舒利迭联合孟鲁司特治疗咳嗽变异性哮喘患者气道炎症的影响分析

目的 探讨舒利迭联合孟鲁司特治疗咳嗽变异性哮喘患者气道炎症的影响.方法 选择2015年3月至2016年3月我院诊治的咳嗽变异性哮喘患者70例作为研究对象.按随机数表法分为观察组和对照组各35例.对照组采用舒利迭进行治疗,观察组在对照组的基础上联合孟鲁司特进行治疗.比较两组患者的症状改善用时情况、肺通气功能、促炎症细胞因子水平、嗜酸性粒细胞(Eosinophil,Eos)及呼出气一氧化氮(Fractional exhaled nitric oxide,FeNO)水平.结果 治疗后,观察组症状缓解和消失用时均短于对照组[(6.05±1.44)d比(7.21±1.52)d,(7.63±1.75)d比(8.74±1.58)d](P<0.05);观察组患者肺通气功能中第1秒用力呼气容积(FEV 1)、第1秒用力呼气容积占预计值百分比(FEV 1/pred)、第1秒用力呼气容积占用力肺活量比值(FEV 1/FVC)及呼气峰流速占预计值百分比(PEF/pred)均高于对照组(P<0.05);观察组的白细胞介素(interleukin,IL)-12高于对照组[(84.26±10.97)ng/L比(68.13±9.82)ng/L](P<0.05),肿瘤坏死因子 α(tumour necrosis factor-α,TNF-α)及IL-6均低于对照组[(0.65±0.13)ng/L比(0.94±0.16)ng/L,(14.11±3.78)ng/L比(20.43±4.14)ng/L](P<0.05);观察组患者的Eos及FeNO均低于对照组[(2.61±1.75)%比(5.34±2.03)%,(45.68±11.43)ppb比(78.46±18.42)ppb](P<0.05).结论 舒利迭联合孟鲁司特治疗咳嗽变异性哮喘能有效改善患者肺通气功能,缩短治疗时间,缓解患者气道炎症并改善患者的炎症反应状态,效果显著,值得推广.     

哮喘患儿应用便携式肺功能仪自主监测通气功能的初步研究

目的 分析哮喘患儿应用便携式肺功能仪监测通气功能指标的准确度、日常自主监测的可行性及其影响因素,为探索哮喘患儿进行慢病个体化管理奠定基础。方法 选择在首都医科大学附属北京儿童医院过敏反应科确诊的53例哮喘患儿,其中男性41例（77.4%）,女性12例（22.6%）;年龄5～14岁,平均年龄8.34岁。应用便携式肺功能设备（呼吸家A1型,简称A1）测定肺通气功能,获得用力呼气肺活量占预计值的百分比（FVC%pred）、第1秒用力呼气容积占预计值的百分比（FEV1%pred）、第1秒用力呼气容积占用力肺活量百分比（FEV1/FVC）、最大呼气流量占预计值的百分比（PEF%pred）、最大呼气中期流量占预计值的百分比（MMEF%pred）、用力呼出25%、50%、75%肺活量时的瞬间流量占预计值的百分比（FEF25%pred、FEF50%pred、FEF75%pred）共8项参数;与同日在肺功能检查室经压差传感器肺功能仪（Jaeger-Masterscreen型,简称MS）测定常规肺通气所得的上述参数结果进行一致性比较,获得A1测定肺通气功能的准确度。对以上患儿启用初始哮喘控制治疗,其中27...     

支气管激发试验在慢性咳嗽及咳嗽变异型哮喘诊断中的临床分析

目的 探讨支气管激发试验(BPT)在慢性咳嗽及咳嗽变异型哮喘(CVA)诊断中的意.方法 回顾性分析我院肺功能室534例慢性咳嗽患者用乙酰甲胆碱进行支气管激发试验的结果.结果 534例慢性咳嗽患者中,不同性别组支气管激发试验阳性率无显著差异,BPT阳性402例,阳性率75.3%.确诊为CVA328例.结论 CVA是慢性咳嗽的主要病因,对不明原因的慢性咳嗽患者应及时进行BPT,有助于早期明确诊断并施以正确治疗.     

