Airway inflammation and hyperresponsiveness in subjects with respiratory symptoms and normal spirometry.
Eur Respir J
; 61(3)2023 03.
Article
em En
| MEDLINE
| ID: mdl-36396140
ABSTRACT
BACKGROUND:
Subjects without a previous history of asthma, presenting with unexplained respiratory symptoms and normal spirometry, may exhibit airway hyperresponsiveness (AHR) in association with underlying eosinophilic (type 2 (T2)) inflammation, consistent with undiagnosed asthma. However, the prevalence of undiagnosed asthma in these subjects is unknown.METHODS:
In this observational study, inhaled corticosteroid-naïve adults without previously diagnosed lung disease reporting current respiratory symptoms and showing normal pre- and post-bronchodilator spirometry underwent fractional exhaled nitric oxide (F ENO) measurement, methacholine challenge testing and induced sputum analysis. AHR was defined as a provocative concentration of methacholine causing a 20% fall in forced expiratory volume in 1â s (PC20) <16â mg·mL-1 and T2 inflammation was defined as sputum eosinophils >2% and/or F ENO >25â ppb.RESULTS:
Out of 132 subjects (mean±sd age 57.6±14.2â years, 52% female), 47 (36% (95% CI 28-44%)) showed AHR 20/132 (15% (95% CI 9-21%)) with PC20 <4â mg·mL-1 and 27/132 (21% (95% CI 14-28%)) with PC20 4-15.9â mg·mL-1. Of 130 participants for whom sputum eosinophils, F ENO or both results were obtained, 45 (35% (95% CI 27-43%)) had T2 inflammation. 14 participants (11% (95% CI 6-16%)) had sputum eosinophils >2% and PC20 ≥16â mg·mL-1, suggesting eosinophilic bronchitis. The prevalence of T2 inflammation was significantly higher in subjects with PC20 <4â mg·mL-1 (12/20 (60%)) than in those with PC20 4-15.9â mg·mL-1 (8/27 (30%)) or ≥16â mg·mL-1 (25/85 (29%)) (p=0.01).CONCLUSIONS:
Asthma, underlying T2 airway inflammation and eosinophilic bronchitis may remain undiagnosed in a high proportion of symptomatic subjects in the community who have normal pre- and post-bronchodilator spirometry.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Asma
/
Bronquite
Tipo de estudo:
Diagnostic_studies
/
Observational_studies
/
Risk_factors_studies
Limite:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article