在全国范围内研究重度或危及生命的哮喘恶化的因素模式
2018/01/08
摘要
背景：减少致命性哮喘恶化是哮喘治疗中的一个关键问题。
目标: 确定真实世界哮喘急性发作前的哮喘模式。
方法: 在190例患者经历了致命性哮喘发作全国性的前瞻性研究中，聚类分析入组前两周的哮喘症状。
结果：使用视觉模拟量表自我报告的形式定义了三种不同的症状群。症状群A(42.1%)：中度发作7.4小时后急性加重入院，低体重指数的中青年患者，有停止服用抗哮喘药物的抑郁倾向，对环境刺激及毛绒宠物的高反应性。症状群B(40.0%)：48小时内症状迅速恶化，大多数为中老年人，比较好的吸入可吸入糖皮质激素（ICS）或ICS+LABA（β受体激动剂），对呼吸困难感知度低。症状群C(17.9%)：入院前10天症状缓慢恶化，对呼吸困难、吸烟和每日慢性轻中度症状的高度认识。过度使用短效β受体激动剂，基线哮喘严重程度，或入院后的结果在这3个集群中没有差异。
结论：为了减少严重或危及生命的哮喘恶化，每个集群都应考虑个性化的哮喘管理计划。改善ICS或ICS+LABA的依从性及戒烟对症状群A非常重要。为了减轻对呼吸困难的低感知，监测哮喘患者呼气流速峰值和/或呼出的一氧化氮对B群患者是有效的。避免环境刺激，增加常规用药，新型抗2型反应靶向药物可考虑应用于症状群C。
Identification of patterns of factors preceding severe or life-threatening asthma exacerbations in a nationwide study.
Tanaka H, Nakatani E
Abstract
BACKGROUND: Reducing near-fatal asthma exacerbations is a critical problem in asthma management.
OBJECTIVES: To determine patterns of factors preceding asthma exacerbations in a real-world setting.
METHODS: In a nationwide prospective study of 190 patients who had experienced near-fatal asthma exacerbation, cluster analysis was performed using asthma symptoms over the 2-week period before admission.
RESULTS: Three distinct clusters of symptoms were defined employing the self-reporting of a visual analogue scale. Cluster A (42.1%): rapid worsening within 7.4 hours from moderate attack to admission, young to middle-aged patients with low Body mass index and tendency to depression who had stopped anti-asthma medications, smoked, and hypersensitive to environmental triggers and furred pets. Cluster B (40.0%): fairly rapid worsening within 48 hours, mostly middle-aged and older, relatively good inhaled corticosteroid (ICS) or ICS/long-acting beta-agonist (LABA) compliance, and low perception of dyspnea. Cluster C (17.9%): slow worsening over 10 days before admission, high perception of dyspnea, smokers, and chronic daily mild-moderate symptoms. There were no differences in overuse of short-acting beta-agonists, baseline asthma severity, or outcomes after admission for patients in these 3 clusters.
CONCLUSION: To reduce severe or life-threatening asthma exacerbation, personalized asthma management plans should be considered for each cluster. Improvement of ICS and ICS/LABA compliance and cessation of smoking are important in cluster A. To compensate for low perception of dyspnea, asthma monitoring of peak expiratory flow rate and/or exhaled nitric oxide would be useful for patients in cluster B. Avoidance of environmental triggers, increase usual therapy, or new anti-type 2 response-targeted therapies should be considered for cluster C.
背景：减少致命性哮喘恶化是哮喘治疗中的一个关键问题。
目标: 确定真实世界哮喘急性发作前的哮喘模式。
方法: 在190例患者经历了致命性哮喘发作全国性的前瞻性研究中，聚类分析入组前两周的哮喘症状。
结果：使用视觉模拟量表自我报告的形式定义了三种不同的症状群。症状群A(42.1%)：中度发作7.4小时后急性加重入院，低体重指数的中青年患者，有停止服用抗哮喘药物的抑郁倾向，对环境刺激及毛绒宠物的高反应性。症状群B(40.0%)：48小时内症状迅速恶化，大多数为中老年人，比较好的吸入可吸入糖皮质激素（ICS）或ICS+LABA（β受体激动剂），对呼吸困难感知度低。症状群C(17.9%)：入院前10天症状缓慢恶化，对呼吸困难、吸烟和每日慢性轻中度症状的高度认识。过度使用短效β受体激动剂，基线哮喘严重程度，或入院后的结果在这3个集群中没有差异。
结论：为了减少严重或危及生命的哮喘恶化，每个集群都应考虑个性化的哮喘管理计划。改善ICS或ICS+LABA的依从性及戒烟对症状群A非常重要。为了减轻对呼吸困难的低感知，监测哮喘患者呼气流速峰值和/或呼出的一氧化氮对B群患者是有效的。避免环境刺激，增加常规用药，新型抗2型反应靶向药物可考虑应用于症状群C。
(中日友好医院医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校)
(Allergy. 2017 Dec 1. doi: 10.1111/all.13374)
(Allergy. 2017 Dec 1. doi: 10.1111/all.13374)
Identification of patterns of factors preceding severe or life-threatening asthma exacerbations in a nationwide study.
Tanaka H, Nakatani E
Abstract
BACKGROUND: Reducing near-fatal asthma exacerbations is a critical problem in asthma management.
OBJECTIVES: To determine patterns of factors preceding asthma exacerbations in a real-world setting.
METHODS: In a nationwide prospective study of 190 patients who had experienced near-fatal asthma exacerbation, cluster analysis was performed using asthma symptoms over the 2-week period before admission.
RESULTS: Three distinct clusters of symptoms were defined employing the self-reporting of a visual analogue scale. Cluster A (42.1%): rapid worsening within 7.4 hours from moderate attack to admission, young to middle-aged patients with low Body mass index and tendency to depression who had stopped anti-asthma medications, smoked, and hypersensitive to environmental triggers and furred pets. Cluster B (40.0%): fairly rapid worsening within 48 hours, mostly middle-aged and older, relatively good inhaled corticosteroid (ICS) or ICS/long-acting beta-agonist (LABA) compliance, and low perception of dyspnea. Cluster C (17.9%): slow worsening over 10 days before admission, high perception of dyspnea, smokers, and chronic daily mild-moderate symptoms. There were no differences in overuse of short-acting beta-agonists, baseline asthma severity, or outcomes after admission for patients in these 3 clusters.
CONCLUSION: To reduce severe or life-threatening asthma exacerbation, personalized asthma management plans should be considered for each cluster. Improvement of ICS and ICS/LABA compliance and cessation of smoking are important in cluster A. To compensate for low perception of dyspnea, asthma monitoring of peak expiratory flow rate and/or exhaled nitric oxide would be useful for patients in cluster B. Avoidance of environmental triggers, increase usual therapy, or new anti-type 2 response-targeted therapies should be considered for cluster C.
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严重哮喘的气道病理与气流阻塞有关，但与症状控制无关
下一篇：
吸入糖皮质激素应用与哮喘儿童骨折的关系
