Chua T P, Lalloo U G, Worsdell M Y, Kharitonov S, Chung K F, Coats A J
Department of Cardiac Medicine, Royal Brompton Hospital, London.
Heart. 1996 Aug;76(2):144-9. doi: 10.1136/hrt.76.2.144.
To investigate the airway and cough responsiveness in non-smoking patients with stable chronic heart failure. Cough and wheeze, features associated with hyper-responsive airways, are not uncommon especially in decompensated chronic heart failure. Bronchial hyperresponsiveness has previously been demonstrated in chronic heart failure but this may have been confounded by smoking and acute decompensation.
Case-control study.
Tertiary specialist hospital.
Airway responsiveness to methacholine (a direct stimulant of smooth muscle in the airways), sodium metabisulphite (a putative stimulant of airway sensory nerves), and exercise was examined in 10 non-smoking patients with stable chronic heart failure (age 56.5 (3.2) (SEM) years; 7 men; radionuclide left ventricular ejection fraction 20.8 (2.9)%; radiographic cardiothoracic ratio 0.56 (0.02)). Exhaled nitric oxide, a product of the action of proinflammatory cytokines, was also measured to assess the contribution of local inflammation to airway responsiveness. The cough responses to low-concentration chloride solutions and to capsaicin were studied. Because all patients were receiving angiotensin-converting enzyme inhibitors, which may influence airway responsiveness and cough, 8 asymptomatic non-smoking controls taking angiotensin-converting enzyme inhibitors for essential hypertension were also studied (age 54.3 (2.8) years; 6 men; radiographic cardiothoracic ratio 0.46 (0.01)).
The mean provocative concentration that induced a 20% decrease in forced expiratory volume in 1 second (FEV1) was 67.6 v 79.8 mg/ml (P = 0.71) for methacholine and 276.7 v 290.4 mg/ml (P = 0.79) for sodium metabisulphite in chronic heart failure patients and controls respectively. The change in FEV1 after maximal cardiopulmonary exercise testing was +1.44% in patients and +2.53% in controls (P = 0.47), indicating that there was no exercise-induced bronchospasm in either group (peak oxygen consumption was 16.9 (1.3) v 26.5 (2.3) ml/kg/min respectively, P < 0.01). Exhaled nitric oxide concentration was not increased in chronic heart failure (12.3 (1.7) v 16.2 (3.3) ppb, P = 0.32). The median cough counts after nebulised 0 mM and 37.5 mM chloride solutions were 2.5 v 1.0 (P = 0.6) and 5.5 v 5.5 (P = 0.5) respectively and the capsaicin concentration causing two or more coughs was 13.5 v 6.5 microM (P = 0.5).
Airway hyper-responsiveness is not a predominant feature in non-smoking patients with stable chronic heart failure treated with, and tolerant to, angiotensin-converting enzyme inhibitors. It is unlikely to contribute to the exertional dyspnoea seen in these patients.
研究稳定期慢性心力衰竭非吸烟患者的气道和咳嗽反应性。咳嗽和喘息是与气道高反应性相关的特征，在失代偿性慢性心力衰竭中并不少见。此前已证实慢性心力衰竭患者存在支气管高反应性，但这可能受到吸烟和急性失代偿的干扰。
病例对照研究。
三级专科医院。
对10例稳定期慢性心力衰竭非吸烟患者（年龄56.5（3.2）（标准误）岁；7例男性；放射性核素左心室射血分数20.8（2.9）%；胸部X线心胸比率0.56（0.02））进行了气道对乙酰甲胆碱（气道平滑肌的直接刺激剂）、焦亚硫酸钠（一种假定的气道感觉神经刺激剂）和运动的反应性检测。还测量了呼出一氧化氮（促炎细胞因子作用的产物），以评估局部炎症对气道反应性的影响。研究了对低浓度氯化物溶液和辣椒素的咳嗽反应。由于所有患者均接受血管紧张素转换酶抑制剂治疗，而该类药物可能影响气道反应性和咳嗽，因此还对8例因原发性高血压服用血管紧张素转换酶抑制剂的无症状非吸烟对照者进行了研究（年龄54.3（2.8）岁；6例男性；胸部X线心胸比率0.46（0.01））。
慢性心力衰竭患者和对照者中，使一秒用力呼气容积（FEV1）下降20%的乙酰甲胆碱平均激发浓度分别为67.6比79.8mg/ml（P = 0.71），焦亚硫酸钠为276.7比290.4mg/ml（P = 0.79）。最大心肺运动试验后患者FEV1的变化为+1.44%，对照者为+2.53%（P = 0.47），表明两组均无运动诱发的支气管痉挛（峰值耗氧量分别为16.9（1.3）比26.5（2.3）ml/kg/min，P < 0.01）。慢性心力衰竭患者呼出一氧化氮浓度未升高（12.3（1.7）比16.2（3.3）ppb，P = 0.32）。雾化吸入0mM和37.5mM氯化物溶液后的咳嗽次数中位数分别为2.5比1.0（P = 0.6）和5.5比5.5（P = 0.5），引起两次或更多次咳嗽的辣椒素浓度为13.5比6.5μM（P = 0.5）。
在接受血管紧张素转换酶抑制剂治疗且耐受的稳定期慢性心力衰竭非吸烟患者中，气道高反应性并非主要特征。它不太可能导致这些患者出现劳力性呼吸困难。
