哮喘联盟

   摘要  
   背景：哮喘控制的吸入糖皮质激素(ICS)治疗一般关注于肺功能和症状，但是与气道炎症的关联不充分。
   目的：一组患者的治疗是基于呼气一氧化氮分数(FENO)和痰液嗜酸性粒细胞，另一组患者的治疗是基于临床评分。本研究将这两组患者的哮喘控制情况做了对比。研究设计和主要的结果：为期24个月的随机、平行对照研究，每6个月进行一次随访，共进行了5次随访。24个月的哮喘急性发作率和症状得分是主要的研究结果。
   参与者：每组各14例嗜酸性粒细胞哮喘。
   结果：对于干预组，与基线值(3.21)相比，每例患者每年的急性发作率在12个月内降低73%(降至0.82) (p<0.01)，在24个月内降低84%(降至0.5) (p<0.01)。对于对照组，每例患者每年的急性发作率只在第12月(3.0)和第24月(2.0)之间显著降低，降低值为33%。干预组的24个月每例患者每年的急性发作率(0.5)比对照组(2.0, p<0.05)减少75%。与基线值相比，两组的24个月平均症状得分都降低（干预组降低72%，对照组降低60%），但是干预组的平均症状得分(8.1±1.0)要比对照组(11±2.6, p<0.05)低27%。在研究过程中，两组的ICS剂量都逐渐增加，但是两组间没有差异。
   结论：与传统策略相比，FENO和痰液嗜酸性粒细胞的纵向监测能够改善嗜酸性粒细胞哮喘控制，在不额外增加ICS的情况下，哮喘症状和急性发作都减少。

 

（苏欣 审校）
Curr Pharm Des. 2015 Jul 10. [Epub ahead of print]

 

The Combined Impact of Exhaled Nitric Oxide and Sputum Eosinophils Monitoring in Asthma Treatment: A Prospective Cohort Study.
 

Malerba M1, Radaeli A, Olivini A, Ragnoli B, Ricciardolo F, Montuschi P.
 

Abstract
BACKGROUND:Inhaled corticosteroids (ICS) treatment for asthma control is generally focused on lung function and symptoms, but inadequately correlated with airway inflammation.
OBJECTIVE:To compare asthma control in a group of patients whose treatment was based on fraction of exhaled nitric oxide (FENO) and sputum eosinophils (intervention group) with a group in whom treatment was based on clinical score (control group). Study design and primary outcome: Randomized parallel-group longitudinal 24-month study including 5 visits every 6 months. A combination of asthma exacerbation rate and symptom score at 24 months was the primary outcome.
PARTICIPANTS:Fourteen patients with eosinophilic asthma per group were included.
RESULTS:In the intervention group, exacerbation rate/patient/year was reduced at 12 months (0.82) (-73%) and, to a greater extent at 24 months (0.5) (-84%) compared with baseline (3.21, p<0.01). In the control group, a significant reduction in exacerbation rate/patient/year was only observed between month 12 (3.0) and 24 (2.0, -33%, p<0.01). At 24 months, exacerbation rate was lower (-75%) in the intervention (0.5) than in the control group (2.0, p<0.05). Compared with baseline, mean symptom scores at 24 months were reduced in both groups (intervention group: -72%; control group: -60%), but were lower in the intervention (8.1±1.0, p<0.05; -27%) than in the control group (11±2.6). ICS dose gradually increased in both groups throughout the study, with no between-group differences.
CONCLUSION:Compared with conventional strategy, longitudinal monitoring of FENO and sputum eosinophils improves eosinophilic asthma control in terms of reduced symptoms and exacerbations without additional increase in ICS treatment.
 

Curr Pharm Des. 2015 Jul 10. [Epub ahead of print]