Theophylline

近年来，咳嗽的诊断、治疗与发病机制研究取得了许多新的进展。为及时反映国内外相关研究结果，2022年中华医学会呼吸病学分会哮喘学组正式发布了《咳嗽的诊断与治疗指南》。一、普通感冒病毒感染是感冒的主要病因。临床表现：除咳嗽外，还伴有其他上呼吸道相关症状，如流涕、喷嚏、鼻塞和鼻后滴流感、咽喉刺激感或不适，可伴发热，全身症状少见。普通感冒的咳嗽常与鼻后滴流有关。药物治疗： 不推荐常规单独使用中枢性止咳药物（如右美沙芬、可待因）。成人推荐由第一代抗组胺药物、减充血剂联合镇咳药物的复方制剂治疗伴有咳嗽的普通感冒。减充血剂与第一代抗组胺药物联合应用能明显缓解咳嗽，改善打喷嚏、鼻塞等症。单用第一代抗组胺药物治疗无明显临床获益。无发热、头痛、肌痛症状的普通感冒患者，不推荐使用非甾体抗炎药物治疗。温馨提示：美敏伪麻口服溶液（惠菲宁等）：含氢溴酸右美沙芬、盐酸伪麻黄碱、马来酸氯苯那敏。复方盐酸伪麻黄碱缓释胶囊（新康泰克）、扑尔伪麻片（乐菲）、伪麻那敏胶囊（宝达）：含盐酸伪麻黄碱、马来酸氯苯那敏。二、急性气管-支气管炎病毒感染是急性气管－支气管炎最常见的病因，少部分可由细菌引起。临床表现：初期常为上呼吸道感染症状，随后咳嗽可渐加剧，伴或不伴咳痰，细菌感染者常咳黄脓痰；病程常自限，全身症状可在数天内消失，但咳嗽、咳痰一般持续2~3周。药物治疗：剧烈干咳者可适当应用镇咳药物，有痰而不易咳出者推荐使用祛痰药物或黏痰溶解剂。缓释愈创甘油醚可缓解急性呼吸道感染的症状。不推荐常规给予抗菌药物治疗。对于咳黄脓痰的急性气管‑支气管炎患者，建议给予抗菌药物治疗。有外周血白细胞计数增高者，可考虑给予口服抗菌药物。温馨提示：愈创木酚甘油醚：美国食品药品监督管理局（FDA）唯一批准的祛痰药物。可刺激胃黏膜，反射性引起气道分泌物增多，降低痰液黏稠度，并有一定的支气管舒张作用，达到增强黏液排出的效果。三、感冒后咳嗽当呼吸道感染的急性期症状消失后，咳嗽仍然迁延不愈，持续3~8周，X线胸片检查无明显异常者称之为感染后咳嗽（PIC）。其中以病毒性感冒引起的咳嗽最为常见，又称为“感冒后咳嗽”。药物治疗：对部分咳嗽症状明显的患者建议短期应用镇咳药、抗组胺药加减充血剂等。复方甲氧那明治疗感染后咳嗽有一定效果。不建议使用吸入性糖皮质激素和孟鲁司特钠治疗。温馨提示：复方甲氧那明：含甲氧那明（β-肾上腺素受体激动药）、那可丁（镇咳药）、氨茶碱（平喘药）、氯苯那敏（抗组胺药）。复方甲氧那明含有氨茶碱。大环内酯类（红霉素、罗红霉素、克拉霉素）、氟喹诺酮类（依诺沙星、环丙沙星、氧氟沙星、左氧氟沙星）、克林霉素等可降低茶碱清除率，增高其血药浓度，避免与复方甲氧那明联用！四、鼻后滴流综合征由于鼻部疾病引起分泌物倒流至鼻后和咽喉等部位，直接或间接刺激咳嗽感受器，导致以咳嗽为主要表现的临床综合征称鼻后滴流综合征。临床表现：慢性咳嗽，以白天或体位转变后咳嗽为主，入睡后较少；有鼻部和咽喉疾病的临床表现和病史。药物治疗：1.非变应性鼻炎以及普通感冒引起的鼻后滴流综合征：推荐首选口服第一代抗组胺药和减充血剂治疗。2.变应性鼻炎以及普通感冒引起的鼻后滴流综合征：推荐首选鼻腔吸入鼻用糖皮质激素和口服第二代抗组胺药治疗。白三烯受体拮抗剂治疗变应性鼻炎有效。3. 慢性鼻窦炎引起的鼻后滴流综合征：推荐应用鼻用糖皮质激素激素治疗伴有鼻息肉的慢性鼻窦炎，可避免不必要的手术。对于合并鼻息肉的慢性鼻窦炎患者，口服激素序贯局部鼻吸入激素的治疗效果优于单用鼻吸入激素治疗。鼻用减充血剂可减轻鼻黏膜充血水肿，有利于分泌物的引流，缓解鼻塞症状，但不宜长期应用，需要警惕其导致药物性鼻炎的不良反应。鼻用减充血剂疗程一般<1周。建议联合应用第一代口服抗组胺药和鼻用减充血剂，疗程2~3周。黏液溶解剂（羧甲司坦/厄多司坦）治疗慢性鼻窦炎可能使患者获益。生理盐水鼻腔冲洗对慢性鼻窦炎治疗有效。五、胃食管反流性咳嗽因胃酸和其他胃内容物反流进入食管，导致以咳嗽为突出表现的临床综合征，属于GERD的一种特殊类型，是慢性咳嗽的常见原因。临床表现：咳嗽大多发生在日间、直立位以及体位变换时，干咳或咳少量白色黏痰。进食酸性、油腻食物容易诱发或加重咳嗽。除咳嗽外，40%~68%的GERC患者可伴反酸、胸骨后烧灼感及嗳气等典型反流症状，但也有不少患者以咳嗽为唯一症状。药物治疗：1.抑酸药物：推荐抑酸药物，包括PPI（奥美拉唑等）和钾离子竞争性酸阻断剂（伏诺拉生）作为GERC的首选治疗方法。PPI的抑酸效果和症状缓解速度佳，但需餐前半小时或1h服用。无PPI时也可选用H2受体拮抗剂。2.促胃动力药：促胃动力药（莫沙必利等）对缓解GERD相关症状可能有效，建议对于GERC患者，可在抑酸基础上联用促胃动力药。抗反流治疗疗程至少8周，逐步减量。六、咳嗽变异性哮喘CVA是哮喘的一种特殊类型，是慢性咳嗽的最常见病因，国内多中心调查结果显示约占慢性咳嗽原因的三分之一。临床表现：咳嗽是其唯一或主要临床表现，无明显喘息、气促等症状，但存在气道高反应性。主要表现为刺激性干咳，通常咳嗽比较剧烈，夜间及凌晨咳嗽为其重要特征。药物治疗：推荐吸入ICS联合支气管舒张剂，如长效β2受体激动剂，或单用ICS治疗。长期吸入激素可能有助于预防典型哮喘的发生。白三烯受体拮抗剂（孟鲁司特）治疗CVA有效，能够减轻患者咳嗽症状、改善生活质量并减缓气道炎症。七、嗜酸粒细胞性支气管炎EB是慢性咳嗽的常见病因，占慢性咳嗽病因的13%~22%。临床表现：主要为慢性刺激性咳嗽，常是唯一的临床症状，干咳或咳少许白色黏液痰，多为白天咳嗽，少数伴有夜间咳嗽。患者对油烟、灰尘、异味或冷空气比较敏感，常为咳嗽的诱发因素。患者无喘息、呼吸困难等气流受限相关症状。痰嗜酸粒细胞增高是必要诊断依据。药物治疗：EB对糖皮质激素反应良好，治疗后咳嗽很快消失或明显减轻。