英国成人哮喘急性发作模式：一项基于人群的研究
2019/01/09
摘要
哮喘理论上来说是异质性的，目前关于哮喘急性加重模式的研究是缺乏的。既往已有相对较短随访时间或针对重症哮喘的研究。本研究的目的是对包括所有疾病严重程度的患者在内的人群长期随访，描述其急性加重模式。方法采用电子医疗记录对2007-2015年18-55岁哮喘患者及其病情加重情况进行调查。使用具有≥7年数据的队列描述由药物使用定义的哮喘严重程度的急性加重模式。使用logistic回归，计算散发性（单年加重）和复发性（>1年）急性加重模式危险因素的影响评估。在嵌套病例对照设计中，评估了病史跨越5年的恶化与未来恶化之间的关系。测量和主要结果显示51462例患者符合7年队列的要求，64%没有急性加重。在那些急性恶化的患者中，51%只发生过一次；恶化频率随疾病严重程度而增加。只有370例（0.7%）患者表现为频繁加重表型（每年加重），其中58%有轻/中度哮喘。确切的危险因素并非与特定的加重模式唯一相关。过去恶化比所有其他因素都增加了未来恶化的风险，尽管这种影响在5年内消散。结论在7年的随访中，大约三分之一的患者出现急性发作。在这些患者中，有一半人不再出现急性发作；未来恶化的时机在很大程度上是不可预测的。只有2%表现出频繁加重的表型。过去病情恶化模式是预测未来病情恶化的最具信息量的风险因素。
Exacerbation Patterns in Adults with Asthma in England: A Population Based Study.
Bloom CI, Palmer T, Feary J, Quint JK, Cullinan P
Abstract
Rationale Asthma is heterogeneous and knowledge on exacerbation patterns is lacking. Previous studies have had a relatively short follow-up or focused on severe disease. Objectives Describe exacerbation patterns over a prolonged follow-up in a population including patients of all disease severity. Methods We used electronic healthcare records to identify asthma patients aged 18-55 years and their exacerbations, 2007-2015. A cohort with ≥7-years of data was used to describe exacerbation patterns by asthma severity defined by medication use. Effect estimates for risk factors were calculated for sporadic (single year of exacerbations) and recurrent (>1 year) exacerbation patterns, using logistic regression. In a nested case-control design, the association between a history of exacerbations, spanning 5-years, and a future exacerbation was examined. Measurements and Main Results 51,462 patients were eligible for the 7-year cohort; 64% had no exacerbations. Of those who exacerbated, 51% did so only once; exacerbation frequency increased with disease severity. Only 370 patients (0.7%) were characterised by a frequent-exacerbator phenotype (yearly exacerbations), of whom 58% had mild/moderate asthma. Exacerbation risk factors were not uniquely associated with a particular exacerbation pattern. A past exacerbation increased the risk of a future exacerbation more than all other factors, although this effect dissipated over 5-years. Conclusions During 7-years of follow-up, exacerbations occur in around one-third of patients. Of those who exacerbate, half do not do so again; the timing of future exacerbations is largely unpredictable. Just 2% exhibit a frequent-exacerbator phenotype. Past exacerbation patterns are the most informative risk factor for predicting future exacerbations.
哮喘理论上来说是异质性的，目前关于哮喘急性加重模式的研究是缺乏的。既往已有相对较短随访时间或针对重症哮喘的研究。本研究的目的是对包括所有疾病严重程度的患者在内的人群长期随访，描述其急性加重模式。方法采用电子医疗记录对2007-2015年18-55岁哮喘患者及其病情加重情况进行调查。使用具有≥7年数据的队列描述由药物使用定义的哮喘严重程度的急性加重模式。使用logistic回归，计算散发性（单年加重）和复发性（>1年）急性加重模式危险因素的影响评估。在嵌套病例对照设计中，评估了病史跨越5年的恶化与未来恶化之间的关系。测量和主要结果显示51462例患者符合7年队列的要求，64%没有急性加重。在那些急性恶化的患者中，51%只发生过一次；恶化频率随疾病严重程度而增加。只有370例（0.7%）患者表现为频繁加重表型（每年加重），其中58%有轻/中度哮喘。确切的危险因素并非与特定的加重模式唯一相关。过去恶化比所有其他因素都增加了未来恶化的风险，尽管这种影响在5年内消散。结论在7年的随访中，大约三分之一的患者出现急性发作。在这些患者中，有一半人不再出现急性发作；未来恶化的时机在很大程度上是不可预测的。只有2%表现出频繁加重的表型。过去病情恶化模式是预测未来病情恶化的最具信息量的风险因素。
(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)
(Am J Respir Crit Care Med. 2018 Dec 3. doi: 10.1164/rccm.201808-1516OC)
(Am J Respir Crit Care Med. 2018 Dec 3. doi: 10.1164/rccm.201808-1516OC)
Exacerbation Patterns in Adults with Asthma in England: A Population Based Study.
Bloom CI, Palmer T, Feary J, Quint JK, Cullinan P
Abstract
Rationale Asthma is heterogeneous and knowledge on exacerbation patterns is lacking. Previous studies have had a relatively short follow-up or focused on severe disease. Objectives Describe exacerbation patterns over a prolonged follow-up in a population including patients of all disease severity. Methods We used electronic healthcare records to identify asthma patients aged 18-55 years and their exacerbations, 2007-2015. A cohort with ≥7-years of data was used to describe exacerbation patterns by asthma severity defined by medication use. Effect estimates for risk factors were calculated for sporadic (single year of exacerbations) and recurrent (>1 year) exacerbation patterns, using logistic regression. In a nested case-control design, the association between a history of exacerbations, spanning 5-years, and a future exacerbation was examined. Measurements and Main Results 51,462 patients were eligible for the 7-year cohort; 64% had no exacerbations. Of those who exacerbated, 51% did so only once; exacerbation frequency increased with disease severity. Only 370 patients (0.7%) were characterised by a frequent-exacerbator phenotype (yearly exacerbations), of whom 58% had mild/moderate asthma. Exacerbation risk factors were not uniquely associated with a particular exacerbation pattern. A past exacerbation increased the risk of a future exacerbation more than all other factors, although this effect dissipated over 5-years. Conclusions During 7-years of follow-up, exacerbations occur in around one-third of patients. Of those who exacerbate, half do not do so again; the timing of future exacerbations is largely unpredictable. Just 2% exhibit a frequent-exacerbator phenotype. Past exacerbation patterns are the most informative risk factor for predicting future exacerbations.
