Sensitivity to environmental irritants and quality of life in COPD

It is a common clinical experience that patients with chronic obstructive pulmonary disease (COPD) complain of airway symptoms provoked by environmental irritants like chemicals and scents, although few studies can confirm such connections. The aim was to study the prevalence of airway symptoms induced by chemicals and scents in a group of patients with newly diagnosed CPOD and to analyze any relation to illness severity and quality of life. Eighty-one patients with COPD were recruited to the study. By mail they were asked to answer three questionnaires regarding symptoms, quality of life, and social and emotional influence of airway symptoms induced by environmental irritants. A majority (62%) of the COPD patients claimed to be hyperreactive to chemicals and scents. As a group they scored higher on a questionnaire measuring social and emotional influences of such environmental irritants compared to healthy control subjects. Further, high scores were more common among patients with a very severe form of COPD and among patients with regular use of β2-stimulants. High scores were also associated with significantly more airway symptoms and, in some aspects, with impaired quality of life. In conclusion, the results of this study show that airway symptoms induced by environmental irritants are common in patients with COPD and that this increased airway sensitivity follows the impairment of lung capacity. The mechanisms behind this remain unclear

Changes in Levels of Nerve Growth Factor in Nasal Secretions after Capsaicin Inhalation in Patients with Airway Symptoms from Scents and Chemicals

Patients complaining of upper and lower airway symptoms caused by scents and chemicals have previously been shown to have increased cough sensitivity to inhaled capsaicin, but the precise mechanisms behind this reaction are unknown. Hypothesizing that a neurochemical alteration related to sensory hyperreactivity (SHR) of the airway mucosa occurs, we measured levels of nerve growth factor (NGF) in nasal lavage fluid (NAL) before and after capsaicin inhalation provocations and related the capsaicin cough sensitivity to the NGF levels. Thirteen patients with SHR and 14 control subjects were provoked with capsaicin inhalation at three different doses. We measured NGF in NAL before and after provocation and recorded cough and capsaicin-induced symptoms. All subjects demonstrated a dose-dependent cough response to capsaicin inhalation, with a more pronounced effect in patients than in controls. Basal levels of NGF were significantly lower in the patient group than in the control subjects (p < 0.01). After capsaicin provocation, the patients showed a significant increase in NGF (p < 0.01), which was related to capsaicin cough sensitivity. The findings demonstrate that, in patients with airway symptoms induced by scents and chemicals, SHR is real and measurable, demonstrating a pathophysiology in the airways of these patients compared to healthy subjects

A study of two generic health-related quality of life quesitonnaires- Nottingham Health Profile and Short-Form 36 Health Survey- and of coping in patients with sensory hyperreactivity. Health Qual Life Out

Abstract Background: Sensory hyperreactivity (SHR) is one explanation for airway symptoms induced by chemicals and scents. Little is known about health-related quality of life (HRQOL) and coping, in this group of patients. A study was done in patients with SHR to (1) compare the Nottingham Health Profile (NHP) and the Short-Form 36 Health Survey (SF-36) in regard to their suitability, validity, reliability, and acceptability; (2) evaluate how the patients cope with the illness; (3) assess whether there are differences between women and men with respect to HRQOL and coping; and (4) assess whether there are differences between patients and normative data with respect to HRQOL and coping. Methods: A total of 115 patients (91 women) with SHR were asked to answer five questionnaires: a study-specific questionnaire, the Chemical Sensitivity Scale for Sensory Hyperreactivity (CSS-SHR), the NHP, the SF-36, and the Jalowiec Coping Scale-60. Results: Eighty-three patients (72%; 70 women) completed all questionnaires. The SF-36 scores were less skewed and more homogeneously distributed and showed fewer floor and ceiling effects than the NHP scores. The SF-36 was also discriminated better between patients with high and low CSS-SHR scores. The reliability standard for both questionnaires was satisfactory. There were no gender differences in HRQOL. Patients with SHR had significantly lower HRQOL scores than the normative data in comparable domains of the NHP and the SF-36: emotional reactions/mental health, energy/vitality, physical mobility/functioning, and pain/bodily pain. In social isolation/functioning, the results were different; the NHP scores were similar to the normative data and the SF-36 scores were lower. The most commonly used coping styles were optimistic, self-reliant, and confrontational. Women used optimistic coping more than men. Compared with the normative group, patients with SHR used confrontational and optimistic coping more and emotive coping less

Quality of Life and Capsaicin Sensitivity in Patients with Airway Symptoms Induced by Chemicals and Scents: A Longitudinal Study

