Tos crónica

Tos Cr ó nica
  • 文章类型: Journal Article
    移民患者和当地人有相同的疾病,但是生物学或环境差异可能导致某些综合征的不同患病率和表现。初级保健中的一些常见情况脱颖而出,比如发烧,腹泻,贫血,嗜酸性粒细胞增多,慢性咳嗽,重要的是要有一个特殊的考虑。发烧可能表明是严重的输入性疾病,疟疾应该被排除在外。腹泻通常是感染性的,在大多数情况下,管理是门诊。贫血可能表明营养不良或吸收不良,而嗜酸性粒细胞增多可能表明寄生虫感染。最后,慢性咳嗽可能是肺结核的征兆,特别是来自流行地区的移民。家庭医学在全面、文化敏感,以人为中心的方法来解决这些问题。
    Migrant patients share the same diseases as natives, but biological or environmental differences may lead to distinct prevalence and manifestations of certain syndromes. Some common conditions in Primary Care stand out, such as fever, diarrhea, anemia, eosinophilia, and chronic cough, where it is important to have a special consideration. Fever may indicate a serious imported illness, and malaria should always be ruled out. Diarrhea is generally of infectious origin, and in most cases, management is outpatient. Anemia may indicate malnutrition or malabsorption, while eosinophilia may indicate a parasitic infection. Lastly, chronic cough may be a sign of tuberculosis, especially in immigrants from endemic areas. Family medicine holds a privileged position for the comprehensive, culturally sensitive, and person-centered approach to these conditions.
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  • 文章类型: Journal Article
    目的:了解家庭医生的看法,肺科医师和过敏症医师对目前慢性咳嗽的治疗方法及其对患者生活质量的影响。
    方法:通过SEAIC科学协会传播的横断面和匿名调查,SEMERGEN,semFYC,SEMG和SEPAR。参与者是620名家庭医生,92名肺科医师和62名过敏症医师。对答案进行了描述性分析。响应百分比,给出了中位数和四分位数间隔。用卡方评估了专业之间百分比的差异。
    结果:只有一半的受访者选择持续时间超过8周作为诊断慢性咳嗽的标准,不到一半的人认为难治性/无法解释的慢性咳嗽本身就是一种疾病。家庭医生认为,慢性咳嗽对患者的影响要小于肺科医师或过敏症医师。在诊断为难治性/原因不明的慢性咳嗽后,所有3个专科都认为最常见的方法是开始治疗并自行对患者进行随访.大多数人说他们没有治疗慢性咳嗽的方案,超过90%的人认为这是必要的。
    结论:家庭医生对慢性咳嗽患者的管理,肺科医师或过敏症医师似乎是异类的。需要标准化诊断的协议,转诊和治疗标准,以优化患者管理并减少慢性咳嗽的影响。
    OBJECTIVE: To understand the perception of family doctors, pulmonologists and allergists about the current approach to chronic cough and its impact on patients\' quality of life.
    METHODS: Cross-sectional and anonymous survey disseminated through the scientific societies SEAIC, SEMERGEN, semFYC, SEMG and SEPAR. The participants were 620 family doctors, 92 pulmonologists and 62 allergists. A descriptive analysis of the answers was conducted. Response percentages, medians and interquartile intervals were presented. The differences in the percentages between specialties were evaluated with the chi-square.
    RESULTS: Only half of the respondents chose a duration greater than 8 weeks as a criterion for diagnosing chronic cough, and less than half considered refractory/unexplained chronic cough a disease in itself. Family doctors perceived that chronic cough had less impact on patients than did pulmonologists or allergists. After a diagnosis of refractory/unexplained chronic cough, all 3specialties considered the most common approach to be to initiate treatment and to do the follow-up of the patient themselves. Most stated that they had no protocols for managing chronic cough, and more than 90% considered these to be necessary.
    CONCLUSIONS: The management of patients with chronic cough by family doctors, pulmonologists or allergists seems to be heterogeneous. There is a need for protocols that standardise diagnosis, referral and treatment criteria to optimise patients\' management and reduce the impact of chronic cough.
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  • 文章类型: Journal Article
    Cough lasting more than 8 weeks is considered chronic. If the classic causes of chronic cough have been discarded, vagus nerve sensory disturbances are currently considered the most important etiological cause. Patients with chronic cough of laryngeal origin have associated symptoms such as globus, dysphagia, dysphonia, dyspnoea and/or stridor. These patients are more likely to have paradoxical vocal fold movement. There is a higher cough reflex sensibility and neuropathic laryngeal response, mainly caused by viral infection or reflux. The cough associated with reflux has 2 mechanisms: Exposure to acid in the distal oesophagus (gastroesophageal reflux) and microaspiration of oesophageal contents into the larynx and tracheo-bronchial tree (pharyngo-laryngeal reflux). Laryngeal neuropathy hypersensitivity responds well to speech therapy as a treatment for refractory chronic cough. Because chronic cough is a sign of laryngeal sensory, neuropathy can improve with neuroleptic drugs such as amitriptyline and gabapentin.
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