胸腺五肽联合化疗治疗对多耐药肺结核患者临床疗效、肺功能的影响

目的:分析胸腺五肽联合化疗治疗多耐药肺结核患者的临床价值.方法:收集本院2019年2月至2020年2月收治的82例多耐药肺结核患者的临床资料.按不同治疗方法分为对照组(n=39例,常规化疗)与研究组(n=43例,胸腺五肽联合化疗).比较两组临床疗效(体温恢复、咳嗽咳痰缓解及全身无力消失时间)、痰菌转阴率、肺功能[用力肺活量(FVC)、第一秒最大呼气量(FEV1)、1秒用力呼气容积占用力肺活量的百分比(FEV1/FVC)]、炎性因子[白介素-10(IL-10)、干扰素-γ(IFN-γ)].结果:研究组体温恢复、咳嗽咳痰缓解及全身无力消失时间均短于对照组(P<0.05).治疗后,研究组患者各时点痰菌转阴率均明显高于对照组(P<0.05);随治疗时间延长,两组痰菌转阴率均逐渐增高.治疗后,两组FVC、FEV1、FEV1/FVC值、IFN-γ水平均较治疗前增高,IL-10水平明显下降,且研究组增高/下降程度更为显著(P<0.05).结论:胸腺五肽联合化疗治疗多耐药肺结核疗效显著,可有效改善患者肺功能,提高痰菌转阴率.     

FeNO 联合肺功能参数在儿童咳嗽变异性哮喘和慢性咳嗽中的鉴别诊断价值

目的:观察FeNO联合肺功能参数在儿童咳嗽变异性哮喘和慢性咳嗽中的鉴别诊断价值.方法:从本院2020年6月至2021年6月收治且确诊的咳嗽变异性哮喘和慢性咳嗽患儿中各选取44例,将咳嗽变异性哮喘患儿设为A组,将慢性咳嗽患儿设为B组,从同期健康体检患儿中选取44例,设为对照组,回顾分析其临床资料,同时为三组患儿进行肺功能参数、痰中嗜酸性粒子细胞比例(EOR)、呼出气一氧化氮(FeNO)及血清C反应蛋白(CRP)水平检测,比较观察三组患儿各指标差异.结果:与对照组患儿比较,A、B两组患儿FeNO水平均较高,且B组高于A组,差异有统计学意义(P<0.05);与对照组相比,A、B两组患儿血清CRP、痰EOR水平均较高,且B组高于A组,差异有统计学意义(P<0.05);与对照组相比,A、B两组患儿最大呼气峰流速(PEF)、第1秒用力呼气量(FEV1)均较小,且B组低于A组,差异有统计学意义(P<0.05);比较三组患儿用力肺活量(FVC),差异>无统计学意义(P>0.05).结论:通过本次实验研究可知FeNO联合肺功能参数在儿童咳嗽变异性哮喘和慢性咳嗽的鉴别诊断中具有较高参考价值.     

血清suPAR、PAI-1对慢性阻塞性肺疾病合并支气管扩张的诊断价值

目的 研究血清可溶性尿激酶型纤溶酶原激活物受体(suPAR)、纤溶酶原激活物抑制剂-1(PAI-1)对慢性阻塞性肺疾病(COPD)合并支气管扩张的诊断价值。方法 在2019年10月至2021年4月,共纳入265例稳定期中重度COPD患者作为研究对象,根据支气管扩张程度将他们分为无支扩组(n=135)和COPD合并支扩组(n=130)。另外纳入100例无肺部疾病或无法控制的慢性疾病志愿者作为对照组。酶联免疫吸附检测血清suPAR、PAI-1和血清炎症因子水平,使用肺功能仪检测肺通气和弥散功能。结果 COPD患者血清suPAR、PAI-1水平均高于对照组(P<0.05),且COPD合并支扩组血清suPAR、PAI-1水平较无支扩组升高更明显(P<0.05)。血清suPAR与第1秒用力呼气容积占预计值百分比(FEV1%pre)、第1秒用力呼气容积/用力肺活量(FEV1/FVC)、一氧化碳弥散量占预计值百分比(DLCO%pre)呈负相关性(P<0.05),与残气量/肺总量、高分辨率计算机断层扫描(HRCT)评分、血清白细胞介素(IL)-6水平呈正相关(P<0.05)。血...     

