黏液高分泌哮喘与鼻窦炎、鼻息肉与哮喘急性加重
2018/05/30
摘要
背景：支气管哮喘高分泌是研究较少的哮喘症状。本研究的目的是确定哮喘患者支气管高分泌的特点。
方法:共有142名哮喘患者（21.8%为男性；平均年龄49.8岁）进行前瞻性随访一年。黏液高分泌在临床上分两类：每日咳痰严重与频繁的咳痰但并不是每天均有。用多元回归分析评估临床和肺功能变量及伴有黏液高分泌。
结果: 28.9%的患者每日咳嗽，52.1%患者每日或大部分时间有痰。粘液分泌过多的患者往往呼吸困难更重、哮喘控制与生活质量均较差，更容易急性发作，并且嗅觉相关的慢性鼻窦炎和鼻息肉易频繁。粘液分泌过多有关的因素是嗅觉障碍，一次或过去几年的频繁急性发作，FEV1/FVC＜70%（AUC 0.75，95% CI 0.66-0.85）为高分泌的第一决定要素，嗅觉障碍、哮喘控制不佳和年龄（AUC 0.75，95% CI 0.67-0.83）为第二决定要素。
结论：哮喘患者的气道黏液高分泌频繁出现，并与慢性上气道疾病，气道阻塞，哮喘控制不佳、急性发作相关。
Mucus hypersecretion in asthma is associated with rhinosinusitis, polyps and exacerbations
Martínez-Rivera C, Crespo A
Abstract
BACKGROUND: Bronchial hypersecretion is a poorly studied symptom in asthma. The aim of the study was to determine the specific characteristics of asthmatics with bronchial hypersecretion.
METHODS: A total of 142 asthmatics (21.8% men; mean age 49.8 years) were prospectively followed for one year. Mucus hypersecretion was clinically classified into two severity categories: daily sputum production and frequent expectoration but not every day. Clinical and pulmonary function variables associated with mucus hypersecretion were assessed by multiple logistic regression analysis.
RESULTS: Daily cough was recorded in 28.9% of patients and sputum production daily or most of the days in 52.1%. Patients with mucus hypersecretion had more dyspnoea, poorer asthma control and quality of life, had suffered from more exacerbations and showed anosmia associated with chronic rhinosinusitis and nasal polyposis more frequently. Factors associated to mucus hypersecretion were anosmia, one exacerbation or more in the previous year and FEV1/FVC <70% (AUC 0.75, 95% CI 0.66-0.85) for the first definition of hypersecretion, and anosmia, poor asthma control and age (AUC 0.75, 95% CI 0.67-0.83) for the second definition.
CONCLUSIONS: Mucus hypersecretion is frequent in patients with asthma, and is associated with chronic upper airways disease, airway obstruction, poor asthma control and more exacerbations.
背景：支气管哮喘高分泌是研究较少的哮喘症状。本研究的目的是确定哮喘患者支气管高分泌的特点。
方法:共有142名哮喘患者（21.8%为男性；平均年龄49.8岁）进行前瞻性随访一年。黏液高分泌在临床上分两类：每日咳痰严重与频繁的咳痰但并不是每天均有。用多元回归分析评估临床和肺功能变量及伴有黏液高分泌。
结果: 28.9%的患者每日咳嗽，52.1%患者每日或大部分时间有痰。粘液分泌过多的患者往往呼吸困难更重、哮喘控制与生活质量均较差，更容易急性发作，并且嗅觉相关的慢性鼻窦炎和鼻息肉易频繁。粘液分泌过多有关的因素是嗅觉障碍，一次或过去几年的频繁急性发作，FEV1/FVC＜70%（AUC 0.75，95% CI 0.66-0.85）为高分泌的第一决定要素，嗅觉障碍、哮喘控制不佳和年龄（AUC 0.75，95% CI 0.67-0.83）为第二决定要素。
结论：哮喘患者的气道黏液高分泌频繁出现，并与慢性上气道疾病，气道阻塞，哮喘控制不佳、急性发作相关。
(中日友好医院医院呼吸与危重症学科 李红雯 摘译 林江涛 审校)
(Respir Med. 2018 Feb;135:22-28. doi: 10.1016/j.rmed.2017.12.013. Epub 2018 Jan 3)
(Respir Med. 2018 Feb;135:22-28. doi: 10.1016/j.rmed.2017.12.013. Epub 2018 Jan 3)
Mucus hypersecretion in asthma is associated with rhinosinusitis, polyps and exacerbations
Martínez-Rivera C, Crespo A
Abstract
BACKGROUND: Bronchial hypersecretion is a poorly studied symptom in asthma. The aim of the study was to determine the specific characteristics of asthmatics with bronchial hypersecretion.
METHODS: A total of 142 asthmatics (21.8% men; mean age 49.8 years) were prospectively followed for one year. Mucus hypersecretion was clinically classified into two severity categories: daily sputum production and frequent expectoration but not every day. Clinical and pulmonary function variables associated with mucus hypersecretion were assessed by multiple logistic regression analysis.
RESULTS: Daily cough was recorded in 28.9% of patients and sputum production daily or most of the days in 52.1%. Patients with mucus hypersecretion had more dyspnoea, poorer asthma control and quality of life, had suffered from more exacerbations and showed anosmia associated with chronic rhinosinusitis and nasal polyposis more frequently. Factors associated to mucus hypersecretion were anosmia, one exacerbation or more in the previous year and FEV1/FVC <70% (AUC 0.75, 95% CI 0.66-0.85) for the first definition of hypersecretion, and anosmia, poor asthma control and age (AUC 0.75, 95% CI 0.67-0.83) for the second definition.
CONCLUSIONS: Mucus hypersecretion is frequent in patients with asthma, and is associated with chronic upper airways disease, airway obstruction, poor asthma control and more exacerbations.
上一篇：
漏诊和过度诊断COPD对医疗卫生服务造成的负担
下一篇：
海拔1500米以上，是 哮喘发病率的主要决定因素，一项生态学研究
