重症哮喘患者中辣椒素敏感性的增加与严重的临床结果相关
2020/02/11
摘要
背景：辣椒素咳嗽反射敏感性（C-CS）与哮喘控制不佳有关，但与重症哮喘的关系尚不清楚。本文旨在确定C-CS对重症哮喘的临床影响。
方法：我们在2016年11月至2019年10月期间纳入了157位哮喘患者（包括根据GINA 2015指南步骤4/5中的122位重症哮喘患者）。对这些患者进行了辣椒素咳嗽试验，肺活量测定和生物标志物评估。辣椒素诱导至少五次咳嗽所需的浓度（定义为C5）被用作C-CS的指标。评估哮喘控制测试（ACT）和合并症。还评估了ERS / ATS指南制定的重症哮喘的4种临床特征的生物标志物的关系（控制欠佳（ACT <20，n = 58），频繁发作（≥2/年，n = 28），入院（≥1/年，n = 17），气流限制（％FEV1 <80，n = 30））。
结果：C-CS升高与哮喘控制差，频繁发作和入院有关，特别是在非特应性患者中（n = 54），但C-CS与气流受限无关。多元回归分析表明C-CS升高（C5≤2.44µM）是哮喘控制不佳和频繁发作的重大风险因素。一般因素和合并症方面，戒烟，糖尿病和慢性鼻-鼻窦炎与重症哮喘的临床特征相关（所有p <0.05）。
结论：C-CS升高是重症哮喘的危险因素。本研究提示气道神经元功能障碍与非2型重症哮喘的病理生理学相关。
Increased Capsaicin Sensitivity in Severe Asthmatics Associated with Worse Clinical Outcome.
Kanemitsu Y, Fukumitsu K, Kurokawa R, Takeda N, Suzuki M, Yap J, Nishiyama H, Tajiri T, Fukuda S, Uemura T, Ohkubo H, Maeno K, Ito Y, Oguri T, Takemura M, Niimi A.
Am J Respir Crit Care Med. 2020 Jan 28. doi: 10.1164/rccm.201911-2263OC. [Epub ahead of print]
Abstract
background:Capsaicin cough reflex sensitivity (C-CS) is associated with poorly controlled asthma, while its association with severe asthma remains unknown. To determine the clinical impact of C-CS on severe asthma.
MEthodS:We prospectively enrolled 157 asthmatic patients (including 122 severe asthma patients who were in step 4/5 according to the GINA 2015 guideline) between November 2016 and October 2019. Capsaicin cough challenge was performed along with spirometry and assessment of biomarkers. The concentration required to induce at least five coughs by capsaicin (defined as C5) was adopted as an index of C-CS. Asthma control test (ACT) and comorbidities were also evaluated. Associations of biomarkers with 4 clinical features of severe asthma made by the ERS/ATS guideline [poor control (ACT <20, n = 58), frequent exacerbations (≥2 /year, n = 28), admissions (≥1 /year, n = 17), and airflow limitation (%FEV1 <80, n = 30)] were assessed.
RESULTS:Heightened C-CS was associated with poor asthma control, frequent exacerbations and admissions, particularly in non-atopic patients (n = 54). Meanwhile, C-CS was not related to airflow limitation. Multivariate regression analysis has revealed that heightened C-CS (C5 ≤2.44 µM) was a significant risk for poor asthma control, and frequent exacerbations. Regarding general factors and comorbidities, ex-smoking, diabetes mellitus, and chronic rhinosinusitis were associated with clinical features of severe asthma (all p <0.05).
CONCLUSIONS:Heightened C-CS is a risk factor for severe asthma. The present study suggests the association of airway neuronal dysfunction with the pathophysiology of non-type2 severe asthma.
背景：辣椒素咳嗽反射敏感性（C-CS）与哮喘控制不佳有关，但与重症哮喘的关系尚不清楚。本文旨在确定C-CS对重症哮喘的临床影响。
方法：我们在2016年11月至2019年10月期间纳入了157位哮喘患者（包括根据GINA 2015指南步骤4/5中的122位重症哮喘患者）。对这些患者进行了辣椒素咳嗽试验，肺活量测定和生物标志物评估。辣椒素诱导至少五次咳嗽所需的浓度（定义为C5）被用作C-CS的指标。评估哮喘控制测试（ACT）和合并症。还评估了ERS / ATS指南制定的重症哮喘的4种临床特征的生物标志物的关系（控制欠佳（ACT <20，n = 58），频繁发作（≥2/年，n = 28），入院（≥1/年，n = 17），气流限制（％FEV1 <80，n = 30））。
结果：C-CS升高与哮喘控制差，频繁发作和入院有关，特别是在非特应性患者中（n = 54），但C-CS与气流受限无关。多元回归分析表明C-CS升高（C5≤2.44µM）是哮喘控制不佳和频繁发作的重大风险因素。一般因素和合并症方面，戒烟，糖尿病和慢性鼻-鼻窦炎与重症哮喘的临床特征相关（所有p <0.05）。
结论：C-CS升高是重症哮喘的危险因素。本研究提示气道神经元功能障碍与非2型重症哮喘的病理生理学相关。
(中日友好医院呼吸与危重症医学科 王瑞茵 摘译 林江涛 审校)
(Am J Respir Crit Care Med. 2020 Jan 28. doi: 10.1164/rccm.201911-2263OC. [Epub ahead of print])
(Am J Respir Crit Care Med. 2020 Jan 28. doi: 10.1164/rccm.201911-2263OC. [Epub ahead of print])
Increased Capsaicin Sensitivity in Severe Asthmatics Associated with Worse Clinical Outcome.
Kanemitsu Y, Fukumitsu K, Kurokawa R, Takeda N, Suzuki M, Yap J, Nishiyama H, Tajiri T, Fukuda S, Uemura T, Ohkubo H, Maeno K, Ito Y, Oguri T, Takemura M, Niimi A.
Am J Respir Crit Care Med. 2020 Jan 28. doi: 10.1164/rccm.201911-2263OC. [Epub ahead of print]
Abstract
background:Capsaicin cough reflex sensitivity (C-CS) is associated with poorly controlled asthma, while its association with severe asthma remains unknown. To determine the clinical impact of C-CS on severe asthma.
MEthodS:We prospectively enrolled 157 asthmatic patients (including 122 severe asthma patients who were in step 4/5 according to the GINA 2015 guideline) between November 2016 and October 2019. Capsaicin cough challenge was performed along with spirometry and assessment of biomarkers. The concentration required to induce at least five coughs by capsaicin (defined as C5) was adopted as an index of C-CS. Asthma control test (ACT) and comorbidities were also evaluated. Associations of biomarkers with 4 clinical features of severe asthma made by the ERS/ATS guideline [poor control (ACT <20, n = 58), frequent exacerbations (≥2 /year, n = 28), admissions (≥1 /year, n = 17), and airflow limitation (%FEV1 <80, n = 30)] were assessed.
RESULTS:Heightened C-CS was associated with poor asthma control, frequent exacerbations and admissions, particularly in non-atopic patients (n = 54). Meanwhile, C-CS was not related to airflow limitation. Multivariate regression analysis has revealed that heightened C-CS (C5 ≤2.44 µM) was a significant risk for poor asthma control, and frequent exacerbations. Regarding general factors and comorbidities, ex-smoking, diabetes mellitus, and chronic rhinosinusitis were associated with clinical features of severe asthma (all p <0.05).
CONCLUSIONS:Heightened C-CS is a risk factor for severe asthma. The present study suggests the association of airway neuronal dysfunction with the pathophysiology of non-type2 severe asthma.