高位硬膜外麻醉对肺通气和血气的影响

为探讨高平面硬膜外阻滞麻醉对肺通气功能的影响,对29例无明显心肺疾患的择期手术成年病人于硬膜外麻醉前后进行肺功能测试和血气分析。结果:麻醉后肺活量,肺活量占预计值百分比、补呼气量、补吸气量、最大通气量及最大用力呼气流量容积曲线的呼气流量均有显著降低(P<0.05)。提示选择高位硬膜外阻滞时对肺通气功能有一定影响,应用时应有呼吸支持的准备。     

克拉霉素联合舒利迭治疗咳嗽变异性哮喘的临床观察

目的:探讨克拉霉素联合舒利迭治疗咳嗽变异性哮喘(CVA)的临床疗效及可能机制.方法:纳入74例CVA病例并随机分成两组,分别使用舒利迭(对照组),克拉霉素联合舒利迭(实验组)各治疗3个月.比较治疗前后临床症状、第1秒用力呼气量占预计值百分比(FEV1%)、峰值呼气流速(PEF)的变异率、血清IgE水平以及外周血单核细胞NF-κB活性.结果:实验组临床疗效明显高于对照组,克拉霉素联合舒利迭能改善患者的FEV1%、PEF变异率,降低血清IgE水平以及外周血单核细胞NF-κB活性.结论:克拉霉素联合舒利迭治疗CVA,可能通过调节患者外周血中单核细胞NF-κB的活性,从而降低了血清IgE水平,减轻了气道高反应性,临床疗效确切.     

不同PEEP水平对AECOPD伴肺动脉高压患者O2UC、血清炎性因子及脑血流灌注状态的影响对比

目的:探讨不同呼气末正压通气(Positive end expiratory pressure,PEEP)水平对慢性阻塞性肺疾病急性加重期(Acute exacerbation of chronic obstructive pulmonary disease,AECOPD)伴肺动脉高压患者的影响.方法:选取2020年6月至2022年5月期间我院收治的103例AECOPD伴肺动脉高压患者作为研究对象,所有患者按照随机数字表法分为常规组(n=51)和高水平组(n=52).常规组采用常规PEEP,高水平组采用高水平PEEP,两组患者均持续治疗3 d.观察两组氧利用率、血清炎性因子、脑血流灌注以及肺功能.结果:治疗3 d后,高水平组氧利用率(Ratio of oxygen utilization,O2UC)高于常规组(P<0.05);高水平组超敏C-反应蛋白(High sensitivity C-reactive protein,hs-CRP)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、白-细胞介素-6(Interleukin-6,IL-6)以及降钙素原(Procalcitonin,PCT)水平低于常规组(P<0.05);高水平组阻力指数(Resistance Index,RI)、搏动指数(Pulsatility index,PI)和平均血流速度(Mean velocity,Vm)和常规组无明显差异(P>0.05);高水平组肺用力肺活量占预计值百分比(Percentage of forced vital capacity to the expected value,FVC％pred)、第一秒用力呼气容积占预计值百分比(Percentage of forced expiratory volume in the first second to the expected value,FEV1％pred)、第一秒用力呼气容积占用力肺活量百分比(Percentage of forced expiratory volume in the first second to forced vital capacity,FEV1/FVC)均高于常规组(P<0.05).结论:相比较于常规PEEP,将高水平PEEP用于AECOPD伴肺动脉高压患者中可提高氧利用率,促进肺功能恢复,减轻机体炎症反应,且不影响脑血流灌注.     

