客观的咳嗽频率，气道炎症和哮喘的疾病控制
2016/04/11
摘要
背景:咳嗽在哮喘的诊断和监控中被视为一个重要又麻烦的症状。哮喘控制是由气道炎症和气道高反应性的程度所决定，但这些跟咳嗽频率是否有关尚不清楚。
目的：探究哮喘中客观的咳嗽频率、疾病控制、气流阻塞和气道炎症的关系
方法：哮喘参与者进行了24小时动态咳嗽监测、呼出气一氧化氮，肺量计，醋甲胆碱激发和痰诱导(细胞计数和炎性介质水平)。通过GINA分类和哮喘控制问卷(ACQ) 对哮喘控制进行评估。
结果：募集89位哮喘受试者，平均年龄57岁(±SD 12)；57%是女性。根据GINA的标准，18 位(20.2%)患者被归类为控制，39位 (43.8%)是部分控制，32位 (36%)未控制。ACQ得分中位数(范围)是1(0.0 -4.4)。ACQ-6与24小时咳嗽频率相关(r=0.40，p<0.40)，与部分控制和控制的哮喘患者相比(1.8 c/h，范围0.2-25.3和0.2 c/h范围0.3-6.7，p=0.01，p=0.002)，未控制的哮喘患者(GINA)有更高的24小时咳嗽频率中位数(4.2 c/h，范围0.3-27.6)。气道炎症水平在GINA不同类别没有显著区别，和ACQ也没有对应关系。在多变量分析中，咳嗽频率的增加和FEV1的下降能独立预测哮喘控制水平。
结论：动态的咳嗽频率监测提供了一个评估哮喘症状的客观指标，这与标准的量表评估的哮喘控制有关，与气流阻塞或气道炎症无关。而且，咳嗽频率和气流阻塞能独立代表哮喘控制的维度。
（南方医科大学南方医院 彭显如 赵海金）
Chest. 2016 Mar10.pii:S00123692(16)416193.doi:10.1016/j.chest.2016.02.676[Epub ahead of print]
Objective Cough Frequency, Airway Inflammation and Disease Control in Asthma.
Marsden PA, Satia I, Ibrahim B, Woodcock A, Yates L, Donnelly I, Jolly L, Thomson NC, Fowler SJ, Smith JA.
Abstract
BACKGROUND:Cough is recognised as an important troublesome symptom in the diagnosis and monitoring of asthma. Asthma control is thought to be determined by the degree of airway inflammation and hyper-responsiveness but how these relate to cough frequency is unclear.
OBJECTIVE:To investigate the relationships between objective cough frequency, disease control, airflow obstruction and airway inflammation in asthma.
METHODS:Participants with asthma underwent 24 hour ambulatory cough monitoring, exhaled nitric oxide, spirometry, methacholine challenge and sputum induction (cell counts and inflammatory mediator levels). Asthma control was assessed by GINA classification and the Asthma Control Questionnaire (ACQ).
RESULTS:Eighty-nine subjects with asthma (mean age 57 years (±SD 12); 57% female) were recruited. According to GINA criteria, 18 (20.2%) patients were classified as controlled, 39 (43.8%) partly controlled and 32 (36%) uncontrolled; median (range) ACQ score was 1 (0.0-4.4). ACQ-6 correlated with 24hr cough frequency (r=0.40; p<0.001) and patients with uncontrolled asthma (GINA) had higher median 24hr cough frequency (4.2c/h, range 0.3-27.6) compared with partially controlled and controlled asthma (1.8c/h, range 0.2-25.3 and 1.7c/h range 0.3-6.7, p=0.01 and p=0.002 respectively). Measures of airway inflammation were not significantly different between GINA categories and were not correlated with ACQ. In multivariate analyses, increasing cough frequency and worsening FEV1 independently predicted measures of asthma control.
CONCLUSION:Ambulatory cough frequency monitoring provides an objective assessment of asthma symptoms that correlates with standard measures of asthma control, but not airflow obstruction or airway inflammation. Moreover, cough frequency and airflow obstruction represent independent dimensions of asthma control.
Chest. 2016 Mar 10. pii: S0012-3692(16)41619-3. doi: 10.1016/j.chest.2016.02.676. [Epub ahead of print]
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哮喘-慢性阻塞性肺疾病重叠综合征（ACOS）在美国的特征和发病率
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关于母亲体重指数、孕期体重增加和后代哮喘的纵向研究