OBJECTIVE: It is common in asthma and allergy clinics to see patients presenting with upper and lower airway symptoms that are induced by chemicals and scents and not explained by allergic or asthmatic reactions. Previous studies have shown that these patients often have increased cough sensitivity to inhaled capsaicin; such sensitivity is known to reflect the airway sensory reactivity. The aim of this study was to evaluate the duration of symptoms induced by chemicals and scents and to measure health-related quality of life (HRQL) in patients with chemically induced airway symptoms. We also wished to determine and compare repeatability of the cough response to capsaicin inhalation, and to evaluate the patients’ airway sensory reactivity in a long-term perspective. PARTICIPANTS: Seventeen patients with a history of at least 12 months of airway symptoms induced by chemicals and scents were followed over 5 years with repeated questionnaires, measurements of HRQL, and capsaicin inhalation tests. RESULTS: The symptoms persisted and did not change significantly over time, and the patients had a reduced HRQL that did not change during the 5-year period. The capsaicin sensitivity was increased at the start of the study, the cough sensitivity was long-lasting, and the repeatability of the capsaicin inhalation test was considered to be good in a long-term perspective. CONCLUSIONS: Upper and lower airway symptoms induced by chemicals and scents represent an entity of chronic diseases, different from asthma or chronic obstructive pulmonary disease, with persistent symptoms, a reduced HRQL, and unchanged sensory hyperreactivity

Airway sensitivity to chemicals and scents. Sympoms, trigger factors and the capsaicin inhalation test

Some patients with airway symptoms, induced by chemicals and scents, but who lackbronchoconstriction or allergy, have shown increased cough sensitivity to inhaled capsaicin. Capsaicinstimulates cough via the sensory nervous system, and a suggested diagnosis for this condition issensory hyperreactivity (SHR).The aims of this thesis were to; (I) study airway sensitivity to inhaled capsaicin, and the occurrenceof airway symptoms induced by chemicals and scents in patients with airway symptoms of unclearaetiology; (II) clarify whether patients with multiple chemical sensitivity (MCS) according to Cullen scriteria have a physiologically substantiated reaction (cough) to inhaled capsaicin that differed fromhealthy controls; (III) compare tidal breathing and dosimeter methods in terms of agreement andrepeatability of cough response to capsaicin inhalation in patients with SHR and in healthy controls;(IV) evaluate the long-term persistence of airway symptoms induced by chemicals and scents and theirinfluence on health-related quality of life (HRQL), and determine the long-term reproducibility ofcough response to capsaicin inhalation.Cough sensitivity to capsaicin was dose dependent and was significantly higher among the patientsthan in the healthy controls (I IV).Fifty-two patients underwent methacholine and capsaicin inhalation tests. Twenty-three percent(12/52) of the patients had a positive methacholine test, of these nine were diagnosed as havingasthma. Seventy-seven percent (40/52) of the patients reported airway symptoms induced bychemicals and scents and they coughed significantly more to inhaled capsaicin than did those withoutsuch sensitivity (I).Twelve patients with MCS, all having airway symptoms induced by chemicals and scents, wereprovoked with inhalation of capsaicin, in a double-blind randomised order, and the resulting responseswere compared with 12 healthy controls. The patients coughed significantly more and experiencedmore other airway symptoms upon capsaicin inhalation than the controls did (II).In 15 patients with SHR and 15 healthy controls, capsaicin inhalation tests were performed twiceusing tidal breathing and twice using the dosimeter method. The dosimeter method causedsignificantly more coughs and other airway symptoms in both patients and controls than did the tidalbreathing method. Both methods showed good repeatability and a similar ability to distinguish patientswith SHR from controls (III).Eighteen patients with airway symptoms induced by chemicals and scents were followed for fiveyears. In most patients the symptoms and a reduced HRQL persisted, and the capsaicin coughsensitivity was increased, reproducible, and long lasting (IV).Conclusion: In patients with SHR and MCS airway sensory reactivity is increased, suggesting thatneurogenic factors may be of importance. Though the methacholine inhalation test may be of somevalue in assessing these patients, in that it can exclude the possibility of bronchial asthma, thecapsaicin inhalation test seems to be a more useful diagnostic tool. In conducting capsaicin inhalationtesting it is important to know the type of inhalation device used, particle size, airflow rate, andinspiratory flow rate, as these factors influence the strength of reaction. SHR appears to be a chroniccondition; it is associated with reduced HRQL and the long-term persistence of increased capsaicincough sensitivity.Key words: asthma, capsaicin, cough, dosimeter method, health-related quality of life,methacholine, multiple chemical sensitivity, Nottingham Health Profile, sensory hyperreactivity, tidalbreathing metho