scholarly journals Small airway dysfunction in patients with cough variant asthma: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jie Gao ◽  
Haigui Wu ◽  
Feng Wu
Keyword(s):  
Retrospective Cohort ◽  
Bronchial Hyperresponsiveness ◽  
Diagnostic Value ◽  
Small Airway ◽  
Small Airways ◽  
Cough Variant Asthma ◽  
Asthmatic Patients ◽  
Cell Test ◽  
Sputum Eosinophils ◽  
The Relationship

Abstract Background Cough variant asthma (CVA) is one of the special populations of asthma. The aim of the study was to compare small airways, the degree of bronchial hyperresponsiveness (BHR) and airway inflammatory subtypes between CVA and classic asthma (CA), and investigate the relationship between these markers to determine the accuracy as indicators of CVA. Methods A total of 825 asthmatic patients participated in the study and 614 were included. 614 patients underwent spirometry and a bronchial challenge with methacholine and 459 patients performed induction sputum cell test. Results The number of CVA patients showed less small airway dysfunction than those of CA patients (p < 0.005). The degree of small airways dysfunction was higher in the CA group compared with the CVA group (p < 0.001). Small airways dysfunction was severer in the eosinophilic airway inflammatory subtype compared with other subtypes (p < 0.05).The area under curve of MMEF, FEF50 and FEF75 (% predicted) was 0.615, 0.621, 0.606, respectively. 0.17mcg of PD20 and 4.7% of sputum eosinophils was the best diagnostic value for CVA with an AUC of 0.582 and 0.575 (p = 0.001 and p = 0.005, respectively). Conclusions The eosinophilic airway inflammatory subtype may be increased small airway dysfunction. The value of small airways, BHR and induction sputum cells in CVA prediction, which reflected significant, but not enough to be clinically useful.

Small airways and bronchial hyper-responsiveness in cough-variant asthma

2020 ◽  
Author(s):  
jie gao ◽  
Feng Wu ◽  
Xing Yang ◽  
Sifang Wu
Keyword(s):  
Area Under Curve ◽  
Pulmonary Function Tests ◽  
Diagnostic Value ◽  
Small Airway ◽  
Small Airways ◽  
Cough Variant Asthma ◽  
Asthmatic Patients ◽  
Bronchial Hyper Responsiveness ◽  
Positive Correlations ◽  
The Relationship

Abstract Background Cough variant asthma (CVA) is one of the special populations of asthma. The study was to compare spirometric parameters of small airways and the degree of bronchial hyper-responsiveness (BHR) between CVA and classic asthma (CA), and examine the relationship between BHR and small airways to determine the accuracy of these markers as indicators of CVA. Methods A total of 825 asthmatic patients were screened for the study and 614 were included. All patients performed spirometry and underwent a bronchial challenge with methacholine. It has been estimated that less than 65% of the small airways must be obstructed before changes can be detected using routine pulmonary function tests. Results CVA patients showed less small airway dysfunction (< 65%) than those of CA patients with MMEF% predicted (70% vs 80.91%, p = 0.002) and FEF50% predicted (62.71% vs 73.5%, p = 0.004). The function of small airways was higher in the CVA group compared with the CA group (p < 0.001). CVA patients had a mild BHR (p = 0.005). Significant positive correlations were observed between PD20 and MMEF% predicted (r = 0.282, p < 0.001), FEF50% predicted (r = 0.2522, p < 0.001), FEF75% predicted (r = 0.2504, p < 0.001) in patients with CVA. The area under curve of MMEF, FEF50 and FEF75 (% predicted) was 0.615, 0.621, 0.606, respectively. 0.17mcg of PD20 was the best diagnostic value for CVA with an AUC of 0.582 (p = 0.001). Conclusions Small airway dysfunction is milder showed in CVA. The value of BHR combined with small airways in CVA prediction, which reflected significant, but not enough to be clinically useful.

