摘要：

Background Subjects without a previous history of asthma, presenting with unexplained respiratory symptoms and normal spirometry, may exhibit airway hyperresponsiveness (AHR) in association with underlying eosinophilic (type 2 (T2)) inflammation, consistent with undiagnosed asthma. However, the prevalence of undiagnosed asthma in these subjects is unknown. Methods In this observational study, inhaled corticosteroid-naive adults without previously diagnosed lung disease reporting current respiratory symptoms and showing normal pre-and post-bronchodilator spirometry underwent fractional exhaled nitric oxide (FENO) measurement, methacholine challenge testing and induced sputum analysis. AHR was defined as a provocative concentration of methacholine causing a 20% fall in forced expiratory volume in 1 s (PC20) <16 mg center dot mL-1 and T2 inflammation was defined as sputum eosinophils >2% and/or FENO >25 ppb. Results Out of 132 subjects (mean +/- SD age 57.6 +/- 14.2 years, 52% female), 47 (36% (95% CI 28-44%)) showed AHR: 20/132 (15% (95% CI 9-21%)) with PC20 <4 mg center dot mL-1 and 27/132 (21% (95% CI 14- 28%)) with PC20 4-15.9 mg center dot mL-1. Of 130 participants for whom sputum eosinophils, FENO or both results were obtained, 45 (35% (95% CI 27-43%)) had T2 inflammation. 14 participants (11% (95% CI 6- 16%)) had sputum eosinophils >2% and PC20 >16 mg center dot mL-1, suggesting eosinophilic bronchitis. The prevalence of T2 inflammation was significantly higher in subjects with PC20 <4 mg center dot mL-1 (12/20 (60%)) than in those with PC20 4-15.9 mg center dot mL-1 (8/27 (30%)) or >16 mg center dot mL-1 (25/85 (29%)) (p=0.01). Conclusions Asthma, underlying T2 airway inflammation and eosinophilic bronchitis may remain undiagnosed in a high proportion of symptomatic subjects in the community who have normal pre-and post-bronchodilator spirometry.

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