A retrospective study of clinical features of cough variant asthma in Chinese adults

Abstract

Background: Clinical features of cough variant asthma (CVA) in Chinese adults are largely uncertain.

Methods: A total of 303 patients newly diagnosed as uncontrolled asthma (symptom control and future risk of adverse outcomes), including 175 CVA and 128 classic asthma (CA), were enrolled in this retrospective survey. Clinical features including basic characteristics, pulmonary function, airway hyperresponsiveness (AHR) and cell counts of induced sputum, were compared retrospectively. All patients were classified into four inflammatory subtypes based on the counts of induced sputum eosinophils and neutrophils as eosinophilic (E), neutrophilic (N), mixed granulocytic (M), and paucigranulocytic (P) subtypes. Inflammatory subtype distribution was also compared.

Results: Compared with CA patients, CVA patients were younger (P = 0.009), had a higher prevalence of female patients (P = 0.001), higher parameter values of baseline pulmonary function (P ≤ 0.01 for all), shorter duration of disease (P = 0.002), lower AHR (P = 0.001) and lower sputum eosinophil% (P = 0.009). There was a difference in the AHR distribution as the percentage of moderate and severe AHR in CVA was significantly lower than in CA (41.72% VS 64.70%, P = 0.001). The inflammatory subtype distribution was different as the proportion of E and M subtypes in CVA was lower than in CA (56.0% vs 67.19%, P = 0.049). The proportion of subtype P was the lowest and subtype M was the highest in both CVA and CA patients. There was a similar negative correlation of sputum eosinophil% with AHR in CVA and CA (r = - 0.337, P < 0.0001 and r = - 0.27, P = 0.026, respectively), and a positive correlation between sputum eosinophil% and improvement rate of FEV₁ after inhalation of bronchodilator (ΔFEV₁%) (r = 0.33, P = 0.01).

Conclusions: CVA patients showed a better pulmonary function and lower airway inflammation in contrast to CA patients, which may participate in the pathogenesis of chronic cough in CVA.

Keywords: Airway hyperresponsiveness (AHR); Classic asthma (CA); Cough variant asthma (CVA); Induced sputum eosinophils; Pulmonary function.

Fig. 1

Correlation between sputum eosinophil% and PD₂₀-FEV₁ in CVA patients (a) or in CA patients (b). Correlation between sputum eosinophil% and the improvement rate in FEV₁ after inhalation of bronchodilator in CA patients (c)