scholarly journals Small Airway Dysfunction in Cough Variant Asthma: Prevalence, Clinical, and Pathophysiological Features

2022 ◽  
Vol 12 ◽  
Author(s):  
Fang Yi ◽  
Ziyu Jiang ◽  
Hu Li ◽  
Chunxing Guo ◽  
Hankun Lu ◽  
...  
Keyword(s):  
Airway Inflammation ◽  
Forced Vital Capacity ◽  
Vital Capacity ◽  
Small Airway ◽  
Asthma Prevalence ◽  
Cough Variant Asthma ◽  
Forced Expiratory Flow ◽  
Sputum Eosinophils ◽  
Expiratory Flow

Introduction: Small airway dysfunction (SAD) commonly presents in patients with classic asthma, which is associated with airway inflammation, disease severity, and asthma control. However, the prevalence of SAD, its relationship with cough severity and airway inflammation, and its development after antiasthmatic treatment in patients with cough variant asthma (CVA) need to be clarified. This study aimed to investigate the prevalence of SAD and its relationship with clinical and pathophysiological characteristics in patients with CVA and the change in small airway function after antiasthmatic treatment.Methods: We retrospectively analyzed 120 corticosteroid-naïve patients with CVA who had finished a standard questionnaire and relevant tests in a specialist cough clinic, such as cough visual analog scale (VAS), differential cells in induced sputum, fractional exhaled nitric oxide (FeNO) measurement, spirometry, and airway hyper-responsiveness. Information of 1-year follow-up was recorded in a part of patients who received complete cough relief after 2 months of treatment. SAD was defined as any two parameters of maximal mid-expiratory flow (MMEF)% pred, forced expiratory flow at 50% of forced vital capacity (FEF50%) pred, and forced expiratory flow at 75% of forced vital capacity (FEF75%) pred measuring &lt;65%.Results: SAD occurred in 73 (60.8%) patients with CVA before treatment. The patients with SAD showed a significantly longer cough duration (24.0 vs. 6.0, p = 0.031), a higher proportion of women (78.1 vs. 59.6%, p = 0.029), older mean age (41.9 vs. 35.4, p = 0.005), and significantly lower forced expiratory volume in 1 s (FEV1%) pred, FEV1/FVC, MMEF% pred, FEF50% pred, FEF75% pred, PEF% pred, and PD20 (all p &lt; 0.01) as compared with patients without SAD. There were no significant differences in cough VAS, sputum eosinophils count, FeNO, and TIgE level between patients with SAD and those without SAD. Among 105 patients who completed 2 months of antiasthmatic treatment and repeatedly experienced spirometry measurement, 57 (54.3%) patients still had SAD, despite a significant improvement in cough VAS, sputum eosinophils, FeNO, FEF50% pred, and PEF% pred (all p &lt; 0.01). As compared with patients without SAD, patients with SAD showed no significant differences in the relapse rate (50.0 vs. 41.9%, p = 0.483) and wheeze development rate (10.4 vs. 0%, p = 0.063) during the follow-up.Conclusions: Small airway dysfunction occurred in over half of patients with CVA and persisted after short-term antiasthmatic treatment, which showed distinctive clinical and pathophysiological features.

scholarly journals EVALUATION OF SMALL AIRWAY REVERSIBILITY AMONG ASTHMATIC PATIENTS WITH NON-OBSTRUCTIVE PATTERNS OF SPIROMETRY

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Tarig Merghani ◽  
Azza Alawad
Keyword(s):  
Airway Disease ◽  
Forced Expiratory Volume ◽  
Small Airway ◽  
Small Airways ◽  
Asthmatic Patients ◽  
Peripheral Airways ◽  
Flow Parameters ◽  
Small Airway Disease ◽  
Forced Expiratory Flow ◽  
Airway Reversibility

