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--> 00:03.484\n大家好，\n\n00:03.484 --> 00:10.121\n让我们今天一起来认识一下什么是咳嗽变异性的哮喘。\n\n00:14.097 --> 00:14.296\n嗯，\n\n00:14.296 --> 00:16.947\n咳嗽变异性的哮喘，\n\n00:17.597 --> 00:20.246\n它的缩写是CVA，\n\n00:20.396 --> 00:25.297\n是支气管哮喘的一种特殊类型。\n\n00:29.947 --> 00:39.847\n典型的哮喘一般表现为反复发作的喘息、气急、胸闷或者咳嗽这些症状，\n\n00:40.497 --> 00:44.497\n而对于咳嗽变异性的哮喘患者，\n\n00:44.597 --> 00:49.446\n咳嗽是唯一或者主要的临床表现，\n\n00:50.196 --> 00:55.247\n而没有明显的喘息气促症状，\n\n00:55.946 --> 00:59.646\n在剧烈咳嗽的时候可伴有。\n\n01:00.646 --> 01:04.997\n呼吸不畅、胸闷、呼吸困难这些症。\n\n01:05.296 --> 01:06.497\n这些表现。\n\n01:10.163 --> 01:10.413\n嗯，\n\n01:10.513 --> 01:17.013\n咳嗽变异性哮喘有哪些典型的症状和特点呢？\n\n01:17.563 --> 01:18.313\n首先，\n\n01:18.413 --> 01:20.313\n从咳嗽来说，\n\n01:20.462 --> 01:26.313\n咳嗽是咳嗽变异性哮喘的唯一或主要的症状，\n\n01:27.163 --> 01:33.013\n它的特点就是说慢性咳嗽的时间大于8周。\n\n01:34.240 --> 01:36.841\n而女性多于男性。\n\n01:38.043 --> 01:41.244\n主要表现为刺激性的干咳。\n\n01:42.596 --> 01:45.846\n每天的痰量小于10ml，\n\n01:45.896 --> 01:49.346\n通常这种咳嗽比较剧烈。\n\n01:50.462 --> 01:53.962\n而在夜间或者说是凌晨，\n\n01:54.163 --> 01:56.962\n咳嗽是重要的特征。\n\n01:58.376 --> 02:01.277\n从咽喉、胸部。\n\n02:02.986 --> 02:03.211\n嗯，\n\n02:03.211 --> 02:04.336\nX线，\n\n02:04.936 --> 02:10.337\n然后肺功能这些检查都没有明显的异常。\n\n02:11.186 --> 02:15.587\n常规感冒抗感染治疗无效。\n\n02:16.757 --> 02:20.106\n而抗哮喘治疗是有效的，\n\n02:20.106 --> 02:24.106\n可以确诊为咳嗽变异性的哮喘。\n\n02:27.164 --> 02:30.563\n当出现这种慢性的咳嗽时，\n\n02:30.714 --> 02:32.764\n我们应该如何？\n\n02:34.304 --> 02:39.804\n区分是咳嗽、变异性哮喘还是其他的毛病呢？\n\n02:41.386 --> 02:44.186\n首先根据这个表一，\n\n02:44.686 --> 02:56.537\n我们看一下咳嗽性变异性的哮喘和其他可能引起慢性咳嗽疾病的区别。\n\n02:58.621 --> 02:58.822\n嗯，\n\n02:59.871 --> 03:04.871\n从咳嗽的特征来说，\n\n03:04.972 --> 03:11.272\n首先咳嗽变异性的哮喘表现为刺激性的干咳。\n\n03:12.384 --> 03:19.083\n明显的夜间咳嗽及凌晨的咳嗽是重要特征，\n\n03:19.134 --> 03:22.083\n抗感染治疗通常无效。\n\n03:23.186 --> 03:25.535\n而慢性支气管炎。\n\n03:26.684 --> 03:32.085\n他的咳嗽、咳痰病程要在两年以上，\n\n03:32.785 --> 03:38.535\n每年累积或持续时间至少3个月。