吸入糖皮质激素与成人哮喘控制哮喘：12年随访研究
2018/04/04
摘要
背景：哮喘患者吸入性皮质激素（ICS）的剂量在横断面研究中进行过研究，而长期随访研究尚未进行。
目的：通过计算12年来新发成人哮喘患者和不同哮喘控制人群的累积ICS剂量和剂量变化，纵向评估处方药物。
方法：Seinäjoki成人哮喘研究（SAAS）中为203例患者为期12年的随访。所有哮喘相关的访问和处方药物在研究期间均从病历中收集。
结果：12年随访中，平均每个病人总的ICS累积剂量为3.4g（±SEM 0.1）。在随访过程中，呼吸专科医师和全科医师处方ICS剂量的加量或减量，并有649次剂量变化被记录（每个病人的中位数为3（1-5））。不受控制的哮喘患者在整个随访期内接受高剂量ICS治疗，因此这组12年的ICS累积剂量（3.8g ± SEM 0.2）高于部分控制组（3.4g ± SEM 0.2）或控制组（2.9g ± SEM 0.2）（P = 0.0001 ）。与控制性疾病患者相比，未控制哮喘患者的ICS剂量变化也更高。
结论：在12年的随访中，尽管频繁的剂量变化和高剂量的ICS，哮喘控制水平仍然很差。这表明高剂量的ICS可能不足以有效控制成人哮喘发作的疾病，需要新的靶向治疗。
Inhaled corticosteroids and asthma control in adult-onset asthma: 12-year follow-up study.
Vähätalo I, Ilmarinen P, Tuomisto LE, Niemelä O, Kankaanranta H.
Abstract
BACKGROUND: Prescribed inhaled corticosteroid (ICS) doses in asthma have been studied in cross-sectional settings whereas long-term follow-up studies have not been carried out.
OBJECTIVE: To evaluate prescribed medication longitudinally by calculating cumulative ICS doses and dose changes in a cohort of new-onset adult asthma during 12 years and in different groups of asthma control.
METHODS: A total of 203 patients were followed for 12 years as part of Seinäjoki Adult Asthma Study (SAAS). All asthma-related visits and prescribed medication over the study period were collected from medical records.
RESULTS: Total cumulative ICS dose for the 12-year follow-up period was 3.4g (±SEM 0.1) per patient. Both respiratory specialists and GPs prescribed step-ups and step-downs in ICS treatment and in total 649 dose changes were noted during the follow-up (median 3(1-5) per patient). Patients with uncontrolled asthma received higher ICS doses throughout the follow-up period, and therefore, cumulative 12-year ICS dose (3.8g ± SEM 0.2) in this group was higher than that in those with partially controlled (3.4g ± SEM 0.2) or controlled disease (2.9g ± SEM 0.2) (p = 0.0001). Patients with uncontrolled asthma were also prescribed a higher number of ICS dose changes than patients with controlled disease.
CONCLUSION: Despite frequent dose changes and high ICS doses during the 12-year follow-up, the level of asthma control remained poor in patients with uncontrolled asthma. This suggests that high ICS doses may not be effective enough for management of disease in patients with uncontrolled adult-onset asthma and novel targeted treatments are required.
背景：哮喘患者吸入性皮质激素（ICS）的剂量在横断面研究中进行过研究，而长期随访研究尚未进行。
目的：通过计算12年来新发成人哮喘患者和不同哮喘控制人群的累积ICS剂量和剂量变化，纵向评估处方药物。
方法：Seinäjoki成人哮喘研究（SAAS）中为203例患者为期12年的随访。所有哮喘相关的访问和处方药物在研究期间均从病历中收集。
结果：12年随访中，平均每个病人总的ICS累积剂量为3.4g（±SEM 0.1）。在随访过程中，呼吸专科医师和全科医师处方ICS剂量的加量或减量，并有649次剂量变化被记录（每个病人的中位数为3（1-5））。不受控制的哮喘患者在整个随访期内接受高剂量ICS治疗，因此这组12年的ICS累积剂量（3.8g ± SEM 0.2）高于部分控制组（3.4g ± SEM 0.2）或控制组（2.9g ± SEM 0.2）（P = 0.0001 ）。与控制性疾病患者相比，未控制哮喘患者的ICS剂量变化也更高。
结论：在12年的随访中，尽管频繁的剂量变化和高剂量的ICS，哮喘控制水平仍然很差。这表明高剂量的ICS可能不足以有效控制成人哮喘发作的疾病，需要新的靶向治疗。
（中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校）
（Respir Med. 2018 Apr;137:70-76. doi: 10.1016/j.rmed.2018.02.025. Epub 2018 Mar 2.）
（Respir Med. 2018 Apr;137:70-76. doi: 10.1016/j.rmed.2018.02.025. Epub 2018 Mar 2.）
Inhaled corticosteroids and asthma control in adult-onset asthma: 12-year follow-up study.
Vähätalo I, Ilmarinen P, Tuomisto LE, Niemelä O, Kankaanranta H.
Abstract
BACKGROUND: Prescribed inhaled corticosteroid (ICS) doses in asthma have been studied in cross-sectional settings whereas long-term follow-up studies have not been carried out.
OBJECTIVE: To evaluate prescribed medication longitudinally by calculating cumulative ICS doses and dose changes in a cohort of new-onset adult asthma during 12 years and in different groups of asthma control.
METHODS: A total of 203 patients were followed for 12 years as part of Seinäjoki Adult Asthma Study (SAAS). All asthma-related visits and prescribed medication over the study period were collected from medical records.
RESULTS: Total cumulative ICS dose for the 12-year follow-up period was 3.4g (±SEM 0.1) per patient. Both respiratory specialists and GPs prescribed step-ups and step-downs in ICS treatment and in total 649 dose changes were noted during the follow-up (median 3(1-5) per patient). Patients with uncontrolled asthma received higher ICS doses throughout the follow-up period, and therefore, cumulative 12-year ICS dose (3.8g ± SEM 0.2) in this group was higher than that in those with partially controlled (3.4g ± SEM 0.2) or controlled disease (2.9g ± SEM 0.2) (p = 0.0001). Patients with uncontrolled asthma were also prescribed a higher number of ICS dose changes than patients with controlled disease.
CONCLUSION: Despite frequent dose changes and high ICS doses during the 12-year follow-up, the level of asthma control remained poor in patients with uncontrolled asthma. This suggests that high ICS doses may not be effective enough for management of disease in patients with uncontrolled adult-onset asthma and novel targeted treatments are required.
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