Purpose: Chronic cough in allergic rhinitis (AR) patients is common with multiple etiologies including cough variant asthma (CVA), non-asthmatic eosinophilic bronchitis (NAEB), gastroesophageal reflux-related cough (GERC), and upper airway cough syndrome (UACS). Practical indicators that distinguish these categories are lacking. We aimed to explore the diagnostic value of the fraction of exhaled nitric oxide (FeNO) and forced expiratory flow at 25% and 75% of pulmonary volume (FEF25-75) in specifically identifying CVA and NAEB in these patients. Methods: Consecutive AR patients with chronic cough were screened and underwent induced sputum, FeNO, nasal nitric oxide, spirometry, and methacholine bronchial provocation testing. All patients also completed gastroesophageal reflux disease questionnaires. Results: Among 1,680 AR patients, 324 (19.3%) were identified with chronic cough, of whom 316 (97.5%) underwent etiology analyses. Overall, 87 (27.5%) patients had chronic cough caused by NAEB, 78 (24.7%) by CVA, 16 (5.1%) by GERC, and 81 (25.6%) by UACS. Patients with either NAEB or CVA (n = 165, in total) were further assigned to a common group designated as CVA/NAEB, because they both responded to corticosteroid therapy. Receiver operating characteristic curves of FeNO revealed obvious differences among CVA, NAEB, and CVA/NAEB (area under the curve = 0.855, 0.699, and 0.923, respectively). The cutoff values of FeNO at 43.5 and 32.5 ppb were shown to best differentiate CVA and CVA/NAEB, respectively. FEF25-75 was significantly lower in patients with CVA than in those with other causes. A FEF25-75 value of 74.6% showed good sensitivity and specificity for identifying patients with CVA. Conclusions: NAEB, CVA, and UACS are common causes of chronic cough in patients with AR. FeNO can first be used to discriminate patients with CVA/NAEB, then FEF25-75 (or combined with FeNO) can further discriminate patients with CVA from those with CVA/NAEB.
基金:
program for Changjiang Scholars and Innovative Research TeamProgram for Changjiang Scholars & Innovative Research Team in University (PCSIRT) [IRT13082]; National Natural Science Fund for the Major International Joint Research Program [81420108009]; National Natural Science FundNational Natural Science Foundation of China (NSFC) [81630023, 81100704, 81441029, 81441031, 81570894]; Beijing Health Bureau Program for High Level Talents [2014-3-018]; Beijing Municipal Administration of Hospitals' Mission Plan [SML20150203]; project of Application of Clinical Features in Capital City by the Beijing Municipal Science & Technology Commission [Z131107002213135]; Beijing Scientific and Technological Overall Plan [Z171100000117002]
第一作者机构:[1]Capital Med Univ, Beijing Tongren Hosp, Dept Resp Med, Beijing 100730, Peoples R China
通讯作者:
通讯机构:[1]Capital Med Univ, Beijing Tongren Hosp, Dept Resp Med, Beijing 100730, Peoples R China[2]Capital Med Univ, Beijing Tongren Hosp, Dept Otolaryngol Head & Neck Surg, Beijing, Peoples R China[3]Minist Educ China, Key Lab Otolaryngol Head & Neck Surg, Beijing Inst Otolaryngol, 17 Hougou Hutong, Beijing 100005, Peoples R China[4]Peking Univ, Dept Resp Med, Hosp 3, Beijing, Peoples R China[*1]Key Laboratory of Otolaryngology Head and Neck Surgery of Ministry of Education of China, Beijing Institute of Otolaryngology, No. 17, Hougou Hutong, Dongcheng District, Beijing 100005, China.[*2]Department of Respiratory Medicine, Beijing Tongren Hospital, Capital Medical University, Dongjiaominxiang, Dongcheng District, Beijing 100730, China.
推荐引用方式(GB/T 7714):
Liu Xiaofang,Wang Xiangdong,Yao Xiujuan,et al.Value of Exhaled Nitric Oxide and FEF25-75 in Identifying Factors Associated With Chronic Cough in Allergic Rhinitis[J].ALLERGY ASTHMA & IMMUNOLOGY RESEARCH.2019,11(6):830-845.doi:10.4168/aair.2019.11.6.830.
APA:
Liu, Xiaofang,Wang, Xiangdong,Yao, Xiujuan,Wang, Yuhong,Sun, Yongchang&Zhang, Luo.(2019).Value of Exhaled Nitric Oxide and FEF25-75 in Identifying Factors Associated With Chronic Cough in Allergic Rhinitis.ALLERGY ASTHMA & IMMUNOLOGY RESEARCH,11,(6)
MLA:
Liu, Xiaofang,et al."Value of Exhaled Nitric Oxide and FEF25-75 in Identifying Factors Associated With Chronic Cough in Allergic Rhinitis".ALLERGY ASTHMA & IMMUNOLOGY RESEARCH 11..6(2019):830-845