ABSTRACT
BACKGROUND: Not all patients with cough variant asthma (CVA) show responsiveness to bronchodilators (RB) in clinic. Whether there are specific clinical and pathophysiological features can indicate RB in patients with CVA needs further investigation. Thus, we aimed to investigate the RB in patients with CVA and associated factors. METHODS: Forty-two CVA patients were randomized in a 2:1 ratio to receive oral bambuterol hydrochloride (10 mg, once daily, for 3 days) or matched placebo, 36 patients (24 with bronchodilator and 12 with placebo) completed the study eventually. RB was considered when cough visual analogue scale (VAS) score decreased 30% or more after 3 days treatment. The baseline clinical and pathophysiological characteristics between patients with RB and patients without RB were compared. CRS was presented with the lowest concentration of capsaicin inducing at least 5 coughing (C5). RESULTS: The responsive rate of patients with bronchodilator was significantly higher than that with placebo (62.5% vs 16.7%, p < 0.01). Patients with RB showed a significant greater mean decline of FEV1% predicted after bronchial provocation (26.7% vs 22.4%, p < 0.05) and higher geometric mean of sputum eosinophils (1.37 vs 0.69, p < 0.05) as compared with these without RB. No significant differences in sputum neutrophil, Log C5 were found between patients with RB and patients without RB. There was a moderate correlation between the decline of FEV1% pred and RB (rs = 0.443, p < 0.05). The regression analysis showed that nocturnal cough was a predictor of RB (OR, 7.33, 95% CI: 1.11-48.26, p = 0.038). No adverse events were reported by all of the patients after the study. CONCLUSION: More than one-third of patients with CVA do not respond to bronchodilator treatment, indicating that the response to bronchodilator should not be a diagnostic requirement of CVA. CVA patients with higher airway responsiveness will more likely respond to bronchodilator. Cough of CVA might be elicited by different mechanisms, which suggests that CVA could be divided into two phenotypes according to the response to bronchodilators.
Subject(s)
Asthma/drug therapy , Bronchodilator Agents/pharmacology , Cough/drug therapy , Adrenergic beta-2 Receptor Agonists/pharmacology , Adult , Aged , Asthma/physiopathology , Bronchial Hyperreactivity , Bronchial Provocation Tests , Cough/physiopathology , Female , Humans , Male , Middle Aged , Terbutaline/analogs & derivatives , Terbutaline/pharmacologyABSTRACT
INTRODUCTION: Whether nonasthmatic eosinophilic bronchitis (NAEB) shows response to bronchodilator (RB) remains unclear. OBJECTIVES: To investigate the RB and its relationship with clinical and pathophysiological features in NAEB. METHODS: Fifty-one patients with NAEB were assigned in a 2:1 ratio to receive oral bambuterol hydrochloride (n = 34, 10 mg, once daily, for 3 days) or matched placebo (n = 17) randomly, of whom 48 patients (32 with bronchodilator and 16 with placebo) completed the study. Sputum induction, spirometry and cough reflex sensitivity were measured. RB was considered when cough Visual analogue scale (VAS) score decreased 30% or more after treatment. Cough reflex sensitivity was defined as the lowest concentration of capsaicin inducing five coughings or more (C5), and presented as Log C5. RESULTS: The responsive rate of patients with bronchodilator was significantly higher than that with placebo (34.4% vs 6.3%, P < 0.05). The VAS score decreased significantly in patients with bronchodilator (median: 6.0-3.0, P < 0.01). There was a significantly higher median Log C5 (2.7 vs 1.3, P < 0.05), and a higher trend of decline in FEV1 % predicted and MMEF% predicted after bronchial provocation in patients with RB as compared with patients without RB. No significant differences in baseline percentages of sputum eosinophil were found between patients with RB and that without RB. CONCLUSIONS: One third of patients with NAEB respond well to bronchodilator treatment, which are related with lower cough reflex sensitivity and increased airway responsiveness. The relationship between NAEB and asthma needs to be investigated further.
Subject(s)
Bronchial Hyperreactivity/physiopathology , Bronchitis/physiopathology , Bronchodilator Agents/therapeutic use , Terbutaline/analogs & derivatives , Administration, Oral , Adult , Airway Remodeling/drug effects , Asthma/physiopathology , Bronchial Hyperreactivity/drug therapy , Bronchial Hyperreactivity/immunology , Bronchitis/diagnosis , Bronchitis/immunology , Capsaicin/therapeutic use , Case-Control Studies , Cough/physiopathology , Eosinophilia/immunology , Female , Humans , Male , Middle Aged , Placebos/administration & dosage , Sensitivity and Specificity , Sensory System Agents/therapeutic use , Sputum/drug effects , Sputum/immunology , Terbutaline/therapeutic use , Visual Analog ScaleABSTRACT
A nanoparticle-bioconjugate was formed by homogeneous hybridization of one polynucleotide target with two oligonucleotide probes labelled by thiol and a nanoparticle, respectively. Deposition of the nanoparticle-bioconjugate on a gold surface by thiol-gold reaction was monitored in situ by quartz crystal microbalance (QCM) and applied for flow analysis of zeptomole amounts of polynucleotide. The formation in solution and adsorption of thiolated conjugates on gold could be fast, uniform and effective, and has been successfully exploited to construct a highly reproducible and sensitive platform for detection of target sequences. Being more rapid, reproducible, sensitive and amenable to automation than previously reported microgravimetric hybridization assays, this technology has great promise for practical applications in molecular diagnostics.
