Airway inflammation, airway responsiveness and cough before and after inhaled budesonide in patients with eosinophilic bronchitis
Airway inflammation, airway responsiveness and cough before and after inhaled budesonide in patients with eosinophilic bronchitis
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DOI：
10.1034/j.1399-3003.2000.15d10.x
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发表时间：
2000-04-01
影响因子：
24.3
通讯作者：
Pavord, ID
中科院分区：
文献类型：
--
作者：
Brightling, CE;Ward, R;Pavord, ID
嗜酸粒细胞性支气管炎是慢性咳嗽的常见原因，其特征是痰嗜酸粒细胞增多，类似于哮喘，但与哮喘不同，患者没有可变气流阻塞或气道高反应性的客观证据，不同功能相关性的原因尚不清楚。作者已经验证了嗜酸粒细胞性支气管炎的炎症主要局限于上呼吸道的假设。（激发浓度导致1秒内用力呼气量下降20%（PC 20））和更高（PC 25 MIF 50）气道反应性组胺，下，上气道炎症诱导痰和鼻腔灌洗，在11例嗜酸性粒细胞性支气管炎。作者评估了吸入400 μ g布地奈德4周后这些指标的变化，以及咳嗽反射对辣椒素的敏感性和咳嗽严重程度的变化，仅3例患者出现鼻嗜酸性粒细胞增多，1例出现上气道高反应性。吸入皮质类固醇治疗后，痰嗜酸性粒细胞计数的几何平均值从12.8%降至2.9%（平均差异4.4倍，95%置信区间（CI）2.14-10.02），100 mm量表上的平均+/-SEM咳嗽视觉模拟评分从27.2+/-6.6 mm降至12.6+/-5.7 mm（平均差异14.6，95%CI 9.1-20.1），咳嗽敏感性评估为引起两次咳嗽（C-2）和五次咳嗽（C-5）所需的辣椒素浓度改善（C-2平均差异0.75倍浓度，95% CI 0.36-1.1; C-5平均差异1.3倍浓度，95% CI 0.6-2.1），吸入布地奈德后痰嗜酸性粒细胞计数的倍数变化与C-5的加倍剂量变化之间存在显著正相关结论：嗜酸粒细胞性支气管炎患者上气道炎症不明显，吸入布地奈德可改善痰液嗜酸粒细胞增多、咳嗽严重程度和敏感性，提示炎症与咳嗽之间存在因果关系。
Eosinophilic bronchitis is a common cause of chronic cough, characterized by sputum eosinophilia similar to that seen in asthma, but unlike asthma the patients have no objective evidence of variable airflow obstruction or airway hyperresponsiveness, The reason for the different functional associations is unclear. The authors have tested the hypothesis that in eosinophilic bronchitis the inflammation is mainly localized in the upper airway.In an open study the authors measured the lower (provocative concentration causing a 20% fall in forced expiratory volume in one second (PC20)) and upper (PC25 MIF50) airway responsiveness to histamine, lower and upper airway inflammation using induced sputum and nasal lavage, in 11 patients with eosinophilic bronchitis. The authors assessed changes in these measures and in cough reflex sensitivity to capsaicin and cough severity after 400 mu g of inhaled budesonide for 4 weeks.A nasal eosinophilia was present in only three patients with one having upper airway hyperresponsiveness. Following treatment with inhaled corticosteroids the geometric mean sputum eosinophil count decreased from 12.8% to 2.9% (mean difference 4.4-fold, 95% confidence interval (CI) 2.14-10.02), the mean+/-SEM cough visual analogue score on a 100 mm scale decreased from 27.2+/-6.6 mm to 12.6+/-5.7 mm (mean difference 14.6, 95% CI 9.1-20.1) and the cough sensitivity assessed as the capsaicin concentration required to cause two coughs (C-2) and five coughs (C-5) improved (C-2 mean difference 0.75 doubling concentrations, 95% CI 0.36-1.1; C-5 mean difference 1.3 doubling concentration, 95% CI 0.6-2.1), There was a significant positive correlation between the fold change in sputum eosinophil count and doubling dose change in C-5 after inhaled budesonide (r=0.61).It is concluded that upper airway inflammation is not prominent in eosinophilic bronchitis and that inhaled budesonide improves the sputum eosinophilia, cough severity and sensitivity suggesting a causal link between the inflammation and cough.