Clinical and Inflammatory Characteristics of the Chinese APAC Cough Variant Asthma Cohort

Kefang Lai; Wenzhi Zhan; Feng Wu; Yunhui Zhang; Lin Lin; Wen Li; Fang Yi; Ziyu Jiang; Yuanrong Dai; Suyun Li; Jiangtao Lin; Yadong Yuan; Yong Jiang; Chen Qiu; Limin Zhao; Meihua Chen; Zhongmin Qiu; Hu Li; Ruchong Chen; Wei Luo; Jiaxing Xie; Chunxing Guo; Mei Jiang; Xiaohong Yang; Guochao Shi; Dejun Sun; Rongchang Chen; Kian Fan Chung; Huahao Shen; Nanshan Zhong

doi:10.3389/fmed.2021.807385

Clinical and Inflammatory Characteristics of the Chinese APAC Cough Variant Asthma Cohort

Front Med (Lausanne). 2022 Jan 21:8:807385. doi: 10.3389/fmed.2021.807385. eCollection 2021.

Authors

Kefang Lai¹, Wenzhi Zhan¹, Feng Wu², Yunhui Zhang³, Lin Lin⁴, Wen Li⁵, Fang Yi¹, Ziyu Jiang¹, Yuanrong Dai⁶, Suyun Li⁷, Jiangtao Lin⁸, Yadong Yuan⁹, Yong Jiang¹⁰, Chen Qiu¹¹, Limin Zhao¹², Meihua Chen¹³, Zhongmin Qiu¹⁴, Hu Li¹, Ruchong Chen¹, Wei Luo¹, Jiaxing Xie¹, Chunxing Guo¹, Mei Jiang¹, Xiaohong Yang¹⁵, Guochao Shi¹⁶, Dejun Sun¹⁷, Rongchang Chen^{1

11}, Kian Fan Chung¹⁸, Huahao Shen⁵, Nanshan Zhong¹

Affiliations

¹ Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
² Department of Pulmonary and Critical Care Medicine, Huizhou The Third People's Hospital, Huizhou, China.
³ Department of Pulmonary and Critical Care Medicine, The First People's Hospital of Yunnan Province, Kunming, China.
⁴ Department of Pulmonary and Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, China.
⁵ Department of Pulmonary and Critical Care Medicine, Key Laboratory of Respiratory Disease of Zhejiang Province, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
⁶ Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
⁷ Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China.
⁸ Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China.
⁹ Department of Pulmonary and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
¹⁰ Department of Respiratory and Critical Care Medicine, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, China.
¹¹ Department of Respiratory and Critical Care Medicine, Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen, China.
¹² Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
¹³ Department of Pulmonary and Critical Care Medicine, Songshan Lake Central Hospital of Dongguan City, The Third People's Hospital of Dongguan City, Dongguan, China.
¹⁴ Department of Pulmonary and Critical Care Medicine, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China.
¹⁵ Department of Respiratory and Critical Care Medicine, Xinjiang Interstitial Lung Disease Clinical Medicine Research Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.
¹⁶ Department of Pulmonary and Critical Care Medicine, School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Beijing, China.
¹⁷ Department of Pulmonary and Critical Care Medicine, The Inner Mongolia Autonomous Region People's Hospital, Hohhot, China.
¹⁸ National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Foundation NHS Trust, London, United Kingdom.

Abstract

Background: The AtyPical Asthma in China (APAC) cohort is a multi-center prospective, observational cohort set-up to investigate the clinical, pathophysiological features, prognosis, and mechanisms of cough variant asthma (CVA).

Objectives: To present the characteristics of newly physician-diagnosed adults with CVA (n = 328) compared to mild-moderate classic asthma (CA, n = 206).

Methods and main results: CVA subjects showed a higher proportion of female (67.1 vs. 55.3%, P = 0.0084), abnormal laryngopharyngeal sensations (71 vs. 51%, p < 0.0001) than CA, but presented with near normal spirometry and higher methacholine PD20-FEV1 values [4.2 (1, 8.6) vs. 0.8 (0.4, 4.7), P < 0.0001]. Lower fractional exhaled nitric oxide (FENO) levels [38.5 (19.8, 72.5) vs. 53. (28.5, 92.2), P = 0.0019], blood eosinophil counts [0.2 (0.1, 0.4) vs. 0.3 (0.2, 0.5), P = 0.0014], and sputum eosinophils [2.3 (0.3, 8.0) vs. 12.2 (2, 34.5), p < 0.0001] were found in CVA. Despite lower total serum IgE levels in CVA, there was similar proportion of atopy in both groups. The prevalence of cough in CA was 86.4%, while CVA reported more severe cough on Visual Analog Scale, Cough Evaluation Test, and Leicester Cough Questionnaire, similar anxiety and depression scores but better asthma control scores as reflected by Asthma Control Test compared to CA. No correlation was found between cough assessment outcomes and sputum eosinophil count, blood eosinophil count, FENO, spirometry variables, or PD20-FEV1.

Conclusion: Cough variant asthma is distinctive from classic asthma in regard to clinical features, lung function, and airway inflammation. Quality of life is badly impaired as well in spite of better asthma control scores.

Keywords: airway inflammation; bronchial hyperresponsiveness; classic asthma (CA); cough; cough variant asthma (CVA).

Grants and funding

MR/T010371/1/MRC_/Medical Research Council/United Kingdom