Han Junjie, Li Li, Gong Ying, Song Juan, Zhu Yichun, Chen Cuicui, Shi Lin, Wang Jian, Song Yuanlin, She Jun
Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
Heliyon. 2024 Aug 15;10(17):e36124. doi: 10.1016/j.heliyon.2024.e36124. eCollection 2024 Sep 15.
Less attention has been paid to the pathophysiological changes in atypical asthma such as cough variant asthma (CVA) and chest tightness variant asthma (CTVA). The obstruction of large and small airways is the important component in the development of asthma. We investigated whether small airway inflammation (SAI) induced small airway dysfunction (SAD) in these atypical asthmatics.
Six hundred and eighty-six patients were enrolled and analyzed in the study. The partitioned airway inflammation was assessed by fractional exhaled nitric oxide (FeNO), such as FnNO, FeNO, FeNO, and calculated alveolar fraction of exhaled NO (CaNO). Correlations between exhaled NOs and SAD-related variables were assessed, whereas cell classification was evaluated by Spearman's rank tests. Classic asthma, CVA, and CTVA about potential risk were conducted using binary logistic regression models.
The whole airway inflammation increased in classic and atypical asthma than controls, whereas the central and peripheral airway inflammation in the CVA and CTVA groups increased compared with the classic asthma group. Smoking exposure was found to increase the central and peripheral airway inflammation in patients with asthma. The exhaled NO of FeNO and FeNO was associated with SAD in classic asthma, but not in CVA and CTVA. FeNO was the main risk (adjusted odds ratio [OR], 1.591; 95 % CI, 1.121-2.259; = .009) in classic asthma and (adjusted OR, 1.456; 95 % CI, 1.247-1.700; = .000) in CVA. The blood eosinophil levels were correlated with FeNO and FeNO in classic asthma and atypical asthma.
More severe inflammatory process was present in central and peripheral airways in CVA and CTVA, which might reflect a pre-asthmatic state. SAI was the predominant risk factor in the development of asthma before SAD.
诸如咳嗽变异性哮喘（CVA）和胸闷变异性哮喘（CTVA）等非典型哮喘的病理生理变化较少受到关注。大小气道阻塞是哮喘发展的重要组成部分。我们研究了小气道炎症（SAI）是否会在这些非典型哮喘患者中诱发小气道功能障碍（SAD）。
686例患者纳入本研究并进行分析。通过呼出一氧化氮分数（FeNO）评估分区气道炎症，如FnNO、FeNO、FeNO，并计算呼出NO的肺泡分数（CaNO）。评估呼出NO与SAD相关变量之间的相关性，而细胞分类通过Spearman秩检验进行评估。使用二元逻辑回归模型对经典哮喘、CVA和CTVA的潜在风险进行分析。
与对照组相比，经典哮喘和非典型哮喘的全气道炎症增加，而CVA和CTVA组的中央和外周气道炎症较经典哮喘组增加。发现吸烟暴露会增加哮喘患者的中央和外周气道炎症。经典哮喘中FeNO和FeNO的呼出NO与SAD相关，但在CVA和CTVA中不相关。FeNO是经典哮喘的主要风险因素（调整后的优势比[OR]，1.591；95%置信区间，1.121 - 2.259；P = 0.009），在CVA中为（调整后的OR，1.456；95%置信区间，1.247 - 1.700；P = 0.000）。经典哮喘和非典型哮喘中血嗜酸性粒细胞水平与FeNO和FeNO相关。
CVA和CTVA的中央和外周气道存在更严重的炎症过程，这可能反映了哮喘前期状态。SAI是SAD之前哮喘发展的主要危险因素。
