Prediction of bronchodilation test in adults with chronic cough suspected of cough variant asthma
BackgroundMany patients with cough variant asthma (CVA) are underdiagnosed and undertreated due to the atypical symptoms, low diagnostic sensitivity of bronchodilator response (BDR), and limited application of bronchial challenge test.ObjectiveTo investigate whether airway reversibility in BDR can p...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-12-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.987887/full |
| _version_ | 1811178356258897920 |
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| author | Huijuan Hao Yilin Pan Zichong Xu Zengchao Xu Wuping Bao Yishu Xue Chengjian Lv Jingwang Lin Yingying Zhang Min Zhang |
| author_facet | Huijuan Hao Yilin Pan Zichong Xu Zengchao Xu Wuping Bao Yishu Xue Chengjian Lv Jingwang Lin Yingying Zhang Min Zhang |
| author_sort | Huijuan Hao |
| collection | DOAJ |
| description | BackgroundMany patients with cough variant asthma (CVA) are underdiagnosed and undertreated due to the atypical symptoms, low diagnostic sensitivity of bronchodilator response (BDR), and limited application of bronchial challenge test.ObjectiveTo investigate whether airway reversibility in BDR can predict CVA diagnosis in patients with chronic cough and negative BDR.MethodsThis open-label, prospective cohort study included patients with chronic cough, nearly normal chest CT scan, and negative BDR results. Inhaled corticosteroids and long-acting β2 agonists were given for 4 weeks. The confirmed diagnosis of CVA was defined as improved symptoms and an increase of forced expiratory volume in 1 s (FEV1) by >12% and >200 mL after 4 weeks of treatment.ResultsOf 155 patients recruited, 140 completed the study. Patients in the CVA positive diagnosis group had greater absolute (Δ) and percent (Δ%) improvements in FEV1 and forced expiratory flows (FEFs), and higher fractional exhaled nitric oxide (FENO) than in the CVA negative diagnosis group. The area under the receiver operating characteristic curves (AUCs) of ΔFEV1%, FEF25–75%pred (percentage of predicted forced expiratory flow at 25% to 75%) and FENO for CVA positive diagnosis was 0.825, 0.714, and 0.637, with cutoff values of 5.90%, 61.99% and 41.50 ppb, respectively. A joint model of ΔFEV1% combined with FEF25–75%pred or FENO increased the AUC to 0.848 and 0.847, respectively.ConclusionΔFEV1% in BDR can predict a CVA diagnosis and response to anti-asthma treatment in patients with chronic cough and negative BDR.Clinical trial registration[http://www.chictr.org.cn/index.aspx], identifier [ChiCTR2000029065]. |
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| format | Article |
| id | doaj.art-edd13150b9714feda55c91e58bb45a6a |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-04-11T06:16:53Z |
| publishDate | 2022-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-edd13150b9714feda55c91e58bb45a6a2022-12-22T04:41:01ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-12-01910.3389/fmed.2022.987887987887Prediction of bronchodilation test in adults with chronic cough suspected of cough variant asthmaHuijuan Hao0Yilin Pan1Zichong Xu2Zengchao Xu3Wuping Bao4Yishu Xue5Chengjian Lv6Jingwang Lin7Yingying Zhang8Min Zhang9Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Mathematics, Shanghai Normal University, Shanghai, ChinaDepartment of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaBackgroundMany patients with cough variant asthma (CVA) are underdiagnosed and undertreated due to the atypical symptoms, low diagnostic sensitivity of bronchodilator response (BDR), and limited application of bronchial challenge test.ObjectiveTo investigate whether airway reversibility in BDR can predict CVA diagnosis in patients with chronic cough and negative BDR.MethodsThis open-label, prospective cohort study included patients with chronic cough, nearly normal chest CT scan, and negative BDR results. Inhaled corticosteroids and long-acting β2 agonists were given for 4 weeks. The confirmed diagnosis of CVA was defined as improved symptoms and an increase of forced expiratory volume in 1 s (FEV1) by >12% and >200 mL after 4 weeks of treatment.ResultsOf 155 patients recruited, 140 completed the study. Patients in the CVA positive diagnosis group had greater absolute (Δ) and percent (Δ%) improvements in FEV1 and forced expiratory flows (FEFs), and higher fractional exhaled nitric oxide (FENO) than in the CVA negative diagnosis group. The area under the receiver operating characteristic curves (AUCs) of ΔFEV1%, FEF25–75%pred (percentage of predicted forced expiratory flow at 25% to 75%) and FENO for CVA positive diagnosis was 0.825, 0.714, and 0.637, with cutoff values of 5.90%, 61.99% and 41.50 ppb, respectively. A joint model of ΔFEV1% combined with FEF25–75%pred or FENO increased the AUC to 0.848 and 0.847, respectively.ConclusionΔFEV1% in BDR can predict a CVA diagnosis and response to anti-asthma treatment in patients with chronic cough and negative BDR.Clinical trial registration[http://www.chictr.org.cn/index.aspx], identifier [ChiCTR2000029065].https://www.frontiersin.org/articles/10.3389/fmed.2022.987887/fullcough variant asthma (CVA)bronchodilation testforced expiratory volume in 1 s (FEV1)fractional exhaled nitric oxide (FENO)diagnosis |
| spellingShingle | Huijuan Hao Yilin Pan Zichong Xu Zengchao Xu Wuping Bao Yishu Xue Chengjian Lv Jingwang Lin Yingying Zhang Min Zhang Prediction of bronchodilation test in adults with chronic cough suspected of cough variant asthma Frontiers in Medicine cough variant asthma (CVA) bronchodilation test forced expiratory volume in 1 s (FEV1) fractional exhaled nitric oxide (FENO) diagnosis |
| title | Prediction of bronchodilation test in adults with chronic cough suspected of cough variant asthma |
| title_full | Prediction of bronchodilation test in adults with chronic cough suspected of cough variant asthma |
| title_fullStr | Prediction of bronchodilation test in adults with chronic cough suspected of cough variant asthma |
| title_full_unstemmed | Prediction of bronchodilation test in adults with chronic cough suspected of cough variant asthma |
| title_short | Prediction of bronchodilation test in adults with chronic cough suspected of cough variant asthma |
| title_sort | prediction of bronchodilation test in adults with chronic cough suspected of cough variant asthma |
| topic | cough variant asthma (CVA) bronchodilation test forced expiratory volume in 1 s (FEV1) fractional exhaled nitric oxide (FENO) diagnosis |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2022.987887/full |
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