper Airway Cough Syndrome / 中国药师

Objective:To observe the clinical effect of Shufeng Jiedu capsules combined with the conventional treatment on upper airway cough syndrome(UACS). Methods:Totally 55 patients with UACS and basic nasal or sinus diseases were randomly divided into two groups:the treatment group (n = 28) and the control group (n = 27). The treatment group was treated with Shufeng Jiedu capsules combined with the regimen for the control group,40 mg·kg-1,3 times a day, and the regimen for the control group was as follows:loratadine tablets, 10 mg,qd, budesonide nasal spray hormone 128 μg, bid, roxithromycin dispersible tablets,0.15 g,qd. The treatment course was 4 weeks. The changes of symptom scores were observed and the adverse reactions were recorded to compare the efficacy between the groups. Results:The total effective rate of the treatment group was 85.71%, which was significantly higher than that of the control group(75.37%,P <0.05). The cough and nasal symptoms were notably improved in the two groups after the treatment(P < 0.05),and all the symptom scores in the treatment group were better than those in the control group (P < 0.05). Conclusion:Shufeng Jiedu capsules combined with the conventional treatment can improve the efficacy in the treatment of UACS.

Etiology and diagnostic value of nasopharyngeal endoscopy in children with upper airway cough syndrome / 中国内镜杂志

Objective To explore the etiological analysis and diagnostic value of nasopharyngeal endoscopy in children with upper airway cough syndrome. Method The results of nasopharyngeal endoscopy in 120 children diagnosed with upper airway cough syndrome from January 2014 to December 2016 were analyzed. Results Of the 132 cases, 125 cases (94.70％) with upper airway lesions were found, and among the 125 cases, 43 cases (32.58％) had sinusitis, 32 cases (24.24％) had chronic rhinitis (including allergic rhinitis), 13 cases (9.85％) had adenoid hypertrophy, 11 cases (8.33％) had chronic pharyngitis, chronic tonsillitis (tonsil hypertrophy) 9 cases (6.82％). The distribution of upper airway lesions was different in different age groups (P < 0.05). Conclusion Nasopharyngeal endoscopy in the upper airway cough syndrome etiology analysis and diagnosis can be accurate and timely detection of local airway lesions, clinical diagnosis and treatment to provide good help. It is a safe and effective examination method, worthy of clinically promotion.

Therapeutic Observation of Electroacupuncture plus Nasal Irrigation for Upper Airway CoughSyndrome / 上海针灸杂志

Objective To observe the clinical efficacy of electroacupuncture plus nasal irrigation in treating upper airway cough syndrome (UACS).Method A total of 114 UACS patients were randomized into 3 groups, 38 cases in each group. Group A was treated with acupuncture plus electrical stimulation with sparse-dense wave, group B was intervened by nasal irrigation with Shuang Huang Lian, and group C was treated with the two methods together. The clinical efficacies of the three groups were compared.Result The total effective rates were respectively 84.2%, 73.7% and 94.7% in group A, group B and group C. The total effective rate of group C was significantly different from that of group A and group B (P<0.05).Conclusion Electroacupuncture plus nasal irrigation can produce a more significant therapeutic efficacy compared to electroacupuncture or nasal irrigation alone.

Evidence-based Evaluation and Management of Chronic Cough.

Chronic cough is common and has a significant impact on the wellbeing of patients and the use and cost of health care services. Traditionally the approach to chronic cough in patients who are nonsmokers and are not taking an angiotensin-converting enzyme inhibitor has focused on the diagnosis and management of the upper airway cough syndrome, asthma, and reflux disease. The evaluation of patients with chronic cough frequently involves trials of empiric therapy for these 3 conditions. Chronic cough may be perpetuated by abnormalities of the cough reflex and sensitization of its afferent and central components.