Small Airway Dysfunction in Asthma Is Associated with Perceived Respiratory Symptoms, Non-Type 2 Airway Inflammation, and Poor Responses to Therapy
Small Airway Dysfunction in Asthma Is Associated with Perceived Respiratory Symptoms, Non-Type 2 Airway Inflammation, and Poor Responses to Therapy
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哮喘中的小气道功能障碍与感知的呼吸道症状、非 2 型气道炎症和治疗反应不佳有关
DOI：
10.1159/000515328
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发表时间：
2021-04
期刊：
影响因子：
3.7
通讯作者：
Oliver Brian G.
中科院分区：
文献类型：
--
作者：
Liu Ying;Zhang Li;Li Hong Lin;Liang Bin Miao;Wang Ji;Zhang Xin;Chen Zhi Hong;Zhang Hong Ping;Xie Min;Wang Lei;Wang Gang;Oliver Brian G.
背景：新的证据表明小气道功能障碍（SAD）导致哮喘的临床表现。目的：本研究的目的是探讨通过 25% 至 75%（FEF25-75%）之间的用力呼气流量评估的 SAD 与哮喘临床和炎症特征以及治疗反应的关系。方法：在研究 I 中，对患有 SAD 和非 SAD 的哮喘患者的呼吸困难强度（Borg 量表）、胸闷、喘息和咳嗽（视觉模拟量表，VAS）以及乙酰甲胆碱激发试验（MCT）前后进行了分析。在研究II中，对患有SAD和非SAD的哮喘受试者进行痰诱导，并检测痰中的炎症介质。在研究 III 中，对接受固定治疗的 SAD 和非 SAD 哮喘患者进行了为期 4 周的前瞻性随访。进行肺活量测定、哮喘控制问卷（ACQ）和哮喘控制测试（ACT）来定义治疗反应。结果：SAD 受试者在 MCT 后呼吸困难 (p = 0.027) 和胸闷 (p = 0.032) 的 ΔVAS 更高。患有 SAD 的哮喘患者痰中干扰素 (IFN)-γ 显着升高（p < 0.05），Spearman 偏相关发现 FEF25-75% 与 IFN-γ 和白介素-8 显着相关（均 p < 0.05）。此外，多变量回归分析表明，SAD 与较差的治疗反应显着相关（ACQ 降低≥0.5，ACT 升高≥3）（p = 0.022 和 p = 0.032）。结论：这项研究表明，哮喘中的 SAD 使患者在支气管收缩期间容易出现更大的呼吸困难和胸闷。患有哮喘的 SAD 患者的特点是非 2 型炎症，这可能是治疗反应不佳的原因。
Background: Emerging evidence has indicated that small airway dysfunction (SAD) contributes to the clinical expression of asthma. Objectives: The aim of the study was to explore the relationships of SAD assessed by forced expiratory flow between 25 and 75% (FEF25–75%), with clinical and inflammatory profile and treatment responsiveness in asthma. Method: In study I, dyspnea intensity (Borg scale), chest tightness, wheezing and cough (visual analog scales, VASs), and pre- and post-methacholine challenge testing (MCT) were analyzed in asthma patients with SAD and non-SAD. In study II, asthma subjects with SAD and non-SAD underwent sputum induction, and inflammatory mediators in sputum were detected. Asthma patients with SAD and non-SAD receiving fixed treatments were prospectively followed up for 4 weeks in study III. Spirometry, Asthma Control Questionnaire (ACQ), and Asthma Control Test (ACT) were carried out to define treatment responsiveness. Results: SAD subjects had more elevated ΔVAS for dyspnea (p = 0.027) and chest tightness (p = 0.032) after MCT. Asthma patients with SAD had significantly elevated interferon (IFN)-γ in sputum (p < 0.05), and Spearman partial correlation found FEF25–75% significantly related to IFN-γ and interleukin-8 (both having p < 0.05). Furthermore, multivariable regression analysis indicated SAD was significantly associated with worse treatment responses (decrease in ACQ ≥0.5 and increase in ACT ≥3) (p = 0.022 and p = 0.032). Conclusions: This study indicates that SAD in asthma predisposes patients to greater dyspnea intensity and chest tightness during bronchoconstriction. SAD patients with asthma are characterized by non-type 2 inflammation that may account for poor responsiveness to therapy.
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影响因子：
--
作者：
Gunnar Borg;H. Linderholm
通讯作者：
Gunnar Borg;H. Linderholm
影响因子：
2.8
作者：
Ciprandi, Giorgio;Capasso, Michele;La Rosa, Mario
通讯作者：
La Rosa, Mario
影响因子：
9.6
作者：
Lapperre, Therese S.;Willems, Luuk N. A.;Sterk, Peter J.
通讯作者：
Sterk, Peter J.
DOI：
10.1152/jappl.1977.42.2.221
发表时间：
1977-02
期刊：
Journal of applied physiology: respiratory, environmental and exercise physiology
影响因子：
--
作者：
R. Brown;R. Ingram;J. Wellman;E. Mcfadden
通讯作者：
R. Brown;R. Ingram;J. Wellman;E. Mcfadden
影响因子：
9.6
作者：
Mahut, B;Delacourt, C;Delclaux, C
通讯作者：
Delclaux, C