Seasonal dynamics of cold airway hyperresponsiveness in patients with asthma

Introduction. Cold air-induced bronchoconstriction in patients with asthma, leading to a breakdown in disease control, is one of the most serious problems in the northern countries of the world.

Aim. To assess the seasonal dynamics of the airway response (ΔFEV_1CA) to cold bronchoprovocation in asthma patients with cold airway hyperresponsiveness (CAHR).

Materials and methods. Out of 513 asthma patients who underwent primary bronchoprovocation testing, 273 patients (140 women; 133 men) with diagnosed CAHR took part in the retrospective analysis. The design objectification of clinical data using the Asthma Control Test questionnaire (ACT, Quality Metric Inc., 2002), a screening questionnaire for identifying clinical symptoms of response to low ambient temperature in everyday life; assessment of the lung function; bronchoprovocation test of 3-minute isocapnic hyperventilation with cold (-20ºC) air (IHCA).

Results. At the time of testing, the average age of patients was 34.8±0.87 years, FEV₁ 88.5±1.3% of predicted, FEV₁/VC 70.9±0.7%; ACT 16 (12; 19) points. On average in the group, ΔFEV_1CA was -19.2±0.6%. The frequency of CAHR detection in the winter was 22%, spring – 34%, summer – 22%, autumn – 24% (p>0.05). The minimum changes in FEV₁ in response to IHCA were recorded in May-June (mean value ΔFEV_1CA -16.2±1.3 and -14.5±1.6%, respectively) and were significantly less in comparison with February (-21.9±2.3%, p˂0.05) and April (-23.0±2.36%, p˂0.01). A correlation has been found between the monthly mean values of meteorological parameters and CAHR, as well as the value of ACT in points and ΔFEV₁ (r=0.16; p=0.018).

Conclusion. Seasonal changes in the strength of the action of meteorological factors produce a change in the response of the airways to cold bronchoprovocation, and contribute to the loss of asthma control. The maximum values of CAHR fall on February-April, August, November. The data obtained reflect the presence of a complex  interaction of physical environmental factors in the induction of seasonal fluctuations of CAHR, which requires a search for specific mechanisms for the formation of altered airway reactivity associated with the characteristics of molecular reception of low temperatures and humidity in the human airways.

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