Usefulness of simultaneous impulse oscillometry and spirometry with airway response to bronchodilator in the diagnosis of asthmatic cough
Usefulness of simultaneous impulse oscillometry and spirometry with airway response to bronchodilator in the diagnosis of asthmatic cough
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DOI：
10.1080/02770903.2022.2094803
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发表时间：
2022-06-29
影响因子：
1.9
通讯作者：
Gemma, Akihiko
中科院分区：
文献类型：
--
作者：
Taniuchi, Namiko;Hino, Mitsunori;Gemma, Akihiko
目的：慢性咳嗽最常见的病因包括咳嗽变异性哮喘（CVA）、支气管哮喘（BA）和哮喘-COPD重叠（ACO）。虽然这些疾病的病因有一些重叠，但由于治疗策略和并发症，尝试早期鉴别诊断在临床上很重要。研究方法：分析了吸入支气管扩张剂前后的肺量测定和脉冲肺功能测定（IOS），以确定临床诊断的CVA（cCVA，n = 203）、BA（cBA，n = 222）和ACO（cACO，n = 61）。结果如下：在cBA和cCVA之间观察到Delta FEV 1存在显著差异（Delta FEV 1分别改善122.5 mL/5.4%和65.7 mL/2.2%），但在Delta PEF、Delta V50或Delta V25中未观察到差异。除R20（20 Hz时的电阻）外，IOS在三组之间观察到显著差异。在IOS中，cCVA和cBA显示对支气管扩张剂的外周气道反应相当，认为这与V50和V25的变化相当。cACO使Δ FEV 1改善81.0 mL/6.2%，并通过向下的呼吸系统电抗（Xrs）波形和有限的支气管扩张剂反应来区分。在IOS与肺量计的相关性中，FEV 1/FVC、%FEV1和%V25与IOS的3个参数X5（5 Hz电抗）、共振频率（Fres）和低频电抗面积（ALX）相关性较强。结论：IOS参数的变化在这项研究中比FEV 1或流量-容量曲线的变化更敏感。考虑到两种不同测试的益处和相关性，同时IOS和肺量测定测试在哮喘性咳嗽的诊断中是有用的。
Objective: Some of the most common causes of chronic cough include cough variant asthma (CVA), bronchial asthma (BA), and asthma-COPD overlap (ACO). Although there is some overlap in the etiology of these diseases, it is clinically important to attempt an early differential diagnosis due to treatment strategies and prognoses. Methods: Spirometry and impulse oscillometry (IOS) before and after bronchodilator inhalation were analyzed for clinically diagnosed CVA (cCVA, n = 203), BA (cBA, n = 222), and ACO (cACO, n = 61). Results: A significant difference in Delta FEV1 was observed between cBA and cCVA (Delta FEV1 improvement of 122.5 mL/5.4% and 65.7 mL/2.2%, respectively), but no difference was observed in Delta PEF, Delta V50, or Delta V25. Except for R20 (resistance at 20 Hz), significant differences between the three groups were observed in IOS. In IOS, cCVA and cBA showed comparable peripheral airway response to bronchodilator which was thought to be commensurate with changes in V50 and V25. cACO improved Delta FEV1 improvement of 81.0 mL/6.2% and was distinguished by a downward respiratory system reactance (Xrs) waveform with a limited bronchodilator response. FEV1/FVC, %FEV1, and %V25 had relatively strong correlations with the three IOS parameters, X5 (reactance at 5 Hz), resonant frequency (Fres), and low-frequency reactance area (ALX), in the correlation between IOS and spirometers. Conclusion: Changes in IOS parameters were more sensitive in this study than changes in FEV1 or the flow-volume curve. Considering the benefits and relevance of the two different tests, simultaneous IOS and spirometry testing were useful in the diagnosis of asthmatic cough.