Work‐related dysphonia in subjects with occupational asthma is associated with neutrophilic airway inflammation

• Published in: Clinical and translational allergy Vol. 13; no. 5; pp. e12218 - n/a
• Main Authors: Migueres, Nicolas, Vandenplas, Olivier, Walusiak‐Skorupa, Jolanta, Munoz, Xavier, Suojalehto, Hille, Kampen, Vera, Mason, Paola, Quirce, Santiago, Blay, Frédéric
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.05.2023; John Wiley and Sons Inc; Wiley
• Subjects: Asthma; Conflicts of interest; dysphonia; Inflammation; Larynx; Letter; Luggage; neutrophilic inflammation; Neutrophils; occupational asthma; Regression analysis; Steroids; Variables; neutrophilic inflammation; occupational asthma; dysphonia
• ISSN: 2045-7022; 2045-7022
• DOI: 10.1002/clt2.12218

The independent variables incorporated into these regression models included gender; sinusitis; high-level treatment at work (i.e., Global Initiative for Asthma treatment step four-fifths); poor asthma control at work (i.e., need for an inhaled short-acting β2-agonist once or more a day); OA caused by a low- versus a high-molecular-weight agent; as well as eosinophil and neutrophil sputum cell counts (expressed as % of total nonsquamous cells; Table 2).The multivariate logistic regression analysis revealed that female gender (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.06–3.92; p = 0.031) and a higher sputum neutrophil count (OR for each 5%-increase in neutrophil count, 1.09; 95% CI, 1.01–1.18; p = 0.025) were significantly associated with a higher likelihood of work-related dysphonia (Table 2). TABLE 1 Univariate associations with self-reported dysphonia at work Characteristics Missing values Subjects without dysphonia at work (n = 292) Subjects with dysphonia at work (n = 49) OR (95% CI) p value Age, year a 0 43 (34–51) 42 (38–52) 1.02 (0.99–1.05) 0.279 Sex, female 0 97 (33.2) 23 (46.9) 1.78 (0.96–3.28) 0.065 Body mass index ≥30 kg/m2 a 0 82 (28.1) 15 (30.6) 1.13 (0.57–2.15) 0.717 Ex-smokers 0 83 (28.4) 10 (20.4) 0.66 (0.29–1.38) 0.286 Current smokers 0 62 (21.2) 12 (24.5) 1.05 (0.49–2.17) 0.890 Atopy b 4/0 146 (50.7) 28 (57.1) 1.30 (0.71–2.41) 0.405 Chronic rhinosinusitis 2/0 21 (7.2) 8 (16.3) 2.50 (0.99–5.83) 0.041 Exposure before symptom onset, months a 2/0 108 (48–204) 150 (21–230) 1.00 (1.00–1.00) 0.218 Duration of asthma symptoms at work, months a 3/0 36 (16–84) 33 (21–68) 1.00 (0.99–1.00) 0.522 Type of causal agent, LMW 0 191 (65.4) 25 (51.0) 1.81 (0.98–3.33) 0.057 Asthma treatment at work Daily dose of ICS, μg a, c 0 500 (0–1000) 500 (0–1000) 1.00 (1.00–1.00) 0.827 High level treatment d 0 19 (6.5) 6 (12.2) 2.12 (1.14–3.94) 0.017 Poor asthma control while at work e 0 74 (25.3) 21 (42.9) 2.21 (1.17–4.11) 0.013 ≥2 exacerbations last 12 months at work 0 26 (8.9) 1 (2.0) 0.21 (0.01–1.04) 0.134 Baseline spirometry FVC, % pred a 0 101 (90–110) 103 (94–110) 1.01 (0.99–1.03) 0.610 FEV1, % pred a 0 90 (79–98) 91 (78–98) 1.01 (0.98–1.03) 0.602 FEV1/FVC, % a 0 74 (67–80) 75 (67–78) 1.00 (0.97–1.03) 0.981 Airflow obstruction f 0 56 (19.2) 13 (26.5) 1.52 (0.73–3.00) 0.238 Baseline NSBH 22/0 Absent 56 (20.7) 11 (22.4) 1.11 (0.51–2.24) 0.787 Mild 139 (51.5) 27 (55.1) 1.16 (0.63–2.15) 0.641 Moderate/severe 75 (27.8) 11 (22.4) 0.75 (0.35–1.50) 0.440 Blood eosinophils, cells/μl a 58/10 280 (199–400) 249 (140–390) 1.00 (1.00–1.00) 0.335 Baseline FeNO, ppb a 184/10 22 (12–41) 22 (10–28) 0.98 (0.96–1.00) 0.049 Baseline sputum eosinophils % a 0 2.0 (1.0–6.0) 1.2 (0.2–2.5) 0.87 (0.77–0.95) 0.011 ≥3% 125 (42.8) 12 (24.5) 0.43 (0.21–0.84) 0.018 Baseline sputum neutrophils % a 0 51.0 (36.0–70.0) 60.0 (48.2–78.5) 1.02 (1.00–1.03) 0.017 ≥76% 57 (19.5) 15 (30.6) 1.82 (0.91–3.52) 0.081 Note: Data are presented as n (% of available data) unless otherwise specified. Abbreviations: FeNO, fractional exhaled nitric oxide; FEV1, forced expiratory volume in one-second; FVC, forced vital capacity; ICS, inhaled corticosteroid; LMW, low-molecular-weight; NSBH, nonspecific bronchial hyperresponsiveness; SIC, specific inhalation challenge. aMedian value with interquartile range (IQR) within parentheses. bAtopy defined by the presence of at least one positive skin prick test result to common allergens. cDaily dose of inhaled corticosteroid expressed as beclomethasone dipropionate equivalent. dHigh-level treatment defined as treatment step 4 or 5 of the Global Initiative for Asthma (http://www.ginasthma.org). ePoor asthma control at work is defined as the use of SABA more than once a day. fAirflow obstruction defined by an FEV1 <80% predicted and an FEV1/FVC ratio <70%. TABLE 2 Logistic multivariate model for dysphonia at work Dysphonia at work (n = 49/341) Independent variables OR (95% CI) p value Sex, female 2.04 (1.06–3.92) 0.031 Chronic rhinosinusitis Poor asthma control while at work a 1.84 (0.91–3.71) 0.087 Type of causal agent, LMW High level treatment b 1.97 (0.97–3.95) 0.057 Eosinophil sputum cell counts ≥3% 0.41 (0.19–0.83) 0.017 Neutrophil sputum cell counts, 5% increase 1.05 (1.03–1.07) <0.001 Note: The model included 338 patients, selection of variables was realized by a stepwise procedure based on Akaike information criterion.