Response of patients with chest tightness variant asthma with routine asthma treatment regimen: A 1‐year multicenter, prospective, real‐world study

Abstract

Dear editor, In 2013, we have reported chest tightness being the only respiratory symptom among 24 asthmatic patients on presentation, 1 and referred to this type of asthma as chest tightness variant asthma (CTVA). Compared with patients with classic asthma (CA) or cough variant asthma (CVA), 2,3 patients with CTVA also presented with eosinophilic airway inflammation. However, whether CTVA has similar response to antiasthma treatment as compared with CA remains unclear. We therefore sought to explore the therapeutic response to standard asthma treatments among 76 patients with CTVA in a 52-week multicenter, prospective, real-world study. The study was conducted in 16 centers (see Supporting Information) in mainland China. Participants were recruited between April 1, 2015 and March 31, 2018 (Figure 1). We recruited treatment-naive patients (14-80 years of age) who had a history of chest tightness for at least 6 months. The definition of CTVA was made based on the chest tightness being the sole symptom and at least one of the following conditions was met: (a) an increase of >12% and >200 mL in forced expiratory volume in 1 s (FEV 1) after inhaling salbutamol; (b) airway hyperresponsiveness as evidenced by a positive finding of bronchial provocation test; (c) a weekly variability in diurnal peak expiratory flow (PEF) of greater than 10%; and (d) a marked clinical improvement in response to β2 receptor agonists, with or without inhaled corticosteroids (ICS). All patients were treated with ICS plus long-acting β2 receptor agonist based on the Global Initiative for Asthma (GINA) guidelines. The following baseline characteristics were collected from eligible patients: age, gender, the history of atopy, smoking status, body mass index (BMI), FEV 1 (percent predicted), the ratio of FEV 1 /forced vital capacity (FVC), diurnal variation in PEF, the fraction of exhaled nitric oxide (FeNO), patient-rated anxiety scale (SAS) This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

A case of chest tightness variant asthma : the usefulness of fractional exhaled nitric oxide as a marker for the diagnosis and clinical improvement.

“…We also demonstrated that FeNO levels were higher in CVA and classic asthma than those in healthy controls and that FeNO were identified as an independent factor to discriminate CVA and non-CVA (20). Recently, Yan et al evaluated the therapeutic response to standard asthma treatments among 76 patients with CTVA in a 52-week multicenter, prospective study (10). There were no significant improvements in FeNO after 52 weeks compared with the baseline level, while chest tightness was significantly ameliorated among most patients with CTVA after treatment.…”

“…In 2013, Shen et al reported 24 patients with asthma whose sole presenting clinical manifestation was chest tightness and referred to this type of asthma as CTVA (3). As is the case in patients with classic asthma or cough variant asthma (CVA) (8,9), patients with CTVA also presented According to their criteria, the diagnosis of CTVA is made based on the chest pain or tightness being the sole symptom and at least one of the following conditions was met : 1) an increase of > 12% and > 200 mL in FEV1 after inhaling short acting β2 agonist ; 2) airway hyperresponsiveness as evidenced by a positive finding of bronchial provocation test ; 3) a weekly variability in diurnal PEF of greater than 10% ; and 4) a marked clinical improvement in response to β2 agonists, with or without ICS (10). The present case also revealed chest pain as the sole symptom and had medical history of outgrown childhood asthma and allergies to several animals with peripheral blood eosinophilia.…”

Perspectives and Management of Atypical Asthma in Chinese Specialists and Primary Care Practitioners—A Nationwide Questionnaire Survey

“…Shen et al further found that CTVA was associated with airway inflammation similar to that of typical asthma (22). A one year multicenter, prospective clinical study showed that patients with CTVA obtained efficacy by using the same treatment scheme (including ICS) recommended by the guidelines as typical asthma (12). Occult asthma emphasized people with asymptomatic bronchial hyperresponsiveness are at high risk of asthma (5,23).…”

“…Many subsequent studies have found that atypical asthma has a pathobiological basis, namely, eosinophilic inflammation, and airway hyperresponsiveness similar to that of classic asthma (9,10). Inhaled corticosteroids (ICS) or a combination of ICS and long-acting beta-agonists (ICS/LABA) resulted in a good response in patients with these asthma types compared with those with classic asthma (11,12). These studies have aided physicians in understanding atypical asthma, reducing the rate of misdiagnosis and improving treatment outcomes.…”

“…Such a complex process requires extensive physician knowledge/awareness and specialized on-site equipment, both of which can be a challenge for front-line primary care practitioners (PCPs). Moreover, studies on atypical asthma are scarce, and the sample sizes are small (12,(17)(18)(19)(20).…”