Chronic cva
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Chronic Cough Variant Asthma (CVA): Understanding and Management
Introduction to Cough Variant Asthma (CVA)
Cough Variant Asthma (CVA) is a form of asthma where chronic cough is the predominant or sole symptom, often without the typical asthmatic symptoms such as wheezing and dyspnea. This condition poses a diagnostic challenge as physical examinations and spirometry results may appear normal, necessitating methacholine inhalation challenge testing to demonstrate bronchial hyperresponsiveness.
Diagnosis and Treatment Approaches
Diagnostic Challenges
Diagnosing CVA can be difficult due to the absence of typical asthma symptoms. The diagnosis is often confirmed retrospectively after observing the resolution of cough with antiasthmatic therapy. This highlights the importance of maintaining a high clinical suspicion for asthma in patients presenting with chronic cough.
Standard Treatment Protocols
The therapeutic approach to CVA generally mirrors that of typical asthma. Most patients respond well to inhaled bronchodilators and corticosteroids. However, some may require additional treatments such as leukotriene receptor antagonists or a short course of oral corticosteroids. Montelukast, a leukotriene receptor antagonist, has been shown to effectively reduce chronic non-productive cough in CVA patients.
Alternative Treatments
Chinese herbal medicine (CHM) has shown promise in treating CVA, particularly in combination with standard anti-inflammatory medications. A randomized controlled trial aims to evaluate the long-term efficacy and safety of CHM in conjunction with conventional treatments, potentially offering a complementary approach to managing CVA.
Chronic Venous Disease (CVD): A Comparative Overview
Prevalence and Impact
Chronic Venous Disease (CVD) is a prevalent condition that worsens with age and significantly impacts patients' quality of life. It ranges from mild symptoms like leg pain and swelling to severe manifestations such as venous ulcers . The prevalence of CVD is highest in Western countries, consuming up to 2% of healthcare budgets.
Pathophysiology and Risk Factors
CVD is characterized by venous hypertension, leading to various pathologies including pain, edema, and skin changes. Risk factors include age, obesity, and prolonged standing or sitting. The condition is often underdiagnosed, and many patients do not receive appropriate treatment.
Treatment and Management
Effective treatments for CVD include venoactive drugs and ablation procedures, which can relieve symptoms, improve quality of life, and slow disease progression . However, there is a significant treatment gap due to suboptimal physician awareness and adherence to guidelines.
Emotional Processing in Chronic CVA Patients
Right Hemisphere Involvement
Patients with chronic CVA often exhibit impairments in processing emotional information, particularly those with right hemisphere brain damage (RBD). Studies have shown that RBD patients perform worse than those with left hemisphere brain damage (LBD) and control groups in tasks involving the identification and production of facial and prosodic emotions. This suggests a preferential involvement of the right hemisphere in processing emotional information in chronic CVA patients.
Conclusion
Cough Variant Asthma (CVA) and Chronic Venous Disease (CVD) are both chronic conditions that significantly impact patients' quality of life. While CVA primarily presents as a chronic cough and requires a high index of suspicion for diagnosis, CVD involves a range of symptoms from mild discomfort to severe ulcerations. Both conditions benefit from early and appropriate treatment to prevent progression and improve patient outcomes. Enhanced awareness and adherence to treatment guidelines are crucial in managing these chronic diseases effectively.
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