Can bronchial asthma with an highly prevalent airway (and systemic) vagal tone be considered an independent asthma phenotype? Possible role of anticholinergics

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• 作者：Gennaro Liccardi^a ; ^b ; ^{gennaro.liccardi@tin.it" class="auth_mail" title="E-mail the corresponding author} ; Antonello Salzillo^a ; Luigino Calzetta^b ; ^c ; Mario Cazzola^b ; ^c ; Maria Gabriella Matera^d ; Paola Rogliani^b ; ^c
• 关键词：Abdominal pain ; Airway hyperreactivity ; Anticholinergics ; Asthma phenotype ; Bronchial asthma ; Gastro-esophageal reflux ; Increased cholinergic tone ; Stress
• 刊名：Respiratory Medicine
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：117
• 期：Complete
• 页码：150-153
• 全文大小：314 K

文摘

Recently, we studied occurrence and role of non-respiratory symptoms (n-RSs) before a worsening of asthma symptoms. Some n-RSs such as anxiety, reflux, heartburn, abdominal pain, which appeared within 3 h before the onset of an asthma attack, are the likely result of an imbalance between sympathetic/parasympathetic systems with an increase in cholinergic tone. Therefore, it is likely that some of these n-RSs induced by the increased cholinergic tone might be present related with specific parasympathetic-associated respiratory symptoms such as those elicited by airway narrowing.

It is likely that, at least in some categories of asthmatics, an increased cholinergic tone, rather than other well-known factors, might play a prevalent role in triggering bronchospasm. If this is the case, it is possible to speculate that the use of anticholinergic agents (mainly those with long-acting activity) in patients suffering from asthma should be more beneficial in individuals characterized by a higher degree of cholinergic tone that, consequently might be the ideal target for the use of long-acting anticholinergics and, possibly, represent a novel asthma phenotype. The presence of parasympathetic-associated n-RSs might help the physician to identify this type of patients, although this might be followed by a more detailed assessment.