\n\n03:39.414 --> 03:41.964\n早晨的症状比较明显，\n\n03:42.615 --> 03:45.664\n一般咳白色泡沫痰，\n\n03:45.714 --> 03:48.065\n或者说是粘液痰。\n\n03:49.240 --> 03:55.091\n而上气道的咳嗽综合征除了咳嗽、咳痰外。\n\n03:56.018 --> 04:00.167\n还有鼻塞、鼻腔分泌物增加，\n\n04:00.968 --> 04:05.917\n频繁的清嗓子和咽喉粘液。\n\n04:07.572 --> 04:09.472\n附着这些症状。\n\n04:10.886 --> 04:11.886\n而食管。\n\n04:13.283 --> 04:18.583\n胃食管反流性的咳嗽除了咳嗽外，\n\n04:18.632 --> 04:26.282\n还可能伴有反酸、烧心、嗳气这些症状。\n\n04:27.246 --> 04:30.045\n咳嗽多发生在白天，\n\n04:30.196 --> 04:36.246\n或者说是直立体位和体位改变的时候。\n\n04:37.475 --> 04:41.524\n一般进食酸性油腻的食物，\n\n04:41.524 --> 04:45.325\n容易诱发或者加重咳嗽。\n\n04:46.403 --> 04:48.602\n抗反流的药物有效。\n\n04:51.838 --> 04:53.787\n很多慢性的咳嗽，\n\n04:53.838 --> 05:03.638\n特别对于拍胸片结果却没有明显的异常的慢性咳嗽，\n\n05:04.187 --> 05:08.088\n因为不能明确到底是什么原因，\n\n05:08.638 --> 05:13.488\n患者常常会反复的进行各种检查。\n\n05:14.402 --> 05:21.052\n或者长期的大量的使用抗菌药物和镇咳药物。\n\n05:21.830 --> 05:24.330\n效果却不是很明显。\n\n05:25.436 --> 05:28.835\n还会产生很多的不良反应。\n\n05:29.335 --> 05:30.485\n事实上，\n\n05:30.485 --> 05:37.135\n多数的慢性咳嗽和感染并没有太大的关系。\n\n05:37.235 --> 05:42.135\n有研究表明，\n\n05:42.135 --> 05:48.786\n82.82%的咳嗽变异性的哮喘曾被误诊为支气管炎。\n\n05:49.777 --> 05:54.127\n慢性支气管炎或者慢性的咽炎。\n\n05:55.197 --> 06:05.898\n使用止咳药和抗生素的慢性咳嗽患者超过了90%。\n\n06:07.036 --> 06:13.486\n但明显缓解或者完全缓解的却不足11%。\n\n06:16.201 --> 06:19.402\n咳嗽变异性的哮喘常见吗？\n\n06:21.746 --> 06:31.645\n咳嗽变异性的哮喘是慢性咳嗽大于八周以上的最常见的病因。\n\n06:31.795 --> 06:33.496\n调查显示，\n\n06:33.596 --> 06:38.621\n我国慢性咳嗽的成人患者中，\n\n06:38.621 --> 06:45.096\n有33%是因为得了咳嗽变异性哮喘。\n\n06:46.055 --> 06:53.955\n因为得了咳嗽变异性的哮喘而患上了慢性咳嗽的。\n\n06:54.872 --> 06:58.722\n儿童的比例高达42%。\n\n07:04.295 --> 07:07.845\n咳嗽变异性的哮喘是怎么得的呢？\n\n07:08.345 --> 07:16.644\n目前认为咳嗽变异性的哮喘作为哮喘的一种特殊类型。\n\n07:18.355 --> 07:22.105\n发病和典型的哮喘是类似的。\n\n07:22.959 --> 07:23.334\n首先，\n\n07:23.334 --> 07:27.859\n从环遗传和环境因素是它的。\n\n07:29.055 --> 07:30.355\n致病因素。\n\n07:31.480 --> 07:35.180\n过敏体质是主要的遗传因素。\n\n07:35.730 --> 07:40.580\n而运动、冷空气、感冒、灰尘。\n\n07:42.617 --> 07:47.467\n还有油烟这一些的主要环境因素，\n\n07:47.516 --> 07:51.566\n容易诱发或者说是加重咳嗽。