建议首选ICS（丙酸氟替卡松气雾剂等）治疗，持续应用8周以上。初始治疗可联合口服泼尼松10~20mg/d，持续3~5d。半数以上的EB患者治疗缓解后会复发，合并鼻炎和持续性嗜酸粒细胞炎症是复发的危险因素。八、变应性咳嗽临床上，某些慢性咳嗽患者具有特应质，痰嗜酸粒细胞正常，无气道高反应性，糖皮质激素及抗组胺药物治疗有效，将此类咳嗽定义为AC。临床表现：刺激性干咳，多为阵发性，白天或夜间均可咳嗽，油烟、灰尘、冷空气、讲话等容易诱发咳嗽，常伴有咽喉发痒。具有下列指征之一：①有变应性疾病史或变应原接触史；②变应原皮试阳性；③血清总IgE或特异性IgE增高。④糖皮质激素或抗组胺药治疗有效。药物治疗：吸入ICS和（或）口服抗组胺药物治疗4周以上，初期可短期口服小剂量糖皮质激素（3~5d）。九、难治性咳嗽除了不明原因慢性咳嗽，临床上还有一些有潜在慢性咳嗽病因的患者，但针对这些病因进行治疗，咳嗽症状无明显缓解，称之为难治性慢性咳嗽。临床研究结果显示神经调节因子类药物加巴喷丁治疗有效，其他药物如阿米替林，巴氯芬、卡马西平、普瑞巴林等亦可选用。雾化吸入利多卡因对临时缓解难治性慢性咳嗽有一定的效果。往期回顾咳咳咳…感冒后咳嗽一个月仍不见好转，镇咳药均不见效！PIC的“阿喀琉斯之踵”其实不是这些药物…什么是内致热源和外致热源？激素退烧可行不可行？一文详述……为何静点左氧氟沙星导致患者全身出血！左氧氟沙星的使用，这些细节一定要注意……降钙素原（PCT）升高评估细菌感染？没这么简单……关于降钙素原升高的临床意义，这些感染才适用！PCT多高才能用抗生素，阈值是多少编辑 | 聪明的一休授权转载、投稿等请联络梅斯医学管理员克里@梅斯医学（微信号：medsci-）

Busy is getting candid about navigating her ADHD diagnosis and treatment experience with Qelbree®The percentage of women newly diagnosed with ADHD between 23-29 and 30-49 years of age nearly doubled in just two years (2020-2022)1Although symptoms are present in childhood, a significant portion of women with ADHD don’t receive a diagnosis until they are adults2 ROCKVILLE, Md., May 01, 2024 (GLOBE NEWSWIRE) -- Actress, author, podcaster, and mother of two, Busy Philipps is teaming up with Supernus Pharmaceuticals to share her personal journey with attention-deficit/hyperactivity disorder (ADHD) – one of the most common psychiatric diagnoses in adults – as well as her experience with Qelbree (viloxazine extended-release capsules), a non-stimulant medication for the treatment of ADHD.3 Busy has been vocal about her personal experience living with ADHD for years, but now she is revealing what it means to be a woman navigating ADHD and wants other women who may be struggling to know they are not alone. Boys are two times more likely than girls to be diagnosed.4 While boys’ symptoms often fit the stereotypical ideas of hyperactive ADHD, girls’ inattentive symptoms are often overlooked. As a result, ADHD often goes undiagnosed in young girls, leading to more adult females being undiagnosed and therefore untreated – a sentiment reflective of Busy’s own experience.2,5 “As women, we tend to mask or overcompensate for our ADHD symptoms and end up working harder to get things done. With the right medication, there’s a sense of relief for women with ADHD – you’re suddenly able to take a deep breath," says Busy. "Since I started treatment with Qelbree, I have been