Chronischer und chronisch persistierender Husten - diagnostische Aspekte

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

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