反流相关症状反映了哮喘控制不佳和气道神经元功能障碍的存在
2022/07/19
摘要
背景：胃食管反流可能通过增加咳嗽反射的敏感性与哮喘的恶化有关。Hull气道反流问卷（HARQ）由14个常见的反流相关症状组成。它可能有助于预测哮喘患者咳嗽反射超敏反应的存在
方法：从2018年8月到2020年7月，266名哮喘病人完成了HARQ。他们接受了血液分析、肺活量测定、呼出一氧化氮分数（FeNO）测定和辣椒素咳嗽激发试验。如果患者的HARQ得分大于等于13分，则被认为有反流相关症状。我们评估了反流相关症状和临床哮喘结果之间的关联。最后，我们进行了多变量分析以确定HARQ对哮喘的临床意义。本研究已在大学医院医疗信息网（UMIN000040732）注册。
结果：平均HARQ分数为13.1（标准差为12.0）。与低HARQ组相比，高HARQ分数组（HARQ≥13，n=105）的患者显示出较低的特应性倾向、较低的FeNO水平、较高的辣椒素咳嗽反射敏感性、较差的哮喘控制和较频繁的因哮喘入院（P值均 <0.05）。当将截断值设定为13时，HARQ对于选择哮喘控制不佳的患者和严重咳嗽的患者很有用。多变量分析显示，辣椒素咳嗽反射敏感性的提高影响了反流相关症状，以及FeNO水平的降低和年龄的降低。
结论：较高的HARQ分数（≥13分）不仅可以预测哮喘状况不佳，还可以在一定程度上预测哮喘患者是否存在气道神经元功能紊乱。
Reflux-related symptoms reflect poor asthma control and the presence of airway neuronal dysfunction.
Kurokawa, R., Kanemitsu, Y., Fukumitsu, K., Takeda, N., Tajiri, T., Nishiyama, H., Yap, J. M., Ito, K., Fukuda, S., Uemura, T., Ohkubo, H., Maeno, K., Ito, Y., Oguri, T., Takemura, M., & Niimi, A.
Abstract
BACKGROUND：Gastroesophageal reflux may be associated with the worsening of asthma by increasing cough reflex sensitivity. Hull Airway Reflux Questionnaire (HARQ) consists of 14 prevalent reflux-related symptoms. It may be useful in predicting the presence of cough reflex hypersensitivity in asthma.
METHODS：From August 2018 to July 2020, 266 asthmatic patients completed the HARQ. They underwent blood analysis, spirometry, fraction of exhaled nitric oxide (FeNO) measurement, and the capsaicin cough challenge test. Patients were considered to have reflux-related symptoms if their HARQ scores were 13 points or higher. We evaluated the association between reflux-related symptoms and clinical asthma outcomes. Finally, we performed a multivariate analysis to determine the clinical significance of the HARQ for asthma. This study was registered in the University Hospital Medical Information Network (UMIN000040732).
RESULTS：The mean HARQ scores were 13.1 (standard deviation 12.0). Patients in the high HARQ scores group (HARQ ≥13, n = 105) showed a lower prevalence of atopic predisposition, lower levels of FeNO, heightened capsaicin cough reflex sensitivity, poorer asthma control, and more frequent admissions due to asthma than those in the low HARQ groups (all p values < 0.05). The HARQ was useful in selecting patients with poor controlled asthma and those with severe cough when the cut-off value was set at 13. Multivariate analysis revealed that heightened capsaicin cough reflex sensitivity affected reflux-related symptoms, as well as lower levels of FeNO and younger age.
CONCLUSION：Higher HARQ scores (≥13) may be useful in predicting not only poor asthma condition but also the presence of airway neuronal dysfunction in patients with asthma to some extent.