慢性阻塞性肺疾病患者深吸气量与运动能力的关系

目的: 探讨慢性阻塞性肺疾病(COPD)患者深吸气量与运动能力的关系。方法: 采用呼气负压技术(NEP)检测42例缓解期COPD患者平静呼吸时呼气气流受限(EFL)情况。将COPD患者分为EFL组和无EFL组,并进行常规肺功能和症状限制递增功率心肺运动测试。结果: 42例COPD患者中29例在平静呼吸时检测到EFL,13例未检测到EFL。与无EFL组相比,EFL组深吸气量占预计值百分比(IC%pred)(P＜0.01)、第1 s用力呼气容积占预计值百分比(FEV₁%pred)(P＜0.01)、第1 s用力呼气容积占用力肺活量百分比(FEV₁/FVC%)(P＜0.01)、比弥散量占预计值百分比(DLCO/V_A%pred)(P＜0.05)和最大摄氧量占预计值百分比(VO₂max%pred)(P＜0.01)均显著下降。多元逐步回归分析结果表明,IC%pred和FEV₁%pred对VO₂max%pred有显著预测意义。在EFL组,IC%pred与VO₂max%pred的相关性最好(r=0.787,P＜0.01);在无EFL组,FEV₁%pred与VO₂max%pred的相关性最好(r=0.625,P＜0.01)。结论: 在平静呼吸时出现EFL的COPD患者,肺过度充气可能是运动能力下降的主要原因;在平静呼吸时无EFL的COPD患者,气流阻塞可能是运动能力下降的主要原因。     

致敏豚鼠咳嗽反应与气道炎症的关系

目的:研究致敏豚鼠不同强度的嗜酸细胞气道炎症对咳嗽反应的作用。方法:卵蛋白致敏豚鼠34只,分成致敏对照组(7只)、低浓度卵蛋白组(7只)、中浓度卵蛋白组(8只)和高浓度卵蛋白组(12只),分别雾化吸入生理盐水、0.04%、0.2%和1%卵蛋白溶液激发。24h后,比较各组豚鼠吸入辣椒素溶液诱导的咳嗽反应,气道对乙酰甲胆碱的反应性(PC₁₅₀)和支气管肺泡灌洗液的细胞数量及成分。结果:致敏对照组和低浓度卵蛋白组无豚鼠死亡,而中浓度卵蛋白组和高浓度卵蛋白组激发后分别有1只和5只豚鼠因严重喘息发作死亡。随激发的卵蛋白浓度增高,吸入辣椒素溶液诱发的咳嗽频率从致敏对照组豚鼠的(6±2)次/3min增加到在高浓度卵蛋白组的(22±4)次/3min(P<0.05);低浓度卵蛋白组的PC150无明显改变,中浓度和高浓度卵蛋白组明显降低,伴有支气管肺泡灌洗液中的细胞数量和嗜酸细胞比例增加。豚鼠的咳嗽反应与支气管肺泡灌洗液中细胞总数及嗜酸细胞比例存在显著的正相关(分别为r=0.84和0.78,P<0.01),与PC150存在显著的负相关(r=-0.78,P<0.01)。PC150与支气管肺泡灌洗液中细胞总数及嗜酸细胞比例存在显著的负相关(分别为r=-0.80和-0.85,P<0.01)。     

Effects of Bakumondo-to (Mai-Men-Dong-Tang) on cough sensitivity to capsaicin in asthmatic patients with cough hypersensitivity]

