Blood eosinophils as a predictor of treatment response in adults with difficult-to-treat chronic cough

Rybka-Frączek, Aleksandra; Dąbrowska, Marta; Grabczak, Elżbieta M.; Białek-Gosk, Katarzyna; Klimowicz, Karolina; Truba, Olga; Nejman-Gryz, Patrycja; Paplińska-Goryca, Magdalena; Krenke, Rafał

doi:10.1183/23120541.00432-2021

Cited by 7 publications

(5 citation statements)

References 63 publications

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“… 7 , 16 , 17 , 26 , 27 , 28 A recent study enrolling 142 adult chronic coughers found that there was a weak correlation between the blood eosinophil counts and sputum eosinophil (r = 0.30). 29 In the present study, we found that the level of blood eosinophil counts was moderately correlated with the percentage of sputum eosinophils (r = 0.54) in chronic coughers. Additionally, our results revealed that blood eosinophil counts ≥0.155 × 10 9 /L indicated a more likelihood of airway eosinophilia-related chronic cough, with an optimal sensitivity (78.9%) and specificity (70.3%).…”

Section: Discussionsupporting

confidence: 57%

Diagnostic accuracy of blood eosinophils in comparison to other common biomarkers for identifying sputum eosinophilia in patients with chronic cough

Yi,

Fang,

Liang

et al. 2023

World Allergy Organization Journal

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Section: Discussionsupporting

confidence: 57%

Diagnostic accuracy of blood eosinophils in comparison to other common biomarkers for identifying sputum eosinophilia in patients with chronic cough

Yi,

Fang,

Liang

et al. 2023

World Allergy Organization Journal

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“…However, increased blood eosinophils were not always found in patients with eosinophilic bronchitis, confirmed by sputum eosinophilia ( 32 ). A recent observational study showed the weak power of blood eosinophils as a predictor of treatment response in chronic cough ( 33 ). Furthermore, there is no RCT evidence.…”

Section: Discussionmentioning

confidence: 99%

Is fractional exhaled nitric oxide a treatable trait in chronic cough: a narrative review

Lee,

Park

et al. 2023

J Thorac Dis

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Background and Objective Current management of chronic cough is largely based on sequential therapeutic trials. The concept of treatable traits was first introduced for individualized treatment of chronic airway diseases; however, it has emerged as a potentially useful strategy in revising the management of chronic cough. This narrative review aimed to analyze the literature to determine if fractional exhaled nitric oxide (FeNO) is a treatable trait in chronic cough, compared to other type 2 biomarkers, and to summarize current knowledge and gaps in the clinical application. Methods An online electronic search was performed on PubMed, Web of Science, and Scopus of English-language literature with following keywords: cough, nitric oxide (NO), eosinophils, biomarker, and treatable trait. Relevance and eligibility of each article were assessed by one or more of the authors and a narrative review was composed. Key Content and Findings Eosinophilic or type 2 airway inflammation is a major treatable trait in patients with chronic cough. Induced sputum tests are regarded as the gold standard for defining inflammatory phenotype, however, technically demanding and cannot be widely applied in clinical practice. FeNO, a practical biomarker, has emerged as an alternative to induced sputum analyses. Mechanistic and clinical evidence indicated that FeNO had a potential for diagnostic utility and treatment response predictability. Conclusions FeNO measurement may help to identify patients with chronic cough that will benefit from corticosteroid treatment. Further studies are warranted to determine the diagnostic roles of FeNO in the management of patients with chronic cough.

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“…All patients underwent diagnostic procedures, including pulmonary function testing, sputum induction, methacholine and capsaicin challenge prior to treatment administration. 12 This step-wise diagnostic algorithm was based on European Respiratory Society and American College of Chest Physicians guidelines. 11 , 13 Methacholine challenge was performed according to the American Thoracic Society guidelines, in a 2-minute tidal breathing protocol.…”

Section: Methodsmentioning

confidence: 99%

Inflammatory Phenotypes of Cough Variant Asthma as Response Predictors to Anti-Asthmatic Therapy

Rybka-Frączek¹,

Dąbrowska²,

Grabczak³

et al. 2022

JIR

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Background Eosinophilic inflammatory phenotype was thought to be the most common phenotype of cough variant asthma (CVA), nevertheless other phenotypes were also reported. Purpose The study aimed to analyze the inflammatory phenotypes of CVA in relation to treatment response to the stepwise anti-asthmatic treatment. Patients and Methods The study included 45 patients with chronic cough (CC) and suspicion of CVA (normal chest X-ray, presence of bronchial hyperresponsiveness and no history of wheezing or dyspnea) in whom induced sputum was successfully collected. Based on the cellular composition of the sputum, patients were divided into major inflammatory phenotypes: eosinophilic, neutrophilic, paucigranulocytic or mixed granulocytic. A stepwise treatment, including inhaled corticosteroids with long-acting β 2 -agonist, montelukast and short-term therapy with prednisone was initiated. Good treatment response was defined as the reduction in cough severity at least 20 mm from the baseline in visual analogue scale and improvement in cough-related quality of life assessed by the Leicester cough questionnaire at least 1.3 points after any of three steps. Results Finally, 40/45 (88.9%) patients improved after therapy. Eosinophilic asthma was found in 13/40 (32.5%) patients, neutrophilic in 6/40 (15.0%) and paucigranulocytic pattern in 21/40 (52.5%) patients. No one demonstrated a mixed granulocytic phenotype. The response to the treatment was similar in all groups. However, the reduction in cough severity was inversely related to the percentage of sputum neutrophils (r = −0.44, P = 0.003). We showed that the percentage of neutrophils in sputum >46% may be considered as a predictor of poor response to anti-asthmatic therapy. Conclusion The diversity of inflammatory phenotypes with paucigranulocytic preponderance was found in subjects with CVA. The response to anti-asthmatic treatment in patients with CVA was not related to the inflammatory phenotype. High neutrophil count in sputum may predict poor response to anti-asthmatic therapy in patients with CC and bronchial hyperresponsiveness.

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Blood eosinophils as a predictor of treatment response in adults with difficult-to-treat chronic cough

Cited by 7 publications

References 63 publications

Diagnostic accuracy of blood eosinophils in comparison to other common biomarkers for identifying sputum eosinophilia in patients with chronic cough

Diagnostic accuracy of blood eosinophils in comparison to other common biomarkers for identifying sputum eosinophilia in patients with chronic cough

Is fractional exhaled nitric oxide a treatable trait in chronic cough: a narrative review

Inflammatory Phenotypes of Cough Variant Asthma as Response Predictors to Anti-Asthmatic Therapy

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