Park Heung-Woo, Kim Sang-Hoon, Chang Yoon-Seok, Lee Byung-Jae, Min Kyung-Up, Kim You-Young, Cho Sang-Heon
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Ann Allergy Asthma Immunol. 2007 Jun;98(6):533-9. doi: 10.1016/S1081-1206(10)60731-4.
The capsaicin cough sensitivity test (CCST), methacholine bronchial provocation test (MBPT), and induced sputum test (IST) are widely used in the clinical evaluation of chronic nonproductive cough. However, little is known about their roles in predicting response to inhaled corticosteroids (ICSs) in patients with chronic nonproductive cough.
To test the hypothesis that the CCST and IST play complementary roles to the MBPT for predicting the response to ICS treatment in patients with chronic nonproductive cough.
A total of 43 patients with chronic nonproductive cough who showed isolated capsaicin cough hypersensitivity (CCST group) and 55 patients with chronic nonproductive cough who had methacholine airway hyperresponsiveness (MBPT group) were enrolled. These patients underwent the IST followed by treatment with ICSs for 4 weeks. Measurement of symptom improvement was recorded by the visual analog scale.
The response rates to ICS treatment in the CCST and MBPT groups were similar (74.5% vs 86.0%; P = .21). Only the neutrophil count in the IST group was significantly different in responders and nonresponders after the ICS treatments (P = .005 for the CCST group and P = .006 for the MBPT group). Interestingly, the absence of sputum neutrophilia used as a criterion for subgroup analysis increased response rates in the patients with either methacholine airway hyperresponsiveness or capsaicin cough hypersensitivity.
In the present study, we demonstrate that CCST and IST play complementary roles to MBPT. By combining the results of these tests, we are able to identify more patients with chronic nonproductive cough and treat patients more successfully with ICSs by improving the response rate to ICS treatment.
辣椒素咳嗽敏感性试验（CCST）、乙酰甲胆碱支气管激发试验（MBPT）和诱导痰试验（IST）广泛应用于慢性干咳的临床评估。然而，它们在预测慢性干咳患者吸入性糖皮质激素（ICSs）反应中的作用却鲜为人知。
检验CCST和IST在预测慢性干咳患者对ICS治疗反应方面与MBPT发挥互补作用的假设。
共纳入43例表现为孤立性辣椒素咳嗽超敏反应的慢性干咳患者（CCST组）和55例有乙酰甲胆碱气道高反应性的慢性干咳患者（MBPT组）。这些患者接受IST，随后接受ICS治疗4周。采用视觉模拟量表记录症状改善情况。
CCST组和MBPT组对ICS治疗的反应率相似（74.5%对86.0%；P = 0.21）。ICS治疗后，仅IST组的中性粒细胞计数在反应者和无反应者之间存在显著差异（CCST组P = 0.005，MBPT组P = 0.006）。有趣的是，将无痰中性粒细胞增多作为亚组分析标准可提高有乙酰甲胆碱气道高反应性或辣椒素咳嗽超敏反应患者的反应率。
在本研究中，我们证明CCST和IST与MBPT发挥互补作用。通过综合这些试验结果，我们能够识别出更多慢性干咳患者，并通过提高对ICS治疗的反应率更成功地用ICS治疗患者。
