Zusammenfassung
Hintergrund: Husten ist ein sehr häufig beklagtes Symptom, dem zahlreiche Ursachen zugrunde liegen
können. Neben Pulmonologen und Gastroenterologen werden auch HNO-Ärzte in die Diagnostik
eingebunden, sie sollten deshalb über die wesentlichen hustenauslösenden Erkrankungen
informiert sein.
Material und Methoden: Anhand aktueller deutscher, britischer und US-amerikanischer Leitlinien wird ein
Überblick über die Ätiologie und Pathogenese des chronischen bzw. chronisch-persistierenden
Hustens gegeben.
Ergebnisse: Asthma in den verschiedenen Formen, Bronchitiden, gastroösophageale Refluxerkrankungen
sowie Erkrankungen der oberen Luftwege gehören zu den häufigsten Ursachen des chronischen
Hustens. Sind diese als Auslöser nicht wahrscheinlich oder ausgeschlossen, hilft die
Kenntnis weniger häufiger oder seltenerer Ursachen zur Diagnosefindung.
Diskussion: Häufig kann die korrekte, einem Husten zugrunde liegende Erkrankung nur ex juvantibus,
d. h. nach einer adäquaten, den chronischen Husten beendenden Behandlung, gefunden
werden. Kompliziert wird die Diagnostik auch dadurch, dass ein chronischer Husten
nicht selten mehrere Ursachen gleichzeitig hat. In der Regel wird ein interdisziplinäres
Vorgehen erforderlich sein, auch um ein Zuviel an diagnostischen Maßnahmen zu vermeiden.
Abstract
Background: Cough is an important and frequent complaint reported by patients and may be due
to a variety of reasons. A proper diagnostic management should include pneumologists,
gastroenterologists and ENT physicians working together. An in-depth knowledge about
pathomechanisms, possible triggers and diseases associated with cough is essential.
Methods: German, British and US-American guidelines are reviewed. Results: Chronic cough defined as one lasting at least more than 8 weeks, is often associated
with asthma, GERD, bronchitis or upper airway diseases. However, many other conditions
may evoke chronic cough. Discussion: A detailed history will often suggest a likely association or trigger. Chest radiography
and spirography should be undertaken in all patients with chronic cough, other examinations
like bronchoscopy and high resolution CT of the thorax are mandatory if the history
is suggesting an etiology not detectable by those procedures mentioned first. In all
patients it has to be kept in mind that chronic cough may not be due to a single reason
but two or more acting together. In many cases the underlying etiology and hence the
proper diagnosis can only be established ex juvantibus after a successful therapeutic
management.
Schlüsselwörter
chronischer Husten - Bronchitits - vocal cord dysfunction - Asthma - gastroösophagealer
Reflux - Larynx
Key words
chronic cough - bronchitis - vocal cord dysfunction - GERD - larynx - asthma
Literatur
- 1
Bolser D C.
Cough suppressant and pharmacologic protussive therapy: ACCP evidence-based clinical
practice guidelines.
Chest.
2006;
129 (1 Suppl)
238S-249S
- 2
Braman S S.
Chronic cough due to acute bronchitis: ACCP evidence-based clinical practice guidelines.
Chest.
2006;
129 (1 Suppl)
95S-103S
- 3
Braman S S.
Chronic cough due to chronic bronchitis: ACCP evidence-based clinical practice guidelines.
Chest.
2006;
129 (1 Suppl)
104S-115S
- 4
Braman S S.
Postinfectious cough: ACCP evidence-based clinical practice guidelines.
Chest.
2006;
129 (1 Suppl)
138S-146S
- 5
Brightling C E.
Chronic cough due to nonasthmatic eosinophilic bronchitis: ACCP evidence-based clinical
practice guidelines.
Chest.
2006;
129 (1 Suppl)
116S-121S
- 6
Brown K K.
Chronic cough due to chronic interstitial pulmonary diseases: ACCP evidence-based
clinical practice guidelines.