Background: Although the forced expiratory flow parameters are increasingly used in the diagnosis of small airway disease (SAD), the reversibility of these indicators is rarely described. The aim of this study is to evaluate the association of small airways reversibility with the presence of SAD and bronchodilator reversibility (BDR) of the proximal airways. Methods: The forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and the indicators of SAD (FEF25%, FEF50%, FEF75%, FEF25-75%, and FEF75-85%) were measured before and 20 minutes after salbutamol administration (200 mcg by using inhaler/Spacer). Positive BDR was accepted when FEV1 or FVC was increased ? 12% and > 200 ml, indicating responsive proximal airways. Positive small airway reversibility was diagnosed when any of the small airway indicators is increased ? 30% above the baseline results. All measurements were performed with the All-flow spirometer (Clement Clarke International, Harlow, UK). Results: Evidence of SAD was found in 62.1% of all participants and in 75.2% of those who showed responsive proximal airways. The positive predictive value of the SAD in diagnosing responsive proximal airways was 67.8%. The reversibility of the small airway indicators showed insignificant association with the FEV1 or FVC BDR. The reversibility of FEF50%, FEF75% and FEF25-75% showed significant association with the diagnosis of SAD, with specificities ranging from 75.5%-81.1%. Conclusion: SAD has a significant association with positive reversibility of both the proximal and the peripheral airways. Further studies are needed to evaluate the clinical significance of positive small airway reversibility in the diagnosis and management of obstructive lung diseases. Keywords: Asthma; Small airway disease; Bronchodilator Reversibility, FEV1, FVC; FEF25-75%

scholarly journals Airway Remodelling in Asthma: From Benchside to Clinical Practice

2010 ◽  
Vol 17 (4) ◽  
pp. e85-e93 ◽  
Author(s):  
Céline Bergeron ◽  
Meri K Tulic ◽  
Qutayba Hamid
Keyword(s):  
Structural Changes ◽  
Small Airways ◽  
Airway Remodelling ◽  
Airway Narrowing ◽  
Asthmatic Patients ◽  
Clinical Consequences ◽  
Characteristic Features ◽  
Airway Walls ◽  
The Relationship ◽  
Subepithelial Fibrosis

Airway remodelling refers to the structural changes that occur in both large and small airways relevant to miscellaneous diseases including asthma. In asthma, airway structural changes include subepithelial fibrosis, increased smooth muscle mass, gland enlargement, neovascularization and epithelial alterations. Although controversial, airway remodelling is commonly attributed to an underlying chronic inflammatory process. These remodelling changes contribute to thickening of airway walls and, consequently, lead to airway narrowing, bronchial hyper-responsiveness, airway edema and mucous hypersecretion. Airway remodelling is associated with poor clinical outcomes among asthmatic patients. Early diagnosis and prevention of airway remodelling has the potential to decrease disease severity, improve control and prevent disease expression. The relationship between structural changes and clinical and functional abnormalities clearly deserves further investigation. The present review briefly describes the characteristic features of airway remodelling observed in asthma, its clinical consequences and relevance for physicians, and its modulation by therapeutic approaches used in the treatment of asthmatic patients.

scholarly journals Downregulation of miR-3934 in Peripheral Blood Mononuclear Cells of Asthmatic Patients and Its Potential Diagnostic Value

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Wenyu Wang ◽  
Jing Wang ◽  
Hong Chen ◽  
Xiaofei Zhang ◽  
Kaiyu Han
Keyword(s):  
Peripheral Blood Mononuclear Cells ◽  
Peripheral Blood ◽  
Mononuclear Cells ◽  
Diagnostic Value ◽  
Healthy Controls ◽  
Peripheral Blood Mononuclear ◽  
Asthmatic Patients ◽  
Blood Mononuclear Cells ◽  
Asthma Patients ◽  
The Relationship