able to better manage my ADHD symptoms and understand what to prioritize versus what can be put on the backburner. I'm excited to collaborate with Supernus as a woman navigating ADHD and shed light on the importance of finding the right treatment by empowering others facing similar challenges.” The partnership comes just in time for Mental Health Awareness Month, an important moment to raise awareness around mental health conditions and overall wellness – including approximately 10 million adults living with ADHD in the United States.3 "Supernus seeks to encourage and lift up those living with ADHD to talk to their doctor about managing and treating their condition, especially during Mental Health Awareness Month,” says Jack A. Khattar, President and Chief Executive Officer of Supernus Pharmaceuticals. “We’re excited to see that more women with ADHD, including Busy, are able to manage their ADHD symptoms with the help of Qelbree.” For more information about Qelbree, visit Qelbree.com. Patients should speak to a doctor about all the medications they take, and to see if Qelbree could be right for them. INDICATIONQelbree® (viloxazine extended-release capsules) is a prescription medicine used to treat ADHD in adults and children 6 years and older. IMPORTANT SAFETY INFORMATIONQelbree may increase suicidal thoughts and actions, in children and adults with ADHD, especially within the first few months of treatment or when the dose is changed. Tell your doctor if you or your child have (or if there is a family history of) suicidal thoughts or actions before starting Qelbree. Monitor your or your child’s moods, behaviors, thoughts, and feelings during treatment with Qelbree. Report any new or sudden changes in these symptoms right away. You or your child should not take Qelbree if you or your child:Take a medicine for depression called a monoamine oxidase inhibitor (MAOI) or have stopped taking an MAOI in the past 14 days. Also, you or your child should avoid alosetron, duloxetine, ramelteon, tasimelteon, tizanidine, and theophylline. Qelbree can increase blood pressure and heart rate. Your or your child’s doctor will monitor these vital signs. Qelbree may cause manic episodes in patients with bipolar disorder. Tell your doctor if you or your child show any signs of mania. Do not drive or operate heavy machinery until you know how Qelbree will affect you or your child. Qelbree may cause