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Vol. 34. Issue 5.
Pages 232-236 (May 1998)
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Vol. 34. Issue 5.
Pages 232-236 (May 1998)
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Tos como equivalente asmático. Características clínicas y funcionales. Estudio de 63 casos
Cough variant asthma. Clinical and functional features in 63 cases
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C. Orejas García*, T. Pascual Pascual, A. Alzueta Álvarez, T. Bazús González
Sección de Neumología. Hospital de Cabueñes. Gijón
J. Martínez González del Ríoa, C. Escudero Buenoa
a Servicio de Ncumología. Hospital Covadonga. Hospital Central de Asturias. Oviedo
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Los objetivos de este estudio han sido: a) estudiar las características de los pacientes que acuden a nuestra consulta externa por presentar tos crónica como único síntoma y son diagnosticados de asma bronquial, y b) evaluar su hiperrespuesta bronquial en relación a la de los pacientes con asma y espirometría normal.

Durante 3 años estudiamos a 193 pacientes consecutivos con tos crónica como único síntoma según el protocolo de estudio que se especifica en el apartado “Pacientes y métodos”. De éstos 63 fueron diagnosticados de asma bronquial. Se consideró que la hiperrespuesta bronquial era la causa de la tos según la obstrucción bronquial reversible o si el test de metacolina era positivo, junto con respuesta de la tos a la terapia específica antiasmática.

De los 63 pacientes estudiados, en 46 (73%) la tos era no productiva, 28 sujetos (44%) referían predominio nocturno de la misma y en 14 (22%) ésta había comenzado coincidiendo con síntomas de infección respiratoria de la vías altas. Solamente cuatro (6%) del total de sujetos presentaban sibilancias en la auscultación pulmonar. El diagnóstico fue hecho por obstrucción reversible en 11 (17%)y por el test de metacolina en 52 (83%). La concentración de metacolina que produce un descenso en el FEV1 del 20% (PC20) media fue superior en los pacientes diagnosticados de tos como equivalente asmático (PC20=10,45±2,48 mg/ml) que en los sujetos con asma bronquial clásico (PC 20=6,57±2,14 mg/ml).

La tos persistente ocasionada por asma, habitualmente no productiva, cursa con poca o nula sintomatología acompañante, a diferencia del asma clásico. La realización del test de metacolina es de una elevada rentabilidad diagnóstica en estos casos.

Palabras clave:
Tos crónica
Hiperreactividad bronquial y tos
Tos como equivalente asmático

To study the characteristics of our outpatient clinic patients presenting with chronic cough as the sole symptom of bronchial asthma, and to evaluate the bronchial hyperreactivity of such patients in comparison with that of classic asthmatic patients with normal spirometry.

For 3 years we studied 193 consecutivo patients with chronic cough as the sole symptom, using the study protocol specified in the section on patients and methods. Sixty-three patients were diagnosed of bronchial asthma. Bronchial hyperreactivity was considered to be the cause of coughing based on reversibility testing or a positive methacholine test, along with response to specific antiasthmatic therapy.

Forty-six (73%) of the 63 patients had unproductive cough and 28 (44%) coughed mainly at night. In 14 (22%) symptoms began with an upper respiratory tract infection. Wheezing couid be heard in oniy 4 (6%). Diagnosis was based on reversibility in 11 (17%) and methacholine testing in 52 (83%). Mean PC20 was higher in patients diagnosed of variant cough.

Unlike classic asthma, persisten! and usually unproductive cough caused by asthma has few or no accompanying symptoms. The diagnostic yield of methacholine testing is high in such patients.

Key words:
Chronic cough
Bronchial hyperreactivity and cough
Cough variant asthma
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Copyright © 1998. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
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