Feijen Jef, Seys Sven F, Steelant Brecht, Bullens Dominique M A, Dupont Lieven J, García-Cruz Maria, Jimenez-Chobillón Alejandro, Larenas-Linnemann Désirée, Van Gerven Laura, Fokkens Wytske J, Agache Ioana, Hellings Peter W
Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Belgium.
KU Leuven Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium.
World Allergy Organ J. 2020 Jul 1;13(6):100132. doi: 10.1016/j.waojou.2020.100132. eCollection 2020 Jun.
Nasal hyperreactivity (NHR) is a common feature of various rhinitis subtypes and represents a novel phenotype of rhinitis. It is being reported in two-thirds of adult rhinitis patients irrespective of the atopic status. Data on the prevalence of NHR in patients with asthma are lacking, as well as the nature of evoking triggers.
Postal questionnaires were distributed to an unselected group of asthmatic patients in Leuven (Belgium, n = 190) and completed by 114 patients. In Mexico City (Mexico) and Brasov (Romania), respectively, 97 out of 110 and 80 out of 100 asthmatic patients attending the outpatient clinic completed the questionnaire. Non-asthmatic volunteers were recruited amongst university and hospital co-workers in Leuven (n = 53). The presence of self-reported NHR, the type of triggers evoking nasal and bronchial symptoms, medication use, self-reported allergy, and environmental factors were evaluated.
Overall, 69% of asthma patients reported NHR, with 32% having more than 4 triggers evoking NHR. These triggers included mainly exposure to temperature and humidity changes, cigarette smoke, and strong odours. A higher prevalence of NHR was detected in allergic compared to non-allergic asthma patients (73% vs. 53% p < 0.01). The prevalence of NHR correlated with asthma severity, ranging from 63% (VAS ≤3) to 81% (VAS ≥7). BHR was found more frequently in patients with NHR compared to without NHR (89% vs. 53%, p < 0.0001).
NHR represents a clinical phenotype of upper airway disease affecting over two-thirds of asthma patients and correlates with asthma severity. Targeting NHR in patients with asthma is often overlooked and should be reinforced in the future to achieve better symptom control.
鼻高反应性（NHR）是各种鼻炎亚型的常见特征，也是鼻炎的一种新表型。三分之二的成年鼻炎患者均有此症状，且与特应性状态无关。目前缺乏哮喘患者中NHR患病率的数据，以及诱发因素的性质。
向比利时鲁汶市一组未经挑选的哮喘患者发放邮政问卷（n = 190），114名患者完成了问卷。在墨西哥城（墨西哥）和布拉索夫（罗马尼亚），分别有110名和100名门诊哮喘患者中的97名和80名完成了问卷。在鲁汶市的大学和医院工作人员中招募了非哮喘志愿者（n = 53）。评估了自我报告的NHR的存在情况、诱发鼻和支气管症状的触发因素类型、药物使用情况、自我报告的过敏情况以及环境因素。
总体而言，69%的哮喘患者报告有NHR，其中32%有超过4种诱发NHR的触发因素。这些触发因素主要包括暴露于温度和湿度变化、香烟烟雾和强烈气味。与非过敏性哮喘患者相比，过敏性哮喘患者中NHR的患病率更高（73%对53%，p < 0.01）。NHR的患病率与哮喘严重程度相关，范围从63%（视觉模拟评分法[VAS]≤3）到81%（VAS≥7）。与无NHR的患者相比，有NHR的患者中支气管高反应性（BHR）更常见（89%对53%，p < 0.0001）。
NHR是一种上呼吸道疾病的临床表型，影响超过三分之二的哮喘患者，并与哮喘严重程度相关。在哮喘患者中针对NHR的治疗常常被忽视，未来应加强这方面治疗以实现更好的症状控制。
