Reflux-related symptoms reflect poor asthma control and the presence of airway neuronal dysfunction
Reflux-related symptoms reflect poor asthma control and the presence of airway neuronal dysfunction
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反流相关症状反映了哮喘控制不佳和气道神经元功能障碍的存在
DOI：
10.1016/j.alit.2021.12.003
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发表时间：
2022
影响因子：
6.8
通讯作者：
Niimi Akio
中科院分区：
文献类型：
--
作者：
Kurokawa Ryota;Kanemitsu Yoshihiro;Fukumitsu Kensuke;Takeda Norihisa;Tajiri Tomoko;Nishiyama Hirono;Yap Jennifer Maries;Ito Keima;Fukuda Satoshi;Uemura Takehiro;Ohkubo Hirotsugu;Maeno Ken;Ito Yutaka;Oguri Tetsuya;Takemura Masaya;Niimi Akio
背景：胃食管反流可能通过增加咳嗽反射敏感性而与哮喘恶化相关。船体气道反流问卷（HARQ）包括14个流行的反流相关症状。方法：从2018年8月至2020年7月，266例哮喘患者完成了HARQ。他们进行了血液分析，肺功能测定，呼出的一氧化氮（FeNO）的测量分数，和辣椒素咳嗽激发试验。如果患者的HARQ评分为13分或更高，则认为患者有反流相关症状。我们评估了反流相关症状和临床哮喘结果之间的关系。最后，我们进行了多变量分析，以确定HARQ对哮喘的临床意义。结果：平均HARQ评分为13.1分（标准差为12.0）。高HARQ评分组（HARQ≥ 13，n= 105）患者的特应性易感性患病率较低，FeNO水平较低，辣椒素咳嗽反射敏感性较高，哮喘控制较差，因哮喘住院的频率高于低HARQ组（所有p值均< 0.05）。当截断值设定为13时，HARQ在选择哮喘控制不良和严重咳嗽的患者时是有用的。多因素分析显示，辣椒素咳嗽反射敏感性升高影响反流相关症状，FeNO水平降低和年龄越小越好。结论：较高的HARQ评分（≥ 13分）不仅可以预测哮喘患者的病情，而且可以在一定程度上预测其气道神经元功能障碍。
Background: Gastroesophageal reflux may be associated with the worsening of asthma by increasing cough reflex sensitivity. Hull Airway Reflux Questionnaire (HARQ) consists of 14 prevalent reflux-related symptoms. It may be useful in predicting the presence of cough reflex hypersensitivity in asthma.Methods: From August 2018 to July 2020, 266 asthmatic patients completed the HARQ. They underwent blood analysis, spirometry, fraction of exhaled nitric oxide (FeNO) measurement, and the capsaicin cough challenge test. Patients were considered to have reflux-related symptoms if their HARQ scores were 13 points or higher. We evaluated the association between reflux-related symptoms and clinical asthma outcomes. Finally, we performed a multivariate analysis to determine the clinical significance of the HARQ for asthma. This study was registered in the University Hospital Medical Information Network (UMIN000040732).Results: The mean HARQ scores were 13.1 (standard deviation 12.0). Patients in the high HARQ scores group (HARQ≥ 13, n= 105) showed a lower prevalence of atopic predisposition, lower levels of FeNO, heightened capsaicin cough reflex sensitivity, poorer asthma control, and more frequent admissions due to asthma than those in the low HARQ groups (all p values< 0.05). The HARQ was useful in selecting patients with poor controlled asthma and those with severe cough when the cut-off value was set at 13. Multivariate analysis revealed that heightened capsaicin cough reflex sensitivity affected reflux-related symptoms, as well as lower levels of FeNO and younger age.Conclusions: Higher HARQ scores (≥ 13) may be useful in predicting not only poor asthma condition but also the presence of airway neuronal dysfunction in patients with asthma to some extent.