Chest.
2006;
129 (1 Suppl)
180S-185S
- 7
Brown K K.
Chronic cough due to nonbronchiectatic suppurative airway disease (bronchiolitis):
ACCP evidence-based clinical practice guidelines.
Chest.
2006;
129 (1 Suppl)
132S-137S
- 8
Canning B J.
Anatomy and neurophysiology of the cough reflex: ACCP evidence-based clinical practice
guidelines.
Chest.
2006;
129 (1 Suppl)
33S-47S
- 9
Chang A B, Glomb W B.
Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical
practice guidelines.
Chest.
2006;
129 (1 Suppl)
260S-283S
- 10
Dicpinigaitis P V.
Angiotensin-converting enzyme inhibitor-induced cough: ACCP evidence-based clinical
practice guidelines.
Chest.
2006;
129 (1 Suppl)
169S-173S
- 11
Dicpinigaitis P V.
Chronic cough due to asthma: ACCP evidence-based clinical practice guidelines.
Chest.
2006;
129 (1 Suppl)
75S-79S
- 12
Dicpinigaitis P V.
Potential future therapies for the management of cough: ACCP evidence-based clinical
practice guidelines.
Chest.
2006;
129 (1 Suppl)
284S-286S
- 13
Ganzer U, Arnold W, Steinhoff H J.
Leitlinie Reizhusten/Räusperzwang Erwachsene. (Klinischer Algorithmus) - AWMF-Leitlinien
Register-Nr. 017/047a - Entwicklungsstufe: 1, nicht aktualisiert.
HNO-Mitteilungen.
1997;
47 (3, Beilage Leitlinien/Algorithmen)
6
- 14
Ganzer U, Arnold W, Steinhoff H J.
Leitlinie Reizhusten/Räusperzwang Kinder. (Klinischer Algorithmus) - AWMF-Leitlinien
Register-Nr. 017/048 - Entwicklungsstufe: 1, nicht aktualisiert.
HNO-Mitteilungen.
1997;
47 (3, Beilage Leitlinien/Algorithmen)
7
- 15
Irwin R S.
Assessing cough severity and efficacy of therapy in clinical research: ACCP evidence-based
clinical practice guidelines.
Chest.
2006;
129 (1 Suppl)
232S-237S
- 16
Irwin R S.
Chronic cough due to gastroesophageal reflux disease: ACCP evidence-based clinical
practice guidelines.
Chest.
2006;
129 (1 Suppl)
80S-94S
- 17
Irwin R S.
Complications of cough: ACCP evidence-based clinical practice guidelines.
Chest.
2006;
129 (1 Suppl)
54S-58S
- 18
Irwin R S.
Introduction to the diagnosis and management of cough: ACCP evidence-based clinical
practice guidelines.
Chest.
2006;
129 (1 Suppl)
25S-27S
- 19
Irwin R S, Baumann M H, Bolser D C, Boulet L P, Braman S S, Brightling C E, Brown K K,
Canning B J, Chang A B, Dicpinigaitis P V, Eccles R, Glomb W B, Goldstein L B, Graham L M,
Hargreave F E, Kvale P A, Lewis S Z, McCool F D, McCrory D C, Prakash U B, Pratter M R,
Rosen M J, Schulman E, Shannon J J, Smith-Hammond C, Tarlo S M.
Diagnosis and management of cough executive summary: ACCP evidence-based clinical
practice guidelines.
Chest.
2006;
129 (1 Suppl)
1S-23S
- 20
Irwin R S, Glomb W B, Chang A B.
Habit cough, tic cough, and psychogenic cough in adult and pediatric populations:
ACCP evidence-based clinical practice guidelines.
Chest.
2006;
129 (1 Suppl)
174S-179S
- 21
Kardos P, Cegla U, Gillissen A, Kirsten D, Mitfessel H, Morr H, Schultze-Werninghaus G,
Sitter H, Vogelmeier C, Voshaar T, Worth H, Eckardt V, Klimek L.