\n\n07:52.834 --> 07:58.684\n而呼吸道的慢性炎症是它最基本的特征，\n\n07:59.535 --> 08:02.234\n程度会比哮喘轻。\n\n08:04.229 --> 08:12.178\n呼吸道的反应性增高是指呼吸道对各种刺激性。\n\n08:13.807 --> 08:14.307\n因此，\n\n08:14.356 --> 08:21.082\n比方说过敏原理化因素、运动、药物，\n\n08:21.082 --> 08:26.106\n这些呈现高度敏感状态，\n\n08:26.606 --> 08:31.457\n表现为患者接触的这些刺激因子。\n\n08:32.494 --> 08:33.895\n呼吸道出现。\n\n08:35.533 --> 08:42.783\n过强或者说是过早的收缩收缩反应。\n\n08:44.684 --> 08:51.809\n而咳嗽敏感性增高是咳嗽变异性哮喘。\n\n08:51.809 --> 08:53.283\n咳嗽症状。\n\n08:54.453 --> 08:56.754\n突出的主要原因。\n\n09:01.093 --> 09:05.093\n得了咳嗽变异性的哮喘严重吗？\n\n09:05.693 --> 09:12.093\n咳嗽变异性哮喘是慢性咳嗽最常见的病例。\n\n09:13.247 --> 09:23.648\n部分的咳嗽变异性哮喘的患者由于没有得到及时正确的诊断和治疗，\n\n09:24.297 --> 09:27.098\n导致病程拖得很长。\n\n09:28.575 --> 09:33.226\n最后可能会发展为典型的哮喘，\n\n09:33.426 --> 09:35.426\n治疗难度更大。\n\n09:37.383 --> 09:40.559\n因此正确的认识咳嗽。\n\n09:40.559 --> 09:43.633\n变异性的哮喘是慢性。\n\n09:45.124 --> 09:50.374\n咳嗽最常见的病因至关重要。\n\n09:53.898 --> 09:55.697\n需要及时的治疗。\n\n09:56.247 --> 09:58.297\n但是咳嗽性。\n\n09:59.861 --> 10:03.310\n咳嗽变异性的哮喘是可控的。\n\n10:04.520 --> 10:19.520\n要坚持长期、持续、规范化的个体化治疗咳嗽变异性的哮喘是可以达到良好的控制的。\n\n10:21.856 --> 10:30.356\n咳嗽变异性哮喘明确诊断前可以进行一些经验性的治疗。\n\n10:31.560 --> 10:31.760\n嗯，\n\n10:31.810 --> 10:40.611\n慢性咳嗽病因诊断的程序首先就是询问病史和体格检查。\n\n10:44.594 --> 10:49.520\n然后要排除一下是否有高血压，\n\n10:49.520 --> 10:53.344\n高血压的药物是否ACEI类。\n\n10:54.270 --> 10:57.820\n如果使用可ACEI类的话。\n\n10:59.979 --> 11:02.604\n我们可以停用ACEI，\n\n11:02.604 --> 11:06.979\n如果咳嗽仍旧长期持续的话，\n\n11:07.629 --> 11:09.278\n再拍胸片，\n\n11:09.328 --> 11:14.479\n在没有明显的病变的情况下还可以进行。\n\n11:16.140 --> 11:18.890\n空气实验和激发实验，\n\n11:18.940 --> 11:22.890\n然后还有诱导痰细胞学的。\n\n11:23.945 --> 11:24.395\n检查。\n\n11:31.193 --> 11:33.268\n最后考虑咳嗽，\n\n11:33.268 --> 11:34.994\n变异性的哮喘，\n\n11:35.193 --> 11:38.443\n然后我们要从病因治疗，\n\n11:38.494 --> 11:40.994\n或者说是经验治疗，\n\n11:40.994 --> 11:42.794\n如果有效的话，\n\n11:43.343 --> 11:45.593\n才可以明确诊断。\n\n11:47.468 --> 11:50.918\n咳嗽变异性哮喘如何治疗呢？\n\n11:52.656 --> 11:55.257\n他的用药误区有。\n\n11:57.013 --> 11:59.413\n最主要有以下三个。\n\n11:59.413 --> 12:03.963\n首先就是说仅在哮喘急性发作。