哮喘联盟

   摘要
   背景：部分哮喘患者表现出持续气流受限，但他们的临床和炎症特征并没有得到广泛的描述。在这项研究中，我们的目的是鉴定表现为持续性气流阻塞和不表现为持续气流阻塞的哮喘患者临床、功能、和炎症特征的差异。
   方法：从2个三级哮喘诊疗中心连续招募患者（170例）。病人的人口统计，肺功能测试，炎性细胞检测（痰培养），气道高反应性测试（乙酰甲胆碱诱导进行BHR试验，PD15）和治疗方案均记录在册。
   结果：60例（35.3%）出现持续性气流阻塞。除了肺功能的差异，持续性气流阻塞患者，乙酰甲胆碱诱导气道高反应测试降低，即PD 20降低，呼出的一氧化氮升高，痰培养结果嗜酸性粒细胞和中性粒细胞计数增高。大多数（71.7%）出现持续性气流阻塞的患者符合美国胸科学会的严重难治性哮喘（SRA）的诊断标准，而不出现持续性气流阻塞的患者只有4.5%。聚类分析确定了三个临床相关的集群：集群1（n = 56，与持续的气流阻塞不相关）包括非过敏患者，未接受高剂量ICS，无SRA；集群2（n = 53，与持续的气流阻塞相关）包括过敏患者，接受大剂量ICS和/或口服CS，符合SRA标准；集群3（n = 61，与持续的气流阻塞不相关）包括过敏患者没有接受大剂量ICS，无SRA。
   结论：与未出现持续性气道阻塞的患者相比，出现持续气流阻塞的哮喘患者表现出独特的哮喘表型，其临床表现、功能和炎症特征有显著差异。这些患者更常表现为严重的难治性哮喘，需要加强的治疗。
 

（苏欣 审校）
Respir Med.2015 Sep 21. pii: S0954-6111(15)30056-1. doi:10.1016/j.rmed.2015.09.009. [Epub ahead of print]

 

Persistent airflow obstruction in patients with asthma: Characteristics of a distinct clinical phenotype.
 

Konstantellou E1, Papaioannou AI2, Loukides S3, Patentalakis G1, Papaporfyriou A1, Hillas G1, Papiris S2, Koulouris N1, Bakakos P1, Kostikas K2.
 

Abstract
BACKGROUND:Some patients with asthma present persistent airflow limitation but their clinical and inflammatory characteristics have not been extensively described. In this study we aimed to identify differences in the clinical, functional and inflammatory characteristics between patients with asthma with and without persistent airflow obstruction.
METHODS:Patients (n = 170) were consecutively recruited from two tertiary Asthma Clinics. Patients' demographics, pulmonary function tests, inflammatory cells in induced sputum, bronchial hyperresponsiveness (BHR, PD15 to methacholine) and treatment regimens were recorded.
RESULTS:Sixty patients (35.3%) presented persistent airflow obstruction. Besides differences in lung function, patients with persistent obstruction presented, lower methacholine PD20, higher exhaled NO, and higher eosinophil and neutrophil counts in induced sputum. The majority (71.7%) of the patients with persistent obstruction fulfilled the ATS criteria for severe refractory asthma (SRA), in contrast to 4.5% in the group without persistent obstruction. A cluster analysis identified three clinically relevant clusters: Cluster 1 (n = 56, not related to persistent airflow obstruction) included non-atopic patients, who did not receive high-dose ICS without SRA; Cluster 2 (n = 53, related to persistent airflow obstruction) included atopic patients, receiving high-dose ICS and/or oral CS, fulfilling SRA criteria; Cluster 3 (n = 61, not related to persistent airflow obstruction) included atopic patients not receiving high-dose ICS, without SRA.
CONCLUSIONS:Asthma patients with persistent airflow obstruction present a distinct asthma phenotype, with significant differences in clinical, functional and inflammatory characteristics compared to patients without fixed airway obstruction. These patients present more often severe refractory asthma and require more intense treatment.
 

Respir Med.2015 Sep 21. pii: S0954-6111(15)30056-1. doi:10.1016/j.rmed.2015.09.009. [Epub ahead of print]