Some patients with bronchial asthma have increased cough sensitivity. In such patients coughing may be an inducer of wheeze. The aim of the present study was to investigate the effect of Bakumondo-to on the cough sensitivity and respiratory tract inflammation in asthmatic patients with increased cough sensitivity. In addition influences of intensity of respiratory tract inflammation, gender, type of asthma, and disease period on the effect of Bakumondo-to on the cough sensitivity were examined. Twenty-one bronchial asthmatics whose cough thresholds to capsaicin were less than 3.9 microM were examined. METHODS: Cough thresholds to capsaicin (concentration of inhaled capsaicin solution causing 5 or more coughs) was measured before and after 2 months or more treatment with Bakumondo-to (9 g/day, TJ-29). Number of eosinophils in peripheral blood, sputum eosinophil ratio, and ECP level in the serum were also measured before and after treatment. RESULTS: Bakumondo-to significantly increased the cough threshold. Although respiratory tract inflammation was not significantly improved, number of eosinophils in peripheral blood, sputum eosinophil ratio and ECP level in the serum were remarkably decreased more than the half. And Bakumondo-to was more effective in asthmatic subjects with severe airway inflammation. Furthermore, a greater effect of it was observed in women. A greater effect was also observed in patients having a disease duration of less than 1 year. CONCLUSION: Our results suggest that Bakumondo-to may be an effective therapeutic preparation for coughing in asthmatic patients with cough hypersensitivity.     

Measurement of cough

Cough is one of the most common symptoms encountered by clinicians particularly when it is persistent. Assessment of cough is essential for determining treatment outcomes, testing new therapies and for study of pathophysiology and mechanisms. There are new tools for measuring different aspects of cough. Apart from the patient's subjective assessment of cough severity using clinical scores, the impact of cough on quality of life can be measured. Direct measurement of cough counts is now possible by using portable devices, but how the counts relate to severity is unclear. A measure of cough intensity is required. Cough reflex measured by response to inhaling citric acid or capsaicin provides a measure of cough sensitivity that may be related to cough severity. In many intervention studies of cough, the response has usually been measured in terms of physician assessment of cough and its changes in cough reflex. How the information obtained between these different measurements interrelate needs to be determined.     

Nature of airway inflammation and remodeling in chronic cough

BACKGROUND: Chronic cough may be a result of asthma and non-asthma causes, but it is unclear whether there are specific inflammatory or remodeling changes. OBJECTIVE: We determined airway mucosal changes in patients presenting with asthmatic cough and cough associated with non-asthmatic causes. METHODS: Patients with chronic cough of non-asthmatic (n=33; postnasal drip/rhinitis in 6, gastroesophageal reflux in 5, bronchiectasis in 3, and idiopathic in 19) and asthmatic (n=14) causes and 15 healthy controls underwent fiberoptic bronchoscopy. Morphometry of bronchial biopsies and capsaicin cough sensitivity were assessed. RESULTS: Compared with controls, submucosal eosinophils and neutrophils were increased in patients with asthmatic cough (P<.005) and submucosal mast cells in patients with non-asthmatic cough (P=.01). Sub-basement membrane thickness, goblet cell area, vascularity, and vessel size were also increased in both groups. Smooth muscle area was higher only in patients with non-asthmatic cough (P=.0007 vs control and P=.019 vs asthmatic cough). None of the pathologic changes were related to the duration of coughing. Cough sensitivity was heightened in patients with non-asthmatic cough compared with controls and patients with asthmatic cough. The degree of goblet cell hyperplasia and epithelial shedding positively correlated with cough sensitivity in patients with non-asthmatic cough (r=0.43; P=.01; and r=0.40; P=.02, respectively). CONCLUSION: Features of airway wall remodeling are prominent in the airways with non-asthmatic as well as asthmatic cough. These are linked to chronic cough rather than to asthma. Mast cell hyperplasia rather than eosinophilia is distinctive for non-asthmatic cough.     

