春天一到，花絮纷飞，呼吸道疾病高发季又来了。
一些人出现呼吸道感染后，其他症状都没了，就是久咳不止。频繁、剧烈咳嗽，引起喉痛、声嘶和呼吸肌疼痛等，苦不堪言。
尤其是，白天明明不咳或很少咳，一到晚上怎么又咳上了？到底感染好了还是没好，还是得了其他的病？该怎么治呢？
▍ 白天不咳或少咳，晚上咳得厉害，怎么回事？
前两个月感冒后，5岁的小枫（化名）咳嗽一直没有好彻底
[6]，最近一周是白天基本不咳嗽，夜间凌晨一个时间段频繁咳嗽，过了这个时间就不咳了，稍微有点痰。还有个清嗓子的症状，一直持续到现在。
别的孩子在公园又蹦又跳，他没跑几步就咳嗽。到后来大笑或哭闹时都会咳起来。严重时，连刚吃的晚饭都会全部吐出来。
到呼吸内科就诊，医生开了支气管舒张剂，咳嗽有好转，支气管激发试验阳性，诊断为咳嗽变异性哮喘
。
▍
「咳嗽变异性哮喘」，是哮喘还是咳嗽？
[
1-3
]
咳嗽变异性哮喘也是哮喘，它是支气管哮喘的一种特殊形式，主要症状就是慢性（8个月以上）刺激性干咳。因为这种哮喘只表现为咳嗽，没有喘息、气促等症状，不易被察觉，又叫隐匿性哮喘。
一般发生在春季倒春寒、深秋浅冬的气候反常的时候。
儿童发病率较高，
4～12 岁的儿童多见，已发现30%以上的儿童干咳，
与咳嗽变异性哮喘有关。
国内外多项研究显示，咳嗽变异性哮喘也是成人慢性咳嗽的常见病因，占慢性咳嗽病因的1/3 。成人咳嗽变异性哮喘的发病年龄，比典型哮喘高，约有13%的患者年龄超过50岁，中年女性多见
[2-3]。
除了老咳嗽，哮喘的
其他标志性症状都不怎么明显，特别是肺部听诊也没什么异常声音（它可导致气道痉挛、狭窄，但狭窄程度还没能引起喘息的症状），医生容易误诊为上呼吸道感染或慢性气管炎。
结果是反复吃抗生素，这对孩子的身心发育肯定是不好的，还会导致病情拖延，最后发展成典型哮喘。所以这病得早点发现，早点治。
▍
咳嗽变异性哮喘，有什么特征和症状？
[
3,5
]
主要有以下几个症状：
1. 刺激性干咳，通常咳嗽比较剧烈
2. 晚上、凌晨咳嗽是重要特征
咳嗽以晚上为主的，要首先考虑咳嗽变异性哮喘。还有的人会出现季节性发作
3. 剧烈咳嗽时可伴有呼吸不畅、胸闷等表现
4. 吸入刺激性气味（如香水、油漆、油烟、蚊香、烟雾）、冷空气等易诱发或加重咳嗽（注意：其他原因的慢性咳嗽也有这些诱发因素）
5. 接触过敏原、剧烈运动后及呼吸道感染后引起
6. 没有明显的喘息、胸闷、气促等典型哮喘症状
7. 可伴有过敏性鼻炎
8.没有感染的症状和体征，或长时间抗生素治疗无效，但用糖皮质激素、支气管舒张剂治疗可明显缓解
▍好好的，为啥突然得
「咳嗽变异性哮喘」？
咳嗽变异型哮喘的病因复杂，除了有过敏性疾病史，如过敏性鼻炎、湿疹等，也可能是有家族过敏史。身体的免疫力，心理状态，还有内分泌和神经状态，都可能是引起哮喘的原因。还有一些其他的风险因素，比如呼吸道感染、药物等
[4-
5
]。
1. 吸入过敏原（室内：尘螨，动物皮屑及排泄物，蟑螂，真菌等；室外：花粉，真菌等）
2. 食物过敏原（牛奶，鱼，虾，鸡蛋，花生等）
3. 呼吸道感染（尤其是病毒及支原体感染）
4. 强烈的情绪变化，如大哭，大笑等
5. 运动和过度通气（呼吸得又快又深，比身体正常需要的还要多，这样就会导致体内二氧化碳水平降低，身体的酸碱度失调）
6. 冷空气刺激
7. 药物（如阿司匹林等）
8. 职业粉尘及气体
▍该怎么治疗？[2,5]
治疗咳嗽变异性哮喘的办法，基本上跟对付普通哮喘差不多。大部分人用吸入性皮质类固醇（用吸入使用的喷雾剂或散剂）或是搭配长效β2受体激动剂（LABA）就挺管用的，至少需要治上8周。
也有人一停药可能又开始咳，这种情况就得长期吃药了。
还有一种药叫白三烯受体拮抗剂（LTRA），对这病也有效。
咳得特别凶，或吸入的药都不管用了，就得考虑换强点的治疗方案了，比如加上白三烯受体拮抗剂，或者短时间用一用口服激素，剂量中等或者偏低。
参考文献
1.李焕龙,王灵,钟志娟等. 玉屏风颗粒治疗儿童咳嗽变异性哮喘的临床观察及对免疫系统的影响 [J]. 中华中医药学刊, 2021, 39 (12): 205-208. DOI:10.13193/j.issn.1673-7717.2021.12.049.
2. 支气管哮喘防治指南（2020年版）
3. 特殊类型哮喘——咳嗽变异性哮喘，医脉通，
2021.10.10
4. 中华医学会呼吸病学分会哮喘学组. 咳嗽的诊断与治疗指南(2015)[J]. 中华结核和呼吸杂志, 2016, 39(5):323-354. DOI:10.3760/cma.j.issn.1001-0939.2016.05.003.
5.Irwin RS, Baumann MH, Bolser DC, et al. Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines [J]. Chest, 2006, 129(1 Suppl): 1S-23S. DOI: 10.1378/chest. 129.1_ suppl.1S.
6. 浙江大学医学院附属儿童医院小儿内科 朱履昌 主治医师 分享病例
温馨提示：科普文章不提供专业诊疗意见，具体诊疗请在专业医生指导下进行，图片来自摄图网
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