成人慢性咳嗽：咳嗽高敏综合征与临床管理的当代综述

文献信息

中文摘要

目的： 综合关于成人慢性咳嗽病因、评估和管理的证据，强调咳嗽高敏、可治疗特征以及基于机制的临床方法。
数据来源： 检索PubMed/MEDLINE和Cochrane图书馆中2015年1月至2026年9月发表的英文文献，并补充参考文献列表审查和选定的早期开创性研究。
研究选择： 优先考虑国际指南、共识声明、系统评价、荟萃分析、随机试验和主要临床综述，这些研究涉及慢性咳嗽、难治性或不明原因咳嗽、咳嗽高敏、喉部和反流相关疾病、可治疗特征以及新兴镇咳疗法。
结果： 慢性咳嗽通常反映重叠的呼吸、上气道或喉部、反流相关、药物相关和神经机制。咳嗽高敏日益被认为是一个重要特征，尤其是在难治性或不明原因慢性咳嗽中，但不应假定其能解释所有表现。可诱导的喉部阻塞被适当地视为上气道和喉部疾病的一部分。胃食管反流病和喉咽反流可能在咳嗽患者中重叠，尽管因果归因通常困难，且这两种情况不应被视为可互换的诊断。初始评估应包括结构化病史采集、体格检查、危险信号识别、胸部X线摄影、肺功能测定以及针对可治疗特征的有针对性评估。尽管进行了适当管理但症状持续，可能提示与持续神经敏化相关的难治性或不明原因慢性咳嗽。
结论： 当前证据支持个体化、基于机制的方法，优先识别和治疗相关疾病及可治疗特征，同时将咳嗽高敏视为潜在治疗靶点。新兴的外周神经疗法可能拓宽难治性慢性咳嗽的未来治疗选择。

英文摘要

OBJECTIVE: To synthesize evidence on the causes, assessment, and management of adult chronic cough, emphasizing cough hypersensitivity, treatable traits, and a mechanism-based clinical approach.
DATA SOURCES: PubMed/MEDLINE and the Cochrane Library were searched for English-language literature published from January 2015 through September 2026, supplemented by reference-list review and selected earlier seminal studies.
STUDY SELECTIONS: Priority was given to international guidelines, consensus statements, systematic reviews, meta-analyses, randomized trials, and major clinical reviews addressing chronic cough, refractory or unexplained cough, cough hypersensitivity, laryngeal and reflux-associated disorders, treatable traits, and emerging antitussive therapies.
RESULTS: Chronic cough commonly reflects overlapping respiratory, upper-airway or laryngeal, reflux-associated, medication-related, and neural mechanisms. Cough hypersensitivity is increasingly recognized as an important feature, particularly in refractory or unexplained chronic cough, but should not be assumed to explain every presentation. Inducible laryngeal obstruction is appropriately considered within upper-airway and laryngeal disorders. Gastroesophageal reflux disease and laryngopharyngeal reflux may overlap in patients with cough, although causal attribution is often difficult and the two conditions should not be regarded as interchangeable diagnoses. Initial evaluation should include structured history taking, physical examination, identification of red flags, chest radiography, spirometry, and targeted assessment of treatable traits. Persistent symptoms despite appropriate management may indicate refractory or unexplained chronic cough associated with ongoing neural sensitization.
CONCLUSION: Current evidence supports an individualized, mechanism-based approach that prioritizes identification and treatment of relevant diseases and treatable traits while recognizing cough hypersensitivity as a potential therapeutic target. Emerging peripheral neural therapies may broaden future treatment options for refractory chronic cough.