Abstract
BackgroundIt is now recognized that asthma can present in different forms. Typically, asthma present with symptoms of wheeze, breathlessness and cough. Atypical forms of asthma such as cough variant asthma (CVA) or chest tightness variant asthma (CTVA) do not wheeze. We hypothesize that these different forms of asthma may have distinctive cellular and molecular features.Methods30 patients with typical or classical asthma (CA), 27 patients with CVA, 30 patients with CTVA, and 30 healthy control adults were enrolled in this prospective study. We measured serum IgE, lung function, sputum eosinophils, nitric oxide in exhaled breath (FeNO). We performed proteomic analysis of induced-sputum supernatants by mass spectrometry.ResultsThere were no significant differences in atopy and FEV1 among patients with CA, CVA, and CTVA. Serum IgE, sputum eosinophil percentages, FeNO, anxiety and depression scores were significantly increased in the three presentations of asthmatic patients as compared with healthy controls but there was no difference between the asthmatic groups. Comprehensive mass spectrometric analysis revealed more than a thousand proteins in the sputum from patients with CA, CVA, and CTVA, among which 23 secreted proteins were higher in patients than that in controls.ConclusionsPatients with CA, CVA, or CTVA share common clinical characteristics of eosinophilic airway inflammation. And more importantly, their sputum samples were composed with common factors with minor distinctions. These findings support the concept that these three different presentations of asthma have similar pathogenetic mechanism in terms of an enhanced Th2 associated with eosinophilia. In addition, this study identified a pool of novel biomarkers for diagnosis of asthma and to label its subtypes.Trial registrationhttp://www.chictr.org.cn (ChiCTR-OOC-15006221)
Highlights
It is recognized that asthma can present in different forms
A diagnosis of asthma was accepted based on relevant symptoms and at least one of the following criteria: (1) a 12% and greater than 200-mL F EV1 increase after inhaling 400 μg salbutamol; (2) a positive bronchial challenge test; (3) variability in diurnal peak expiratory flow (PEF) of more than 10% for 1 day during 1 week
There was no significant difference in age, gender, and body mass index (BMI) between control and total asthma patients. 30 patients with classic asthma (CA), 27 patients with cough variant asthma (CVA), and 30 patients with chest tightness variant asthma (CTVA) were enrolled in the study of clinical characteristics
Summary
Asthma present with symptoms of wheeze, breathlessness and cough. Atypical forms of asthma such as cough variant asthma (CVA) or chest tightness variant asthma (CTVA) do not wheeze. We hypothesize that these different forms of asthma may have distinctive cellular and molecular features. There are groups of patients, whose presenting symptoms were not typical wheezing, show airways hyper-responsiveness and excellent response to bronchodilators treatment. It has been proposed since decades ago that asthma might be presented with atypical symptoms, without obvious wheezing [2]. Clinical heterogeneity of the presence of several disease subtypes may imply a distinct functional or pathobiological mechanism [7]
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