Background. The present study focused on the potential clinical significance of miR-3934 in the occurrence and development of asthma. Methods. 80 asthma and 80 healthy controls were recruited in this study. The peripheral blood mononuclear cells (PBMCs) and serum samples of the asthma patients as well as the healthy controls were isolated, and the expression levels of miR-3934 in PBMCs were examined by RT-qPCR methods. Furthermore, the relationship between the level of miR-3934 in PBMCs and the disease severity has been analyzed, and the potential diagnostic value of miR-3934 was evaluated by the receiver operating characteristics (ROC) curve. Finally, the expression level of IL-6, IL-8, and IL-33 have been detected using the ELISA kits, and Pearson’s correlation analysis was performed to investigate the relationship between the level of miR-3934 in PBMCs and the serum expression of those inflammatory cytokines in asthma patients. Results. miR-3934 was dramatically decreased in PBMCs of the asthma patients, and miR-3934 was markedly reduced in PBMCs of patients with severe asthma vs. mild asthma. Furthermore, ROC analysis showed that levels of miR-3934 in PBMCs can distinguish asthma patient, especially the severe asthma patients from the controls. Finally, the levels of miR-3934 in PBMCs were negatively correlated with the serum levels of IL-6, IL-8, and IL-33 in asthma patients, respectively. Conclusions. miR-3934 was downregulated in PBMCs of asthmatic patients and may function as a potential diagnosis biomarker.

scholarly journals Does small airway predict bronchial hyperresponsiveness? An observational retrospective study to evaluate small airways dysfunction

2019 ◽  
Vol 143 (2) ◽  
pp. AB13
Author(s):  
Diana Betancor ◽  
Blanca Barroso Garcia ◽  
Victoria Villalobos Violan ◽  
Rosialzira Natasha Vera ◽  
Mar Del Mar Fernandez-Nieto
Keyword(s):  
Retrospective Study ◽  
Bronchial Hyperresponsiveness ◽  
Small Airway ◽  
Small Airways

scholarly journals Diagnostic Value of Fractional Exhaled Nitric Oxide and Small Airway Function in Differentiating Cough-Variant Asthma from Typical Asthma

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Yanqi Wang ◽  
Lixuan Zhao ◽  
Fang Chen ◽  
Yufeng Guo ◽  
Hongxia Ma ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Roc Curve ◽  
Provocation Test ◽  
Diagnostic Value ◽  
Exhaled Nitric Oxide ◽  
Small Airway ◽  
Diagnostic Efficiency ◽  
Fractional Exhaled Nitric Oxide ◽  
Cough Variant Asthma ◽  
Airway Function

Purpose. To explore the diagnostic value of fractional exhaled nitric oxide (FeNO), small airway function, and a combined of both in differentiating cough-variant asthma (CVA) from typical asthma (TA). Methods. A total of 206 asthma subjects, including 104 CVA and 102 TA, were tested for pulmonary function, bronchial provocation test and FeNO. The correlation between FeNO, small airway function and other pulmonary indicators was analyzed by single correlation and multiple regression analysis. The receiver operating characteristic (ROC) curve was established to evaluate the diagnostic efficiency of FeNO, small airway function, and their combination and to predict the optimal cut-off point. Results. All the respiratory function parameters and small airway function indicators in TA group were significantly different from those in CVA group, and FeNO value was significantly higher than that in CVA group. In addition, the area under the ROC curve (AUC) was estimated to be 0.660 for FeNO, 0.895 for MMEF75%/25%, 0.873 for FEF50%, 0.898 for FEF25%, 0.695 for Fres, 0.650 for R5-R20, and 0.645 for X5. The optimal cut-off points of FeNO, MMEF75%/25%, FEF50%, FEF25%, Fres, R5-R20 and X5, were 48.50 ppb, 60.02%, 63.46%, 45.26%, 16.63 Hz, 0.38 kPa·L−1·s−1, and −1.32, respectively. And the AUC of FeNO combined with small airway function indexes FEF25%, Fres, R5-R20, and X5 were prior than single indicators. Conclusion. FeNO and small airway function indexes might have great diagnostic value for differentiating CVA from TA. The combination of FeNO and FEF25%, Fres, R5-R20, and X5 provided a significantly better prediction than either alone.

