목적: 만성 기침은 임상에서 매우 흔한 증상이나 시간적, 비용적 문제 때문에 원인 질환을 정확히 진단하고 치료하기가 쉽지 않다. 따라서 저자들은 천식의 유병률의 연구에 사용되었던 ECRHS 설문에 후비루 증후군과 위식도역류에 관한 내용을 추가하여 만성 기침의 원인 중 천식 환자를 진단하는데 설문지를 통한 진단방법이 어느 정도 유용한 지를 평가하였다. 방법: 2004년 10월부터 2008년 3월까지 만성기침을 주소로 충남대학교병원 호흡기내과 외래를 방문한 환자들을 대상으로 전향적으로 조사하였다. 대상 환자들에게 modified ECRHS 설문과 기관지 유발시험을 시행하고 그 결과를 임상의에 의한 진단결과와 비교하였다. 결과: 대상군에서 기관지 유발시험을 통하여 천식으로 진단받은 경우는 1,518명 중 511명이었다. 천식양 증상 각각에 따른 비교 위험도를 비교하였을 때 천명의 비교 위험도가 2.966으로 가장 높았으며 운동 후 호흡곤란이 2.415, 휴식 시 호흡곤란이 2.211로 높았다. 하지만 기타 위식도 역류증이나 후비루 등은 비교위험도가 각각 1.107, 1.116으로 낮았다. ROC curve를 통해 분석한 결과, 8개 설문내용 중 응답한 천식양 증상의 개수가 다섯 개일 때 ROC curve의 면적이 0.533으로 천식 진단에 대한 유용성이 가장 높게 나타났다. 또한, ROC curve를 통해 분석한 결과, 설문 결과와 임상의에 의한 천식진단의 관계는 ROC curve의 면적이 0.631이었고, 기관지 유발 검사상 양성을 보인 경우 천식 진단과의 관계는 ROC curve의 면적이 0.618로 나타났다. 결론: 저자들은 만성 기침 환자를 대상으로 modified ECRHS 설문을 시행하여 분석한 결과, 천식양 증상의 빈도가 높을수록 천식일 확률이 높아짐을 확인하였다. 또한 기도의 과민성도 반영할 수 있으며 실제 환자의 치료를 결정하는데 도움이 될 만한 가능성을 제시하였다.

Background/Aims: Chronic cough may be the only manifestation of asthma. This study prospectively evaluated the validation of a modified European Community Respiratory Health Survey (ECRHS) questionnaire (including postnasal drip and GERD) in patients with chronic cough. Methods: We recruited patients with a chronic cough exceeding 8 weeks from Oct. 2004 to March 2008. The patients had undergone an assessment using the modified ECRHS questionnaire, methacholine challenge test, chest PA, and PNS series, as well as the MAST and skin prick test in some patients. Results: A total of 1518 patients were recruited. A total of 511 patients (33.6%) were physician diagnosed with asthma. Wheezing (53%, odds ratio [OR]: 2.989), nocturnal cough or dyspnea (57.3%,OR: 1.751), resting dyspnea (43.8%, OR: 2.216), post-exercise dyspnea (63.4%,OR: 2.297), esophageal reflux symptoms (34.1%, OR: 1.107) and postnasal drip (13.1%, OR: 1.116) are symptoms that have been reported. As the number of asthmatic symptoms included in the questionnaire increased, the number of patients diagnosed with asthma by a physician increased.  The correlation between bronchial hyperresoponsiveness (BHR) and physician diagnosed asthma was evaluated by the area under the receiver operator characteristic (ROC) curve. The questionnaire was more correlated with BHR than with physician diagnosed asthma (area: 0.852 vs. 0.631). Conclusions: The Modified ECRHS questionnaire is an available method to assist in the diagnosis of asthma and to evaluate BHR in patients with chronic cough.

Background/Aims: Chronic cough may be the only manifestation of asthma. This study prospectively evaluated the validation of a modified European Community Respiratory Health Survey (ECRHS) questionnaire (including postnasal drip and GERD) in patients with chronic cough. Methods: We recruited patients with a chronic cough exceeding 8 weeks from Oct. 2004 to March 2008. The patients had undergone an assessment using the modified ECRHS questionnaire, methacholine challenge test, chest PA, and PNS series, as well as the MAST and skin prick test in some patients. Results: A total of 1518 patients were recruited. A total of 511 patients (33.6%) were physician diagnosed with asthma. Wheezing (53%, odds ratio [OR]: 2.989), nocturnal cough or dyspnea (57.3%,OR: 1.751), resting dyspnea (43.8%, OR: 2.216), post-exercise dyspnea (63.4%,OR: 2.297), esophageal reflux symptoms (34.1%, OR: 1.107) and postnasal drip (13.1%, OR: 1.116) are symptoms that have been reported. As the number of asthmatic symptoms included in the questionnaire increased, the number of patients diagnosed with asthma by a physician increased.  The correlation between bronchial hyperresoponsiveness (BHR) and physician diagnosed asthma was evaluated by the area under the receiver operator characteristic (ROC) curve. The questionnaire was more correlated with BHR than with physician diagnosed asthma (area: 0.852 vs. 0.631). Conclusions: The Modified ECRHS questionnaire is an available method to assist in the diagnosis of asthma and to evaluate BHR in patients with chronic cough.

Chronic cough; Modified ECRHS questionnaire; Asthma