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- Title
Increased Capsaicin Sensitivity in Patients with Severe Asthma Is Associated with Worse Clinical Outcome.
- Authors
Yoshihiro Kanemitsu; Kensuke Fukumitsu; Ryota Kurokawa; Norihisa Takeda; Motohiko Suzuki; Yap, Jennifer; Hirono Nishiyama; Tomoko Tajiri; Satoshi Fukuda; Takehiro Uemura; Hirotsugu Ohkubo; Ken Maeno; Yutaka Ito; Tetsuya Oguri; Masaya Takemura; Akio Niimi; Kanemitsu, Yoshihiro; Fukumitsu, Kensuke; Kurokawa, Ryota; Takeda, Norihisa
- Abstract
Rationale: Capsaicin cough reflex sensitivity (C-CS) is associated with poorly controlled asthma, although its association with severe asthma remains unknown.Objectives: To determine the clinical impact of C-CS on severe asthma.Methods: We prospectively enrolled 157 patients with asthma (including 122 patients with severe asthma who were in step 4 or 5 according to the Global Initiative for Asthma 2015 guidelines) between November 2016 and October 2019. A capsaicin cough challenge was performed along with spirometry and assessment of biomarkers. The concentration required to induce at least five coughs by capsaicin was adopted as an index of C-CS. An Asthma Control Test and comorbidities were also evaluated. Associations of biomarkers with four clinical features of severe asthma made by the European Respiratory Society/American Thoracic Society guidelines (poor control [Asthma Control Test < 20; n = 58], frequent exacerbations [≥2/yr; n = 28], admissions [≥1/yr; n = 17], and airflow limitation [FEV1% predicted < 80%; n = 30]) were assessed.Measurements and Main Results: Heightened C-CS was associated with poor asthma control, frequent exacerbations, and admissions, particularly in patients without atopy (n = 54). Meanwhile, C-CS was not related to airflow limitation. Multivariate regression analysis has revealed that heightened C-CS (at least five coughs by capsaicin ≤ 2.44 μM) was a significant risk for poor asthma control and frequent exacerbations. Regarding general factors and comorbidities, ex-smoking status, diabetes mellitus, and chronic rhinosinusitis were associated with clinical features of severe asthma (all P < 0.05).Conclusions: Heightened C-CS is a risk factor for severe asthma. The present study suggests the association of airway neuronal dysfunction with the pathophysiology of non-type 2 severe asthma.
- Subjects
JAPAN; ASTHMA; PATHOLOGICAL physiology; COMORBIDITY; DIABETES; PATIENTS; DRUG therapy for asthma; THERAPEUTIC use of capsaicin; RESEARCH; CHRONIC diseases; RESEARCH methodology; EVALUATION research; MEDICAL cooperation; SEX distribution; COMPARATIVE studies; DOSE-effect relationship in pharmacology; INHALATION administration; CAPSAICIN; LONGITUDINAL method
- Publication
American Journal of Respiratory & Critical Care Medicine, 2020, Vol 201, Issue 9, p1068
- ISSN
1073-449X
- Publication type
journal article
- DOI
10.1164/rccm.201911-2263OC