Wellcome-Wolfson Institute for Experimental Medicine, Belfast, UK.
Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Eur Respir J. 2022 Dec 8;60(6). doi: 10.1183/13993003.03205-2021. Print 2022 Dec.
The relationship between objectively measured cough and type 2 (T2) biomarkers and other measures of asthma control and severity is poorly understood. The objective of this study was to assess the relationship between objective and subjective cough measurement tools and clinical biomarkers of asthma.
Patients with severe asthma and mild-to-moderate asthma completed validated asthma and cough-related measurement tools (including ambulatory cough monitoring) and measurement of spirometry and T2 biomarkers (exhaled nitric oxide fraction ( ) and peripheral blood eosinophil count). Patients were classified according to T2 status based on T2-low ( <20 ppb and peripheral blood eosinophils <150 cells·µL), T2-intermediate ( ≥20 ppb or peripheral blood eosinophils ≥150 cells·µL) or T2-high ( ≥20 ppb and peripheral blood eosinophils ≥150 cells·µL).
61 patients completed the study measurements (42 severe asthma and 19 mild-to-moderate asthma). Patients with severe asthma had higher rates of cough than those with mild-to-moderate asthma in terms of total 24-h cough counts (geometric mean±sd 170.3±2.7 60.8±4.1; p=0.002) and cough frequency (geometric mean±sd 7.1±2.7 2.5±4.1 coughs·h; p=0.002). T2-low patients with severe asthma had significantly lower 24-h cough frequency compared with T2-intermediate and T2-high patients.
In patients with low biomarkers of T2 inflammation, cough frequency measurements were not elevated, suggesting that the mechanism for cough in asthma is underlying T2 eosinophilic inflammation and the logical first step for treating cough in asthma may be to achieve adequate suppression of T2 inflammation with currently available therapies.
客观测量的咳嗽与 2 型（T2）生物标志物以及其他哮喘控制和严重程度的测量方法之间的关系尚未得到充分理解。本研究的目的是评估客观和主观咳嗽测量工具与哮喘的临床生物标志物之间的关系。
严重哮喘和轻中度哮喘患者完成了经过验证的哮喘和咳嗽相关测量工具（包括动态咳嗽监测）以及肺功能测定和 T2 生物标志物（呼气一氧化氮分数（ ）和外周血嗜酸性粒细胞计数）的测量。根据 T2 状态将患者分为 T2 低（ <20 ppb 且外周血嗜酸性粒细胞 <150 细胞·µL）、T2 中（ ≥20 ppb 或外周血嗜酸性粒细胞 ≥150 细胞·µL）或 T2 高（ ≥20 ppb 且外周血嗜酸性粒细胞 ≥150 细胞·µL）。
61 例患者完成了研究测量（42 例严重哮喘和 19 例轻中度哮喘）。与轻中度哮喘相比，严重哮喘患者的总 24 小时咳嗽计数（几何均数±标准差 170.3±2.7 60.8±4.1；p=0.002）和咳嗽频率（几何均数±标准差 7.1±2.7 2.5±4.1 咳嗽·h；p=0.002）更高。严重哮喘 T2 低患者的 24 小时咳嗽频率明显低于 T2 中值和 T2 高患者。
在 T2 炎症生物标志物低的患者中，咳嗽频率测量并未升高，这表明哮喘中咳嗽的机制是潜在的 T2 嗜酸性粒细胞炎症，治疗哮喘咳嗽的逻辑第一步可能是用目前可用的疗法充分抑制 T2 炎症。
