分析毛发以监测哮喘或COPD患者使用吸入药物的依从性
2018/09/10
摘要
背景：哮喘和/或COPD患者对吸入药物治疗的较差依从性可能使其治疗效果欠佳。 已经采用测量毛发样品中的残留药物来评估口服药物的使用情况。在这里，通过测试分析哮喘和/或COPD患者头发样本的可行性，来评估对吸入药物的依从性。
方法：总共招募了200名男性和女性受试者，其年龄≥18岁，处于哮喘和/或COPD稳定期，每日吸入药物在可接受标准范围内。在门诊就诊期间采集头发样本，并通过Fischer-Saller量表根据头发颜色分组。使用固相萃取技术从研磨的毛发样品中提取残留药物，并使用液相色谱－串联质谱法分析。
结果：72％的受试者在毛发中检测到吸入药物，并且可由此分析样本（n = 157/200）。 从使用福莫特罗或维兰特罗的受试者中获得的大多数头发样品具有可确定浓度的药物量，并且能够证明剂量反应。在所有颜色的毛发中都有检测到药物，与浅色毛发相比，在深色毛发中观察到更高浓度的福莫特罗。
结论：这是第一项证明吸入药物可以在患有哮喘和/或COPD的受试者的毛发样本中检测的研究。结果显示，毛发中的药物浓度能够提供既往使用吸入药物的依从性情况。
Hair analysis to monitor adherence to prescribed chronic inhaler drug therapy in patients with asthma or COPD
Dave Hassall, Noushin Brealey
Abstract
Background:Poor adherence to inhaled drug therapy in individuals with asthma and/or chronic obstructive pulmonary disease (COPD) may be associated with suboptimal therapeutic outcomes. Measurement of drug residues in hair samples has been employed to assess oral medication use over time. Here, we test the feasibility of analyzing hair samples from patients with asthma and/or COPD for assessing adherence to prescribed inhaled medication.
Methods:In total, 200 male and female subjects, ≥ 18 years of age, with stable asthma and/or COPD who were receiving an acceptable standard of care daily inhaled product consistently, were recruited. Head hair samples were taken during a single visit to the clinical site and grouped by hair color according to the Fischer-Saller scale. Drug residues were extracted from milled hair samples using solid-phase extraction and analyzed using liquid chromatography–tandem mass spectrometry.
Results:Inhaled drugs were detected in hair for 72% of subjects from whom it was possible to analyze hair samples (n=157/200). Most hair samples obtained from subjects receiving formoterol or vilanterol had amounts of drug present that allowed determination of a quantifiable concentration, and demonstrated a dose response. Drugs were detected in all hair colors, with higher concentrations of formoterol observed in dark- haired versus light-haired individuals.
Conclusions:This is the first study to demonstrate that inhaled medication can be measured in hair samples from subjects with asthma and/or COPD. The results show that hair drug concentration data could potentially provide a record of historical adherence to inhaled therapeutics.
背景：哮喘和/或COPD患者对吸入药物治疗的较差依从性可能使其治疗效果欠佳。 已经采用测量毛发样品中的残留药物来评估口服药物的使用情况。在这里，通过测试分析哮喘和/或COPD患者头发样本的可行性，来评估对吸入药物的依从性。
方法：总共招募了200名男性和女性受试者，其年龄≥18岁，处于哮喘和/或COPD稳定期，每日吸入药物在可接受标准范围内。在门诊就诊期间采集头发样本，并通过Fischer-Saller量表根据头发颜色分组。使用固相萃取技术从研磨的毛发样品中提取残留药物，并使用液相色谱－串联质谱法分析。
结果：72％的受试者在毛发中检测到吸入药物，并且可由此分析样本（n = 157/200）。 从使用福莫特罗或维兰特罗的受试者中获得的大多数头发样品具有可确定浓度的药物量，并且能够证明剂量反应。在所有颜色的毛发中都有检测到药物，与浅色毛发相比，在深色毛发中观察到更高浓度的福莫特罗。
结论：这是第一项证明吸入药物可以在患有哮喘和/或COPD的受试者的毛发样本中检测的研究。结果显示，毛发中的药物浓度能够提供既往使用吸入药物的依从性情况。
（中日友好医院呼吸与危重症医学科 张鑫 摘译 林江涛 审校）
（Pulmonary Pharmacology & Therapeutics 51 (2018) 59–64.）
（Pulmonary Pharmacology & Therapeutics 51 (2018) 59–64.）
Hair analysis to monitor adherence to prescribed chronic inhaler drug therapy in patients with asthma or COPD
Dave Hassall, Noushin Brealey
Abstract
Background:Poor adherence to inhaled drug therapy in individuals with asthma and/or chronic obstructive pulmonary disease (COPD) may be associated with suboptimal therapeutic outcomes. Measurement of drug residues in hair samples has been employed to assess oral medication use over time. Here, we test the feasibility of analyzing hair samples from patients with asthma and/or COPD for assessing adherence to prescribed inhaled medication.
Methods:In total, 200 male and female subjects, ≥ 18 years of age, with stable asthma and/or COPD who were receiving an acceptable standard of care daily inhaled product consistently, were recruited. Head hair samples were taken during a single visit to the clinical site and grouped by hair color according to the Fischer-Saller scale. Drug residues were extracted from milled hair samples using solid-phase extraction and analyzed using liquid chromatography–tandem mass spectrometry.
Results:Inhaled drugs were detected in hair for 72% of subjects from whom it was possible to analyze hair samples (n=157/200). Most hair samples obtained from subjects receiving formoterol or vilanterol had amounts of drug present that allowed determination of a quantifiable concentration, and demonstrated a dose response. Drugs were detected in all hair colors, with higher concentrations of formoterol observed in dark- haired versus light-haired individuals.
Conclusions:This is the first study to demonstrate that inhaled medication can be measured in hair samples from subjects with asthma and/or COPD. The results show that hair drug concentration data could potentially provide a record of historical adherence to inhaled therapeutics.
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肺部超声在成人肺炎、急性心衰、慢性阻塞性肺疾病／哮喘急性加重的紧急诊断中的应用：系统评价及Meta分析
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