Induced sputum: comparison of postinfectious cough with allergic asthma in children

BACKGROUND: Cough persisting after a respiratory infection is common in children and is often managed as asthma. However, little is known about the pathophysiologic mechanisms of such cough and how it compares with asthma. OBJECTIVE: We used the technique of induced sputum to examine the inflammatory index values associated with persistent cough or allergic asthma in children. We hypothesized that the sputum from children with persistent postinfectious cough would differ from that of children with allergic asthma in that the former would lack eosinophils compared with the latter.Study design: Sputum production was induced with hypertonic saline solution in 34 children: 12 with cough persisting for 1 month or more after an apparent respiratory tract infection, not treated with corticosteroid; 11 with untreated atopic asthma, not using inhaled corticosteroid; and 11 with treated atopic asthma using inhaled corticosteroid. RESULTS: The percentage of eosinophils in the sputum of children with cough was significantly lower than in the sputum of children with untreated allergic asthma (median 0.5% vs 14.5%, P <.0001). Similarly, the percentage of eosinophils in the sputum of children with asthma treated with inhaled steroids was significantly lower compared with untreated asthmatic children (1.5% vs 14.5%, P <.0001). The peripheral blood eosinophils, serum eosinophil cationic protein, and nasal percent eosinophils of the patients with cough were also significantly lower than those from patients with untreated asthma. Methacholine challenge in 6 of the 11 cough patients tested showed mild-to-moderate hyperresponsiveness, whereas the other 5 had a negative methacholine challenge. CONCLUSIONS: Children with persistent postinfectious cough do not have airway eosinophilia typical of untreated asthma. Despite the absence of eosinophilic inflammation, some of the patients with chronic cough had reactive airways. These results suggest that postinfectious cough in children has different pathophysiologic features than allergic asthma and probably represents a different disease.     

Capsaicin cough sensitivity is related to the older female predominant feature in chronic cough patients

Purpose

The present study aimed to examine the age and gender distributions among chronic cough patients referred to a tertiary cough clinic in Korea, and to investigate clinical factors related to the demographic findings.

Methods

Study participants were unselectively recruited from adult chronic cough patients who attended the cough clinic for the first time during one year. To validate their representativeness, their age and gender distributions were compared to the entire chronic cough population, or with those presenting with other chronic disease. Data from the baseline investigations were analyzed to identify clinical factors related to the demographic findings.

Results

A total of 272 chronic cough patients were included. They had a middle-aged female predominant feature (mean age: 52.8±15.7 years and female 69.1%). Their age and gender distributions were almost identical to the entire chronic cough population, but were distinct from patients with hypertension. Among clinical factors, the older female predominance was associated with enhanced capsaicin cough sensitivity, and also with the presence of ''cough by cold air'' symptom. Allotussia and laryngeal paresthesia were highly common in chronic cough patients, affecting 94.8% and 86.8% of them, respectively.

Conclusions

The present study demonstrated older female predominance among adult chronic cough patients attending a referral cough clinic in Korea. The demographic features were significantly associated with the capsaicin cough responses and also potentially with allotussia (particularly cold air as the trigger). These findings suggest a role of cough reflex sensitization in the pathophysiology of chronic cough in adults.     

Utility of Cough Provocation Tests in Chronic Cough and Respiratory Diseases: A Comprehensive Review and Introduction of New Reference Ranges for the Capsaicin Test

Cough provocation tests (CPTs) are an objective measurement of the sensitivity of the cough reflex arc. However, they are not established in clinical practice because a large variability of response in healthy subjects limits their diagnostic value. There is a paucity of studies that have investigated CPT reference ranges in healthy subjects. This systematic review describes the variability of the responses to CPTs in healthy subjects and factors that influence it. A new analysis of 134 healthy subjects was conducted to create reference ranges for single-breath capsaicin CPT by calculating the interquartile ranges for the provocative concentration of capsaicin to induce 2 and 5 coughs. Female subjects had a more sensitive cough reflex than male counterparts. The ability of CPTs to distinguish various respiratory diseases from healthy subjects was also reviewed. Cough sensitivity was consistently heightened in the following groups: unselected patients with chronic, refractory, or recurrent cough, unexplained chronic cough, gastro-esophageal reflux-associated cough, cough-variant asthma, lower airway symptoms induced by chemical irritants, and fibrotic interstitial lung diseases. In the following groups, hypersensitivity of the cough reflex was present in those individuals whose symptom profile was predominated by cough: asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis, and sarcoidosis. In the following conditions, patients usually cough in order to expectorate mucus from their airways, not because of a hypersensitive cough reflex arc: productive cough, asthma, upper airway cough syndrome, COPD, bronchiectasis, cystic fibrosis, and chronic respiratory infections. CPTs have the potential to identify patients with chronic respiratory symptoms due to cough reflex hypersensitivity, thereby providing a targeted approach for therapy.     

