客观咳嗽频率，气道炎症和哮喘疾病控制
2017/07/12
背景：咳嗽被认为是哮喘诊断和监测中最重要的症状之一。 哮喘控制情况被认为与气道炎症程度和气道高反应性相关，但这些因素与咳嗽频率的关系尚不清楚。本研究的目的是调查客观咳嗽频率，疾病控制，气流阻塞和气道炎症之间的关系。
材料与方法：受试者接受24小时动态咳嗽监测和呼出气一氧化氮，肺功能，乙酰甲胆碱激发试验和诱导痰（细胞计数和炎症介质水平）检测。 使用全球哮喘倡议（GINA）进行分类，哮喘控制问卷（ACQ）评估哮喘控制。 手动计数咳嗽声数，并表示为每小时咳嗽数（c / h）
结果:研究纳入了89名哮喘患者（平均57±12岁;女性57％）。 根据GINA关于哮喘控制标准的描述，18例（20.2％）患者为完全控制，39例（43.8％）部分控制，32例（36％）未控制; 中位ACQ评分为1（范围0.0-4.4）。 6项ACQ与24小时咳嗽频率（r = 0.40; P <0.001）相关，与部分控制性哮喘（1.8 c / h;范围，0.2-25.3; P = 0.01）和控制性哮喘（1.7 c / h;范围，0.3-6.7; P = .002）相比，未控制哮喘患者具有较高的24小时咳嗽中位数（4.2 c / h;范围0.3 -27.6）。气道炎症指标与ACQ无相关性。在多变量分析中，咳嗽频率的增加以及FEV1的减低分别是哮喘控制预测的独立指标。
结论：动态咳嗽频率监测为哮喘症状的客观评估提供了依据，它与哮喘控制的指标相关，但与气道阻塞或气道炎症情况无关，咳嗽频率和气道阻塞情况分别代表了哮喘控制的不同方面。
（Marsden P A, Satia I, Ibrahim B, et al. Objective Cough Frequency, Airway Inflammation and Disease Control in Asthma.[J]. Chest, 2016, 149(6):1460-1466.）
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 recognized 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 hyperresponsiveness but how these factors relate to cough frequency is unclear. The goal of this study was to investigate the relationships between objective cough frequency, disease control, airflow obstruction, and airway inflammation in asthma.
METHODS:Participants with asthma underwent 24-h ambulatory cough monitoring and assessment of exhaled nitric oxide, spirometry, methacholine challenge, and sputum induction (cell counts and inflammatory mediator levels). Asthma control was assessed by using the Global Initiative for Asthma (GINA) classification and the Asthma Control Questionnaire (ACQ). The number of cough sounds was manually counted and expressed as coughs per hour (c/h).
RESULTS:Eighty-nine subjects with asthma (mean ± SD age, 57 ± 12 years; 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; the median ACQ score was 1 (range, 0.0-4.4). The 6-item ACQ correlated with 24-h cough frequency (r = 0.40; P < .001), and patients with uncontrolled asthma (per GINA criteria) had higher median 24-h cough frequency (4.2 c/h; range, 0.3-27.6) compared with partially controlled asthma (1.8 c/h; range, 0.2-25.3; P = .01) and controlled asthma (1.7 c/h; range, 0.3-6.7; P = .002). 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.
CONCLUSIONS: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.
Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
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学龄儿童支气管肺发育异常（BPD）与哮喘的临床特点异同
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返流在哮喘中的潜在作用
