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Does bronchial hyperresponsiveness predict a diagnosis of cough variant asthma in adults with chronic cough: a cohort study.

ABSTRACT: Bronchial hyperresponsiveness is a typical, but non-specific feature of cough variant asthma (CVA). This study aimed to determine whether bronchial hyperresponsiveness may be considered as a predictor of CVA in non-smoking adults with chronic cough (CC). The study included 55 patients with CC and bronchial hyperresponsiveness confirmed in the methacholine provocation test, in whom an anti-asthmatic, gradually intensified treatment was introduced. The diagnosis of CVA was established if the improvement in cough severity and cough-related quality of life in LCQ were noted.The study showed a high positive predictive value of bronchial hyperresponsiveness in this population. Cough severity and cough related quality of life were not related to the severity of bronchial hyperresponsiveness in CVA patients. A poor treatment outcome was related to a low baseline capsaicin threshold and the occurrence of gastroesophageal reflux-related symptoms. In conclusion, bronchial hyperresponsiveness could be considered as a predictor of cough variant asthma in non-smoking adults with CC.

SUBMITTER: Rybka-Fraczek A

PROVIDER: S-EPMC8461979 | biostudies-literature | 2021 Sep

REPOSITORIES: biostudies-literature

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Does bronchial hyperresponsiveness predict a diagnosis of cough variant asthma in adults with chronic cough: a cohort study.

Rybka-Fraczek Aleksandra A Dabrowska Marta M Grabczak Elzbieta M EM Bialek-Gosk Katarzyna K Klimowicz Karolina K Truba Olga O Krenke Rafal R

Respiratory research 20210923 1

Bronchial hyperresponsiveness is a typical, but non-specific feature of cough variant asthma (CVA). This study aimed to determine whether bronchial hyperresponsiveness may be considered as a predictor of CVA in non-smoking adults with chronic cough (CC). The study included 55 patients with CC and bronchial hyperresponsiveness confirmed in the methacholine provocation test, in whom an anti-asthmatic, gradually intensified treatment was introduced. The diagnosis of CVA was established if the impro ...[more]

PMID: 34556106

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Project description:ObjectivesTo compare physical information, such as age, sex, height, weight, body mass index (BMI) and pulmonary function test (PFT) results, between cough variant asthma (CVA) and chronic cough (CC) and establish a diagnostic model of CVA.DesignA case-control study of patients with suspected CVA enrolled at The First Affiliated Hospital of Zhejiang Chinese Medical University.SettingOne leader unit of the National Key Specialised Pulmonary Disease Cooperation Group in China.ParticipantsEnrolled 545 patients who underwent PFT and bronchial provocation tests.Outcome measuresWe obtained physical information and pulmonary test data and established the model using logistic regression analysis. The Hosmer-Lemeshow goodness-of-fit test, area under the receiver operating characteristic curve (AUC), calibration plot and decision curve analysis were used to evaluate this model. All data were analysed using SPSS V.27 and RStudio software.ResultsThe CVA group had more female patients (%) (68.12% vs 51.48%, p value<0.001) and lower height (m) (1.61 (0.40) vs 1.65 (3.26), p value<0.001), weight (kg) (60 (56) vs 63 (85), p value<0.001) and BMI (kg/m2) (22.59 (17.91) vs 23.28 (21.81), p value=0.016) than the CC group. Differences between CVA and CC in forced vital capacity (FVC) in percent predicted values (FVC% pred)(94.4 (57.3) vs 91.60 (94.10), p value=0.006), forced expiratory volume in 1 s/FVC (FEV1/FVC) (%) (84.65±6.82 vs 86.91±6.71, p value<0.001), peak expiratory flow in per cent predicted values (PEF% pred) (93.00 (81.10) vs 98.00 (108.00), p value=0.005), maximal mid-expiratory flow in percent predicted values (MMEF% pred) (74.50 (100.60) vs 90.85 (170.30), p value<0.001), forced expiratory flow (FEF) at 50% of FVC in per cent predicted values (FEF50% pred) (78.9(113.50) vs 93.10(169.80), p value<0.001) and FEF at 75% of FVC in per cent predicted values (FEF75% pred) (69.70 (137.60) vs 85.60 (225.80), p value<0.001) were significant. Patients with CVA were more in number compared with patients with CC at a lower degree (<65%) of MMEF% pred (32.37% vs 14.50%, p value<0.001), FEF50% pred (26.09% vs 13.02%, p value<0.001) and FEF75% pred (39.13% vs 23.67%, p value<0.001). FVC% pred, FEV1/FVC, BMI and MMEF% pred aided in establishing a model with an AUC of 0.733 (95% CI: 0.6829 to 0.7831). The model was tested using internal and external data (p value=0.2865 and p value=0.3197, respectively).ConclusionBMI, FVC% pred, FEV1/FVC (%) and MMEF% pred were used to establish the diagnostic model. Our model potentially indicates CVA.Trial registration numberNCT06199830.

Project description:IntroductionOver the past 50 years, the prevalence of allergic respiratory diseases has been increasing. The Hygiene hypothesis explains this progression by the decrease in the bio-diversity of early microbial exposure. This study aims to evaluate the effect of early-life farm exposure on airway hyperresponsiveness and cough hypersensitivity in an allergic airway inflammation rabbit model.MethodA specific environment was applied to pregnant rabbits and their offspring until six weeks after birth. Rabbits were housed in a pathogen-free zone for the control group and a calf barn for the farm group. At the end of the specific environmental exposure, both groups were then housed in a conventional zone and then sensitized to ovalbumin. Ten days after sensitization, the rabbit pups received ovalbumin aerosols to provoke airway inflammation. Sensitization to ovalbumin was assessed by specific IgE assay. Cough sensitivity was assessed by mechanical stimulation of the trachea, and bronchial reactivity was assessed by methacholine challenge. The farm environment was characterized by endotoxin measurement.ResultsA total of 38 rabbit pups were included (18 in the farm group). Endotoxin levels in the farm environment varied from 30 to 1854 EU.m-3. There was no significant difference in specific IgE values to ovalbumin (p = 0.826) between the two groups. The mechanical threshold to elicit a cough did not differ between the two groups (p = 0.492). There was no difference in the number of cough (p = 0.270) or the intensity of ventilatory responses (p = 0.735). After adjusting for age and weight, there was no difference in respiratory resistance before and after methacholine challenge.ConclusionEarly exposure to the calf barn did not affect cough sensitivity or bronchial reactivity in ovalbumin-sensitized rabbits. These results suggest that not all farm environments protect against asthma and atopy. Continuous exposure to several sources of microbial diversity is probably needed.

Dataset Information

Does bronchial hyperresponsiveness predict a diagnosis of cough variant asthma in adults with chronic cough: a cohort study.

Publications

Does bronchial hyperresponsiveness predict a diagnosis of cough variant asthma in adults with chronic cough: a cohort study.

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