Rybka-Fraczek Aleksandra, Dabrowska Marta, Grabczak Elzbieta M, Bialek-Gosk Katarzyna, Klimowicz Karolina, Truba Olga, Nejman-Gryz Patrycja, Paplinska-Goryca Magdalena, Krenke Rafal
Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland.
J Inflamm Res. 2022 Jan 26;15:595-602. doi: 10.2147/JIR.S343411. eCollection 2022.
Eosinophilic inflammatory phenotype was thought to be the most common phenotype of cough variant asthma (CVA), nevertheless other phenotypes were also reported.
The study aimed to analyze the inflammatory phenotypes of CVA in relation to treatment response to the stepwise anti-asthmatic treatment.
The study included 45 patients with chronic cough (CC) and suspicion of CVA (normal chest X-ray, presence of bronchial hyperresponsiveness and no history of wheezing or dyspnea) in whom induced sputum was successfully collected. Based on the cellular composition of the sputum, patients were divided into major inflammatory phenotypes: eosinophilic, neutrophilic, paucigranulocytic or mixed granulocytic. A stepwise treatment, including inhaled corticosteroids with long-acting β-agonist, montelukast and short-term therapy with prednisone was initiated. Good treatment response was defined as the reduction in cough severity at least 20 mm from the baseline in visual analogue scale and improvement in cough-related quality of life assessed by the Leicester cough questionnaire at least 1.3 points after any of three steps.
Finally, 40/45 (88.9%) patients improved after therapy. Eosinophilic asthma was found in 13/40 (32.5%) patients, neutrophilic in 6/40 (15.0%) and paucigranulocytic pattern in 21/40 (52.5%) patients. No one demonstrated a mixed granulocytic phenotype. The response to the treatment was similar in all groups. However, the reduction in cough severity was inversely related to the percentage of sputum neutrophils (r = -0.44, P = 0.003). We showed that the percentage of neutrophils in sputum >46% may be considered as a predictor of poor response to anti-asthmatic therapy.
The diversity of inflammatory phenotypes with paucigranulocytic preponderance was found in subjects with CVA. The response to anti-asthmatic treatment in patients with CVA was not related to the inflammatory phenotype. High neutrophil count in sputum may predict poor response to anti-asthmatic therapy in patients with CC and bronchial hyperresponsiveness.
嗜酸性粒细胞炎症表型曾被认为是咳嗽变异性哮喘（CVA）最常见的表型，不过也有其他表型的报道。
本研究旨在分析CVA的炎症表型与逐步抗哮喘治疗反应之间的关系。
本研究纳入45例慢性咳嗽（CC）且疑似CVA的患者（胸部X线正常、存在支气管高反应性且无喘息或呼吸困难病史），这些患者均成功采集到诱导痰。根据痰液的细胞组成，将患者分为主要炎症表型：嗜酸性粒细胞型、中性粒细胞型、少粒细胞型或混合粒细胞型。开始进行逐步治疗，包括吸入糖皮质激素联合长效β受体激动剂、孟鲁司特以及泼尼松短期治疗。良好的治疗反应定义为视觉模拟量表中咳嗽严重程度较基线至少降低20 mm，且在三个治疗步骤中的任何一步后，通过莱斯特咳嗽问卷评估的咳嗽相关生活质量改善至少1.3分。
最终，40/45（88.9%）例患者治疗后病情改善。40例患者中，13例（32.5%）为嗜酸性粒细胞性哮喘，6例（15.0%）为中性粒细胞性哮喘，21例（52.5%）为少粒细胞型。无人表现为混合粒细胞表型。所有组的治疗反应相似。然而，咳嗽严重程度的降低与痰液中性粒细胞百分比呈负相关（r = -0.44，P = 0.003）。我们发现痰液中中性粒细胞百分比>46%可被视为抗哮喘治疗反应不佳的预测指标。
在CVA患者中发现炎症表型具有多样性，以少粒细胞型为主。CVA患者对抗哮喘治疗的反应与炎症表型无关。痰液中高中性粒细胞计数可能预示CC和支气管高反应性患者对抗哮喘治疗反应不佳。
