만성 기침 환아에서 메타콜린 유발시험의 양성율 및 유발 증상에 관한 연구 : 기침형 천식의 진단을 중심으로

다국어 초록 (Multilingual Abstract)

Chronic cough is an important, relatively frequent, and sometimes frustrating problem that can be a sole presenting manifestation of asthma in adults and children. To evaluate the positive rates and provocated symptoms in patients with chronic cough, we underwent the methacholine bronchial provocation test (MBPT) in 34 children(6-13 years old) who suffered from chronic cough, We compared the results of MBPT and allergic skin tests(by scratch method) between the following two groups ' Group I included 14 children with chronic, nocturnal, dry cough combined with wheezing and Group II, 20 children with chronic cough but without wheezing. Positive rate of MBPT in Group I and Group II were 86% (12 out of 14) and 65% (15 out of 20), respectively. Geometric mean of provocative concentration of the methacholine causing a 20 percent fall of PEFR(PC20) in 25 methacholine provocation test positive sujects were 1.41mg/ml(Group I) and 3.09 mg/ml(Group II)(p=0.167). Twenty-four out of 54 children showed positive skin reactions to 1 or more common allergens, among whom 21(88%) children had positive results of MBPT. Among 10 children with negative skin reactions, only 4(40% ) children had positive results of MBFT. During MBPT, in Group I, 36.4% of patients had complained cough and 90% of patie- nts, wheezing whereas in Group II, 66.7% and 58.3% complained respectively. But there were no significant differences in the threshoIds of PEFR causing cough and wheezing, maximal percent fall of PEFR and bronchodilator eRect between Group I and Group II. In conclusion, most cases of the children suffering from chronic cough with frequent wheezing can be easily diagnosed as asthma by the history taking only, but cases of chronic cough without history of wheezing need fur- ther evaluation with MBPT or other diagnostic modalities such as exercise loading test, cold air inhalation test and bronchodilator test to identify the reversible airway obstraction.