哮喘联盟

   摘要
   原理：年龄和性别都与哮喘患病率和发病率的差异有关。
   目的：为了确定在轻中度哮喘患者中，年龄和性别是否与不同的表型和对治疗的不同反应相关。
   方法：我们选取1993年至2003年间参与10次试验的受试者，利用哮喘临床研究网络数据来确定年龄和性别对表型和治疗失败的影响。
   测量值和主要结果：对1200例受试者[中位年龄为30.4岁，男性为 520例（43.3％），女性为680例（56.7％）]进行了鉴定和分析。30岁以上受试者治疗失败的比例较高（17.3％ vs 10.3％; OR = 1.82，CI = 1.30-2.54; P <0.001）；并且整个队列中30岁以上受试者的治疗失败率随年龄的增加而成比例的增加 [每年OR= 1.02，(CI = 1.01-1.04），每5年OR= 1.13（CI 1.04-1.22），p <0.001]。较差的肺功能和较长的哮喘持续时间与较高的治疗失败风险相关。30岁以上接受控制药物治疗的受试者中治疗失败的比例较高。当根据特效疗法进行分层时，30岁以上接受吸入糖皮质激素治疗的受试者治疗失败每年持续增加 [每年OR= 1.03（CI 1.01-1.07）]。女性有稍高的FEV1％预测值（84.5％ vs 81.1％，P <0.001），但哮喘的控制措施相似。女性和男性的治疗失败率（15.2％ vs 11.7％，P = 0.088）没有显著的统计学差异。
   结论：较高年龄与治疗失败风险的增加相关，尤其是接受吸入糖皮质激素治疗的受试者。而男女之间的治疗失败率没有显著差异。
 

（杨冬 审校）
Am J Respir Crit Care Med. 2015 Jun 11. [Epub ahead of print]

 

Impact of Age and Gender on Response to Asthma Therapy.
 

Dunn RM1, Lehman E2, Chinchilli VM3, Martin RJ4, Boushey HA5, Israel E6, Kraft M7, Lazarus SC8, Lemanske RF9,Lugogo NL10, Peters SP11, Sorkness CA12, Szefler S13, Wechsler ME14; NHLBI Asthma Clinical Research Network..
 

Abstract
RATIONALE:Age and gender are associated with differences in asthma prevalence and morbidity.
OBJECTIVES:Determine if age and gender associate with distinct phenotypes and a variable response to therapy in mild-moderate asthmatics.
METHODS:We utilized Asthma Clinical Research Network data to determine the impact of age and gender on phenotypes and treatment failures among subjects participating in 10 trials from 1993 to 2003.
MEASUREMENTS AND MAIN RESULTS:1,200 subjects were identified [median age = 30.4 years, male = 520 (43.3%), female = 680(56.7%)] and analyzed. A higher proportion of subjects ≥30 years old experienced treatment failures (17.3% vs. 10.3%; OR=1.82, CI=1.30-2.54; P < 0.001); and rates increased proportionally with increasing age above 30 across the cohort [OR per year = 1.02, CI=1.01-1.04), OR per 5-year = 1.13 (CI 1.04-1.22), P<0.001]. Lower lung function and longer duration of asthma were associated with a higher risk of treatment failure. A higher proportion of subjects ≥30 years old receiving controller therapy experienced treatment failures. When stratified by specific therapy, treatment failures increased consistently for every year above age 30 in subjects on inhaled corticosteroids [OR per year = 1.03 (CI 1.01-1.07)]. Females had a slightly higher FEV1% predicted (84.5% vs. 81.1%; P <0.001) but similar asthma control measures. There was not a statistically significant difference in treatment failures between females and males (15.2% vs. 11.7%, P =0.088).
CONCLUSION:Older age is associated with an increased risk of treatment failure, particularly in subjects taking inhaled corticosteroids. There was no significant difference in treatment failures between genders.
 

Am J Respir Crit Care Med. 2015 Jun 11. [Epub ahead of print]