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\begin{document}

\title{Enhanced sensory nerve reactivity in non-eosinophilic asthma}



\author[1]{Hajar Ali}%
\author[2]{Collin Brooks}%
\author[3]{Julian Crane}%
\author[4]{Richard Beasley}%
\author[5]{Stephen  Holgate}%
\author[6]{Peter Gerard Gibson}%
\author[7]{Philip Pattemore}%
\author[8]{Yu-Chieh Tzeng}%
\author[9]{Thorsten Stanley}%
\author[10]{Neil Pearce}%
\author[1]{Jeroen Douwes}%
\affil[1]{Massey University}%
\affil[2]{Massey University Centre for Public Health Research}%
\affil[3]{Wellington School of Medicine \& Health Sciences}%
\affil[4]{Medical Research Institute of NZ}%
\affil[5]{University of Southampton}%
\affil[6]{The University of Newcastle Hunter Medical Research Institute}%
\affil[7]{Christchurch School of Medicine}%
\affil[8]{University of Otago, Wellington, NZ}%
\affil[9]{University of Otago}%
\affil[10]{London School of Hygiene and Tropical Medicine}%


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  \date{May 04, 2024}


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\begin{abstract}
ABSTRACT Background: Neural mechanisms may play an important role in
non-eosinophilic asthma. This study compared airway sensory nerve
reactivity, using capsaicin challenge, in eosinophilic and
non-eosinophilic asthma and non-asthmatics. Methods: Thirty-eight
asthmatics and nineteen non-asthmatics (aged 14-21 years) underwent
combined hypertonic saline challenge/sputum induction, exhaled nitric
oxide (FeNO), atopy, and spirometry tests, followed by capsaicin
challenge. Eosinophilic (EA) and non-eosinophilic asthma (NEA) were
defined using a sputum eosinophil cut-point of 2.5\%. Airway
hyperreactivity (AHR) was defined as a [?]15\% drop in FEV1 during saline
challenge. Sensory nerve reactivity was defined as the lowest capsaicin
concentration that evoked 5 (C5) coughs. Results: Non-eosinophilic
asthmatics (n=20) had heightened capsaicin sensitivity (lower C5)
compared to non-asthmatics (n=19) (geometric mean C5: 58.3\selectlanguage{greek}μ\selectlanguage{english}M, 95\%
confidence interval 24.1-141.5 vs 193.6\selectlanguage{greek}μ\selectlanguage{english}M, 82.2-456.0;
p\textless{}0.05). There was a similar (but non-significant) difference
in capsaicin sensitivity in NEA compared with EA (n=18), (58.3\selectlanguage{greek}μ\selectlanguage{english}M,
24.1-141.5 vs 191.0\selectlanguage{greek}μ\selectlanguage{english}M, 70.9-514.0; p=0.07). FEV1 was significantly
reduced from baseline following capsaicin inhalation in both asthmatics
and non-asthmatics but no differences were found between subgroups. No
associations with capsaicin sensitivity and atopy, sputum eosinophils,
blood eosinophils, asthma control, or treatment were observed.
Conclusion: Non-eosinophilic asthma, but not eosinophilic asthma, showed
enhanced capsaicin sensitivity compared with non-asthmatics. Sensory
nerve reactivity may therefore play an important role in the
pathophysiology of non-eosinophilic asthma.%
\end{abstract}%



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