\n\n12:05.210 --> 12:06.286\n时候用药，\n\n12:06.286 --> 12:07.861\n这个是不对的。\n\n12:08.866 --> 12:14.666\n而哮喘缓解期不使用或者不规范用药，\n\n12:14.666 --> 12:16.716\n这个也是不对的。\n\n12:17.685 --> 12:20.085\n最后就是滥用抗生素，\n\n12:20.236 --> 12:25.685\n因为咳嗽性变异性哮喘往往是过敏因素更多，\n\n12:26.185 --> 12:29.935\n跟细菌感染没有太直接的关系。\n\n12:34.577 --> 12:39.077\n咳嗽变异性哮喘应该如何治疗呢？\n\n12:39.577 --> 12:41.627\n它的常用药物？\n\n12:42.656 --> 12:46.057\n首先我们从药物分类来说，\n\n12:46.057 --> 12:49.956\n它分为控制药物和缓解药物。\n\n12:50.859 --> 12:53.008\n从作用机理来说，\n\n12:53.109 --> 13:04.109\n控制性的药物主要是通过抗炎作用使哮喘维持临床控制。\n\n13:05.943 --> 13:06.143\n嗯，\n\n13:06.244 --> 13:09.744\n要坚持服用8周以上，\n\n13:09.794 --> 13:11.893\n或长期随访，\n\n13:11.943 --> 13:13.343\n预防复发。\n\n13:14.270 --> 13:28.570\n主要的药药物有吸入糖皮质激素、白三烯受体拮抗剂、长效的贝塔二受体激动剂、茶碱，\n\n13:29.570 --> 13:35.719\n其他有助于减少全身激素剂量的药物。\n\n13:36.418 --> 13:38.418\n而缓解期的药物，\n\n13:38.418 --> 13:46.668\n它主要是通过迅速解除支气管痉挛。\n\n13:48.190 --> 13:50.841\n从而缓解哮喘症状。\n\n13:50.940 --> 13:54.440\n使用方法是按需使用。\n\n13:55.577 --> 13:58.377\n比方说速效吸入的。\n\n13:59.455 --> 14:01.755\n贝塔二受体激动剂。\n\n14:07.336 --> 14:11.786\n咳嗽变异性哮喘要注意哪些事项呢？\n\n14:11.786 --> 14:14.637\n首先就是远离过敏源。\n\n14:16.057 --> 14:18.857\n家里面不要饲养宠物。\n\n14:19.875 --> 14:23.976\n戒烟或者避免被动吸烟，\n\n14:24.176 --> 14:28.075\n不要在室内放置香水。\n\n14:29.281 --> 14:31.382\n或者说是香烛。\n\n14:32.081 --> 14:36.182\n要常更换床单和枕头。\n\n14:38.560 --> 14:39.510\n注意锻炼，\n\n14:39.661 --> 14:41.361\n增加抵抗力，\n\n14:41.810 --> 14:43.611\n冷暖适宜，\n\n14:43.611 --> 14:44.960\n避免感冒。\n\n14:49.374 --> 14:50.723\n咳嗽变异性。\n\n14:52.030 --> 14:56.054\n哮喘患者注意事项有哪些？\n\n14:56.054 --> 14:58.679\n首先就是定期就诊，\n\n14:58.679 --> 15:01.080\n进行病情的评估，\n\n15:01.780 --> 15:04.630\n建立良好的医患关系。\n\n","v0347cg10004d60q93qljht737gl57dg",909,928,"2026-01-24 20:44:03"," 认识咳嗽变异性哮喘：症状、诊断与治疗全解析  "," 咳嗽变异性哮喘,慢性咳嗽,哮喘症状,咳嗽治疗,哮喘诊断,过敏性咳嗽,哮喘管理  "," 咳嗽变异性哮喘是一种以慢性咳嗽为主要表现的哮喘类型。本文详细介绍其典型症状、诊断方法、治疗方案及日常管理建议，帮助您正确识别和应对这一特殊哮喘类型。","2026-02-10 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