哮喘联盟

   摘要
   背景：重度哮喘的发病率很高，但是，关于其自然病程和确诊第一年危险因素如何影响疾病进展，目前尚不清楚。
   方法：本研究运用健康管理数据，回顾性地跟踪观察了加拿大不列颠哥伦比亚省14-55岁的新诊重度哮喘患者。根据资源利用强度（药物治疗）、哮喘急性发作情况，每个病人-年划分为轻度、中度和重度哮喘。运用四态马尔可夫模型，估算研究期间三种疾病严重程度之间相互转化或进展至死亡的概率，并评估重度哮喘十年发展轨迹和基线危险因素的影响。
   结果：本研究共跟踪观察了13,467例患者。重度哮喘发病十年后，83%的患者严重程度减轻（轻度：43%；中度：40%）。发病第一年社会经济地位低、共病疾病负担高和依从性（哮喘控制药物使用天数的比例(PDC)）高，与随后十年重度哮喘风险分别升高10%、24%和35%独立相关。性别与临床病程无关。
   结论：随着时间的推移，大部分重度哮喘患者仅需使用较少的药物治疗，提示重度哮喘严重程度长期减轻的趋势。重度哮喘预后不良的潜在可控危险因素包括社会经济地位低和共病疾病负担高。PDC与未来哮喘严重程度的关系可能由疾病严重程度的残余混杂因素所致。
 

（杨冬 审校）
Thorax. 2016Jan5.pii:thoraxjnl-2015-207530.doi:10.1136/thoraxjnl-2015-207530. [Epub ahead of print]


 

The natural history of severe asthma and influences of early risk factors: a population-based cohort study.
 

Chen W1, Marra CA2, Lynd LD2, FitzGerald JM3, Zafari Z4, Sadatsafavi M3.
 

Abstract
BACKGROUND:Severe asthma is associated with disproportionately high morbidity, but little is known about its natural history and how risk factors at first year of diagnosis modify its subsequent development.
METHODS:Using administrative health data, we retrospectively followed patients 14-55 years of age with newly diagnosed severe asthma in British Columbia, Canada. Based on intensity of resource use (drug therapy) and occurrence of exacerbations, each patient-year was classified into mild, moderate, or severe asthma. We estimated the probability of transition between severity levels or to death over the study period using a four-state Markov model, and used this to assess the 10-year trajectory of severe asthma and the influence of baseline risk factors.
RESULTS:We followed 13 467 patients. Ten years after incident severe asthma, 83% had transitioned to a less severe level (mild: 43%, moderate: 40%). Low socioeconomic status, high comorbidity burden, and high adherence (proportion of days covered (PDC) by asthma controller therapy) in the first year were independently associated with, respectively, 10%, 24% and 35% more time in severe asthma over the next 10 years. Sex was not associated with the clinical course.
CONCLUSIONS:Most patients with incident severe asthma used fewer resources over time, indicating a long-term transition to milder asthma. Potentially modifiable risk factors for poor prognosis of severe asthma include low socioeconomic status and high comorbidity burden. The association between PDC and future asthma severity is likely due to residual confounding by disease severity.
 

Thorax. 2016Jan5.pii:thoraxjnl-2015-207530.doi:10.1136/thoraxjnl-2015-207530. [Epub ahead of print]