title: Can bronchial asthma with an highly prevalent airway (and systemic) vagal tone be considered an independent asthma phenotype? Possible role of anticholinergics.
abstract: Recently, we studied occurrence and role of non-respiratory symptoms (n-RSs) before a worsening of asthma symptoms. Some n-RSs such as anxiety, reflux, heartburn, abdominal pain, which appeared within 3 h before the onset of an asthma attack, are the likely result of an imbalance between sympathetic/parasympathetic systems with an increase in cholinergic tone. Therefore, it is likely that some of these n-RSs induced by the increased cholinergic tone might be present related with specific parasympathetic-associated respiratory symptoms such as those elicited by airway narrowing. It is likely that, at least in some categories of asthmatics, an increased cholinergic tone, rather than other well-known factors, might play a prevalent role in triggering bronchospasm. If this is the case, it is possible to speculate that the use of anticholinergic agents (mainly those with long-acting activity) in patients suffering from asthma should be more beneficial in individuals characterized by a higher degree of cholinergic tone that, consequently might be the ideal target for the use of long-acting anticholinergics and, possibly, represent a novel asthma phenotype. The presence of parasympathetic-associated n-RSs might help the physician to identify this type of patients, although this might be followed by a more detailed assessment.
authors: Department of Pulmonology, Haematology and Oncology, Division of Pneumology and Allergology, High Speciality "A.Cardarelli" Hospital, Naples, Italy; Postgraduate School of Respiratory Medicine, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy. Electronic address: gennaro.liccardi@tin.it.
authors: Gennaro
authors: G
authors: Liccardi
authors: Department of Pulmonology, Haematology and Oncology, Division of Pneumology and Allergology, High Speciality "A.Cardarelli" Hospital, Naples, Italy.
authors: Antonello
authors: A
authors: Salzillo
authors: Postgraduate School of Respiratory Medicine, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
authors: Luigino
authors: L
authors: Calzetta
authors: Postgraduate School of Respiratory Medicine, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
authors: Mario
authors: M
authors: Cazzola
authors: Department of Experimental Medicine, Second University of Naples, Naples, Italy.
authors: Maria Gabriella
authors: MG
authors: Matera
authors: Postgraduate School of Respiratory Medicine, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
authors: Paola
authors: P
authors: Rogliani
mesh_terms: D015746:Abdominal Pain / Q000150:complications / Q000503:physiopathology; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D018680:Cholinergic Antagonists / Q000627:therapeutic use*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000503:physiopathology; D006801:Humans; D010641:Phenotype; D015995:Prevalence; D012137:Respiratory System / Q000294:innervation* / Q000503:physiopathology; D013315:Stress, Psychological / Q000150:complications / Q000503:physiopathology; D014630:Vagus Nerve / Q000503:physiopathology*
chemical_list: D018680:Cholinergic Antagonists
keywords: Abdominal pain; Airway hyperreactivity; Anticholinergics; Asthma phenotype; Bronchial asthma; Gastro-esophageal reflux; Increased cholinergic tone; Stress