Leitlinie der Deutschen Gesellschaft für Pneumologie zur Diagnostik und Therapie von
Patienten mit akutem und chronischem Husten.
Pneumologie.
2004;
58
570-602
- 22
Kvale P A.
Chronic cough due to lung tumors: ACCP evidence-based clinical practice guidelines.
Chest.
2006;
129 (1 Suppl)
147S-153S
- 23
McCool F D.
Global physiology and pathophysiology of cough: ACCP evidence-based clinical practice
guidelines.
Chest.
2006;
129 (1 Suppl)
48S-53S
- 24
McCool F D, Rosen M J.
Nonpharmacologic airway clearance therapies: ACCP evidence-based clinical practice
guidelines.
Chest.
2006;
129 (1 Suppl)
250S-259S
- 25
McCrory D C, Lewis S Z.
Methodology and grading of the evidence for the diagnosis and management of cough:
ACCP evidence-based clinical practice guidelines.
Chest.
2006;
129 (1 Suppl)
28S-32S
- 26
Morice A H, McGarvey L, Pavord I.
Recommendations for the management of cough in adults.
Thorax.
2006;
61
1-24
- 27
Prakash U B.
Uncommon causes of cough: ACCP evidence-based clinical practice guidelines.
Chest.
2006;
129 (1 Suppl)
206S-219S
- 28
Pratter M R.
Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred
to as postnasal drip syndrome): ACCP evidence-based clinical practice guidelines.
Chest.
2006;
129 (1 Suppl)
63S-71S
- 29
Pratter M R.
Cough and the common cold: ACCP evidence-based clinical practice guidelines.
Chest.
2006;
129 (1 Suppl)
72S-74S
- 30
Pratter M R.
Overview of common causes of chronic cough: ACCP evidence-based clinical practice
guidelines.
Chest.
2006;
129 (1 Suppl)
59S-62S
- 31
Pratter M R.
Unexplained (idiopathic) cough: ACCP evidence-based clinical practice guidelines.
Chest.
2006;
129 (1 Suppl)
220S-221S
- 32
Pratter M R, Brightling C E, Boulet L P, Irwin R S.
An empiric integrative approach to the management of cough: ACCP evidence-based clinical
practice guidelines.
Chest.
2006;
129 (1 Suppl)
222S-231S
- 33
Rosen M J.
Chronic cough due to bronchiectasis: ACCP evidence-based clinical practice guidelines.
Chest.
2006;
129 (1 Suppl)
122S-131S
- 34
Rosen M J.
Chronic cough due to tuberculosis and other infections: ACCP evidence-based clinical
practice guidelines.
Chest.
2006;
129 (1 Suppl)
197S-201S
- 35
Rosen M J.
Cough in the immunocompromised host: ACCP evidence-based clinical practice guidelines.
Chest.
2006;
129 (1 Suppl)
204S-205S
- 36
Smith-Hammond C A, Goldstein L B.
Cough and aspiration of food and liquids due to oral-pharyngeal dysphagia: ACCP evidence-based
clinical practice guidelines.
Chest.
2006;
129 (1 Suppl)
154S-168S
- 37
Tarlo S M.
Cough: occupational and environmental considerations: ACCP evidence-based clinical
practice guidelines.
Chest.
2006;
129 (1 Suppl)
186S-196S
- 38
Tarlo S M.
Peritoneal dialysis and cough: ACCP evidence-based clinical practice guidelines.
Chest.
2006;
129 (1 Suppl)
202S-203S
Prof. Dr. Dr. h. c. Martin Ptok
Klinik und Poliklinik für Phoniatrie und Pädaudiologie
Medizinische Hochschule Hannover
Carl-Neuberg-Straße 1
30625 Hannover
Email: Ptok.Martin@MH-Hannover.de