哮喘表型：咳嗽和喘息是否预示持续性哮喘的加重？
2017/12/29
摘要
我们对控制不佳的哮喘长期症状以及这些症状是否预示着不同的表型知之甚少。这些分析的主要目的是评估在控制不佳的哮喘患者中咳嗽和喘息的日型，其次是为了检验这些症状表现是如何对治疗产生影响的。
我们对1701名患者每天采集两次电子数据，并与人口统计学资料相关。对比沙丁胺醇的缓解治疗与倍氯米松/福莫特罗的维持缓解治疗。我们将急性加重的次数与症状关联。
随着BMI指数的增长，在老年患者中症状更加常见。在大多数患者中，咳嗽与喘息是密切相关的（r=0.73）。我们选出咳嗽表型和哮喘表型的患者，前者是超重的老年女性，后者是老年男性。两种疗法均缓解了咳嗽和喘息的日间症状。倍氯米松/福莫特罗维持缓解治疗组较沙丁胺醇组急性加重次数降低了三分之一，这在症状越少的患者中效果越好。
咳嗽和喘息在哮喘控制不佳的患者中高度相关，有些患者以咳嗽为主，有些以喘息为主。症状和急性加重次数相关性较差，这说明是在病理生理中的选择性。在症状最少的患者中，倍氯米松/福莫特罗的维持缓解治疗方案可能是首选。
Asthma phenotypes: do cough and wheeze predict exacerbations in persistent asthma?
Jaymin B. Morjaria, Alan S. Rigby, Alyn H. Morice
European Respiratory Journal 2017 50: 1701366; DOI: 10.1183/13993003.01366-2017
Abstract
Little is known of the long-term symptom profile in uncontrolled asthma and whether symptoms can predict distinct phenotypes. The primary objective of these analyses was to assess diurnal profile of cough and wheeze in an uncontrolled asthma population. Secondary outcomes were to examine how these symptom profiles influence response to treatment.
Twice-daily electronically recorded data from 1701 patients were examined in relation to the population demographics. Reliever treatment with salbutamol was then compared with extra-fine beclometasone/formoterol maintenance and reliever therapy (MART). Exacerbation frequency was then correlated with the symptom profile.
Symptoms were commoner in older patients with an increased body mass index. In most patients, reported cough and wheeze were closely correlated (r=0.73). Two phenotypes of cough- and wheeze-predominant patients were identified; the former were overweight, older females and the latter older males. Diurnal symptoms of cough and wheeze were similarly attenuated by both therapies. MART reduced exacerbation frequency by a third compared with salbutamol, and this effect was greatest in patients with fewest reported symptoms.
While cough and wheeze are highly correlated in uncontrolled asthma, some patients predominantly have cough whereas others wheeze. Symptoms and exacerbation frequency appear poorly associated, suggesting an alternative pathophysiology. MART may be the preferred option in those with fewest symptoms.
我们对控制不佳的哮喘长期症状以及这些症状是否预示着不同的表型知之甚少。这些分析的主要目的是评估在控制不佳的哮喘患者中咳嗽和喘息的日型，其次是为了检验这些症状表现是如何对治疗产生影响的。
我们对1701名患者每天采集两次电子数据，并与人口统计学资料相关。对比沙丁胺醇的缓解治疗与倍氯米松/福莫特罗的维持缓解治疗。我们将急性加重的次数与症状关联。
随着BMI指数的增长，在老年患者中症状更加常见。在大多数患者中，咳嗽与喘息是密切相关的（r=0.73）。我们选出咳嗽表型和哮喘表型的患者，前者是超重的老年女性，后者是老年男性。两种疗法均缓解了咳嗽和喘息的日间症状。倍氯米松/福莫特罗维持缓解治疗组较沙丁胺醇组急性加重次数降低了三分之一，这在症状越少的患者中效果越好。
咳嗽和喘息在哮喘控制不佳的患者中高度相关，有些患者以咳嗽为主，有些以喘息为主。症状和急性加重次数相关性较差，这说明是在病理生理中的选择性。在症状最少的患者中，倍氯米松/福莫特罗的维持缓解治疗方案可能是首选。
(复旦大学附属中山医院 呼吸科 包 晨 摘译 杨 冬 审校)
(European Respiratory Journal 201750:1701366;DOI:10.1183/13993003.01366-2017)
(European Respiratory Journal 201750:1701366;DOI:10.1183/13993003.01366-2017)
Asthma phenotypes: do cough and wheeze predict exacerbations in persistent asthma?
Jaymin B. Morjaria, Alan S. Rigby, Alyn H. Morice
European Respiratory Journal 2017 50: 1701366; DOI: 10.1183/13993003.01366-2017
Abstract
Little is known of the long-term symptom profile in uncontrolled asthma and whether symptoms can predict distinct phenotypes. The primary objective of these analyses was to assess diurnal profile of cough and wheeze in an uncontrolled asthma population. Secondary outcomes were to examine how these symptom profiles influence response to treatment.
Twice-daily electronically recorded data from 1701 patients were examined in relation to the population demographics. Reliever treatment with salbutamol was then compared with extra-fine beclometasone/formoterol maintenance and reliever therapy (MART). Exacerbation frequency was then correlated with the symptom profile.
Symptoms were commoner in older patients with an increased body mass index. In most patients, reported cough and wheeze were closely correlated (r=0.73). Two phenotypes of cough- and wheeze-predominant patients were identified; the former were overweight, older females and the latter older males. Diurnal symptoms of cough and wheeze were similarly attenuated by both therapies. MART reduced exacerbation frequency by a third compared with salbutamol, and this effect was greatest in patients with fewest reported symptoms.
While cough and wheeze are highly correlated in uncontrolled asthma, some patients predominantly have cough whereas others wheeze. Symptoms and exacerbation frequency appear poorly associated, suggesting an alternative pathophysiology. MART may be the preferred option in those with fewest symptoms.
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在中年人中，五年以上的交通相关空气污染暴露可增加哮喘风险并损害肺功能
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长期应用全身糖皮质激素对重症哮喘的影响：英国回顾性队列分析