scholarly journals Bronchial provocation tests in clinical practice

2011 ◽  
Vol 129 (4) ◽  
pp. 243-249 ◽  
Author(s):  
Marcos de Carvalho Borges ◽  
Erica Ferraz ◽  
Elcio Oliveira Vianna
Keyword(s):  
Clinical Practice ◽  
Bronchial Hyperresponsiveness ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Bronchial Challenge ◽  
Cough Variant Asthma ◽  
Asthmatic Patients ◽  
Provocation Tests ◽  
Bronchial Provocation Tests ◽  
Bronchial Provocation

Bronchial hyperresponsiveness, which consists of an exaggerated response of the airways to bronchoconstrictor stimuli, is one of the main characteristics of asthma, presented in nearly all asthmatic patients. Bronchial hyperresponsiveness may also be present in other diseases, such as allergic rhinitis, chronic obstructive pulmonary disease, cystic fibrosis, heart failure and respiratory infection, and with some medications, such as β-blockers. Bronchial provocation tests (also known as bronchial challenges) are used to evaluate bronchial responsiveness. These tests have become increasingly used over the last 20 years, with the development and validation of accurate, safe and reproducible tests, and with the publication of well-detailed protocols. Several stimuli can be used in a bronchial challenge, and they are classified as direct and indirect stimuli. There are many indications for a bronchial challenge. In this review, we discuss the main differences between direct and indirect stimuli, and the use of bronchial challenges in clinical practice, especially for confirming diagnoses of asthma, exercise-induced bronchoconstriction and cough-variant asthma, and for use among elite-level athletes.

scholarly journals Impulse oscillometry for detection of small airway dysfunction in subjects with chronic respiratory symptoms and preserved pulmonary function

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Liang-Yuan Li ◽  
Tian-Sheng Yan ◽  
Jing Yang ◽  
Yu-Qi Li ◽  
Lin-Xi Fu ◽  
...  
Keyword(s):  
Pulmonary Function ◽  
Respiratory Symptoms ◽  
Early Stage ◽  
Roc Curves ◽  
Diagnostic Value ◽  
Small Airway ◽  
Impulse Oscillometry ◽  
Additional Method ◽  
Cutoff Values ◽  
Higher Sensitivity

Abstract Background Subjects with chronic respiratory symptoms and preserved pulmonary function (PPF) may have small airway dysfunction (SAD). As the most common means to detect SAD, spirometry needs good cooperation and its reliability is controversial. Impulse oscillometry (IOS) may complete the deficiency of spirometry and have higher sensitivity. We aimed to explore the diagnostic value of IOS to detect SAD in symptomatic subjects with PPF. Methods The evaluation of symptoms, spirometry and IOS results in 209 subjects with chronic respiratory symptoms and PPF were assessed. ROC curves of IOS to detect SAD were analyzed. Results 209 subjects with chronic respiratory symptoms and PPF were included. Subjects who reported sputum had higher R5–R20 and Fres than those who didn’t. Subjects with dyspnea had higher R5, R5–R20 and AX than those without. CAT and mMRC scores correlated better with IOS parameters than with spirometry. R5, R5–R20, AX and Fres in subjects with SAD (n = 42) significantly increased compared to those without. Cutoff values for IOS parameters to detect SAD were 0.30 kPa/L s for R5, 0.015 kPa/L s for R5–R20, 0.30 kPa/L for AX and 11.23 Hz for Fres. Fres has the largest AUC (0.665, P = 0.001) among these parameters. Compared with spirometry, prevalence of SAD was higher when measured with IOS. R5 could detect the most SAD subjects with a prevalence of 60.77% and a sensitivity of 81% (AUC = 0.659, P = 0.002). Conclusion IOS is more sensitive to detect SAD than spirometry in subjects with chronic respiratory symptoms and PPF, and it correlates better with symptoms. IOS could be an additional method for SAD detection in the early stage of diseases.

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