背景：胃食管反流可能通过增加咳嗽反射的敏感性与哮喘的恶化有关。Hull气道反流问卷（HARQ）由14个常见的反流相关症状组成。它可能有助于预测哮喘患者咳嗽反射超敏反应的存在
方法：从2018年8月到2020年7月，266名哮喘病人完成了HARQ。他们接受了血液分析、肺活量测定、呼出一氧化氮分数（FeNO）测定和辣椒素咳嗽激发试验。如果患者的HARQ得分大于等于13分，则被认为有反流相关症状。我们评估了反流相关症状和临床哮喘结果之间的关联。最后，我们进行了多变量分析以确定HARQ对哮喘的临床意义。本研究已在大学医院医疗信息网（UMIN000040732）注册。
结果：平均HARQ分数为13.1（标准差为12.0）。与低HARQ组相比，高HARQ分数组（HARQ≥13，n=105）的患者显示出较低的特应性倾向、较低的FeNO水平、较高的辣椒素咳嗽反射敏感性、较差的哮喘控制和较频繁的因哮喘入院（P值均 <0.05）。当将截断值设定为13时，HARQ对于选择哮喘控制不佳的患者和严重咳嗽的患者很有用。多变量分析显示，辣椒素咳嗽反射敏感性的提高影响了反流相关症状，以及FeNO水平的降低和年龄的降低。
结论：较高的HARQ分数（≥13分）不仅可以预测哮喘状况不佳，还可以在一定程度上预测哮喘患者是否存在气道神经元功能紊乱。
(中日友好医院呼吸与危重症医学科 沈焜路 摘译 林江涛 审校)
(Allergol Int. 2022 Jul;71(3):318-324. DOI: 10.1016/j.alit.2021.12.003)
(Allergol Int. 2022 Jul;71(3):318-324. DOI: 10.1016/j.alit.2021.12.003)
Reflux-related symptoms reflect poor asthma control and the presence of airway neuronal dysfunction.
Kurokawa, R., Kanemitsu, Y., Fukumitsu, K., Takeda, N., Tajiri, T., Nishiyama, H., Yap, J. M., Ito, K., Fukuda, S., Uemura, T., Ohkubo, H., Maeno, K., Ito, Y., Oguri, T., Takemura, M., & Niimi, A.
Abstract
BACKGROUND：Gastroesophageal reflux may be associated with the worsening of asthma by increasing cough reflex sensitivity. Hull Airway Reflux Questionnaire (HARQ) consists of 14 prevalent reflux-related symptoms. It may be useful in predicting the presence of cough reflex hypersensitivity in asthma.
METHODS：From August 2018 to July 2020, 266 asthmatic patients completed the HARQ. They underwent blood analysis, spirometry, fraction of exhaled nitric oxide (FeNO) measurement, and the capsaicin cough challenge test. Patients were considered to have reflux-related symptoms if their HARQ scores were 13 points or higher. We evaluated the association between reflux-related symptoms and clinical asthma outcomes. Finally, we performed a multivariate analysis to determine the clinical significance of the HARQ for asthma. This study was registered in the University Hospital Medical Information Network (UMIN000040732).
RESULTS：The mean HARQ scores were 13.1 (standard deviation 12.0). Patients in the high HARQ scores group (HARQ ≥13, n = 105) showed a lower prevalence of atopic predisposition, lower levels of FeNO, heightened capsaicin cough reflex sensitivity, poorer asthma control, and more frequent admissions due to asthma than those in the low HARQ groups (all p values < 0.05). The HARQ was useful in selecting patients with poor controlled asthma and those with severe cough when the cut-off value was set at 13. Multivariate analysis revealed that heightened capsaicin cough reflex sensitivity affected reflux-related symptoms, as well as lower levels of FeNO and younger age.
CONCLUSION：Higher HARQ scores (≥13) may be useful in predicting not only poor asthma condition but also the presence of airway neuronal dysfunction in patients with asthma to some extent.
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重症哮喘尿代谢型降低独立于口服糖皮质激素治疗的卡尼汀代谢：源自U-BIOPRED研究
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通过中重度哮喘全基因组测序识别哮喘风险相关肺功能基因位点