Eosinophilic inflammation, remodeling of lower airway, bronchial responsiveness and cough reflex sensitivity in non-asthmatic subjects with nasal allergy

BACKGROUND: It has been reported that nasal allergy influences the lower airway inflammation and functions. We elucidated whether nasal allergy would contribute to lower airway inflammation and functions. METHODS: 266 subjects aged 21-39 years were interviewed with special emphasis on history of asthma and nasal allergies (perennial allergic rhinitis (PAR) and seasonal allergic rhinitis (Japanese cedar pollinosis; PO)). Symptomatic subject was defined when nasal symptoms were present during a 3-week study period. Pulmonary function, provocative concentration of methacholine causing a 20% fall in forced expiratory volume in 1 s (PC20), capsaicin cough threshold defined as capsaicin concentration eliciting 5 or more coughs (C5) and eosinophil percentage in hypertonic saline-induced sputum were measured. RESULTS: Based on the interview, 232 subjects without asthma were divided into symptomatic (n = 25) and asymptomatic (n = 22) PAR, PO on-season (n = 15) and off-season (n = 36), and non-nasal allergy subjects (control) (n = 134). Sputum eosinophils were significantly greater in symptomatic PAR than another four groups (p < 0.01). FEV1/FVC ratio was significantly lower in PAR than control (p < 0.05). Maximum mean expiratory flow was lower in PAR than control (asymptomatic: p < 0.05, symptomatic: p = 0.06). C5 was not different among groups. PAR tended to have a lower PC20 compared to control (symptomatic: p = 0.078; asymptomatic: p = 0.086). CONCLUSIONS: These results suggest that eosinophilic inflammation occurred in symptomatic period of PAR may contribute to development of lower airway remodeling and bronchial hyperresponsiveness. Reversely, PO may not be associated with lower airway eosinophilic inflammation or abnormal bronchial functions. Nasal allergy dose not influence the cough reflex sensitivity.     

Airway inflammation and cough sensitivity in cough-variant asthma

BACKGROUND: Mechanisms underlying cough and bronchoconstriction in patients with cough-variant asthma (CVA) are not well established. Differences in location or degree of activation of eosinophils and allergic cytokines have been suggested as the likely causes. To address this issue, we have carried out a comparative study of airway inflammatory markers between patients with CVA and classic asthma (CA). The relationship between these markers with airway hyperresponsiveness (AHR) and cough sensitivity has also been studied. METHODS: Twenty-seven non-smokers and steroid-naive patients with CVA (12) and CA (15) were examined. Capsaicin challenge, histamine bronchoprovocation test, nitric oxide levels in exhaled air and sputum induction were performed in all of them. Differential cell sputum recount and supernatant concentrations of eosinophil granule-derived cationic proteins (ECP), interleukin (IL)5, IL8 and tumour necrosis factor (TNF)-alpha were also measured. RESULTS: There were no significant differences in either the inflammatory pattern of soluble markers or differential cell counts between CA and CVA. Histamine PC20 was correlated with IL-5 in CVA, whereas it was associated with sputum eosinophilia in CA. Cough sensitivity (log C5) and histamine PC20 were inversely related in CA. CONCLUSIONS: Although the pattern of inflammatory sputum markers in patients with asthma and cough-variant asthma is similar, its relation with bronchial hyperreactivity and cough sensitivity is different in each group.