you or your child to feel sleepy or tired. The most common side effects of Qelbree in patients 6 to 17 years are sleepiness, not feeling hungry, feeling tired, nausea, vomiting, trouble sleeping, and irritability, and in adults, insomnia, headache, sleepiness, tiredness, nausea, decreased appetite, dry mouth, and constipation. These are not all the possible side effects of Qelbree. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088. Please see full Prescribing Information, including Boxed Warning, for Qelbree here. 1Russell, J., et al. (2023). Number of ADHD Patients Rising, Especially Among Women. Epic Research.2Holthe, M. E. G., Langvik, E. (2017). The Strives, Struggles, and Successes of Women Diagnosed with ADHD as Adults. SAGE Journals.3Culpepper, L., Mattingly, G. (2010). Challenges in Identifying and Managing Attention-Deficit/Hyperactivity Disorder in Adults in the Primary Care Setting: A Review of the Literature. Primary Care Companion Journal of Clinical Psychiatry.4Reuben C., Elgaddal N. (2024) Attention-deficit/hyperactivity disorder in children ages 5–17 years: United States, 2020–2022. NCHS Data Brief, no 499. Hyattsville, MD: National Center for Health Statistics.5Quinn, P. O., Madhoo, M. (2014). A Review of Attention Deficit/Hyperactivity Disorder in Women and Girls: Uncovering This Hidden Diagnosis. Prim Care Companion CNS Disord. About Supernus Pharmaceuticals, Inc. Supernus Pharmaceuticals is a biopharmaceutical company focused on developing and commercializing products for the treatment of central nervous system (CNS) diseases. Our diverse neuroscience portfolio includes approved treatments for epilepsy, migraine, ADHD, hypomobility in Parkinson’s disease (PD), cervical dystonia, chronic sialorrhea, dyskinesia in PD patients receiving levodopa-based therapy, and drug-induced extrapyramidal reactions in adult patients. We are developing a broad range of novel CNS product candidates including new potential treatments for hypomobility in PD, epilepsy, depression, and other CNS disorders. For more information, please visit www.supernus.com. CONTACTS: Jack A. Khattar, President and CEOTimothy C. Dec, Senior Vice President and CFOSupernus Pharmaceuticals, Inc.Tel: (301) 838-2591 Or INVESTOR CONTACT: Peter VozzoICR WestwickeOffice: (443) 213-0505Email: Peter.Vozzo@westwicke.com MEDIA CONTACT: Heidi Donato Tel: (516) 359-1146Email: Heidi.Donato@bcw-global.com