全球重症哮喘的描述：来自国际重症哮喘登记(ISAR)
2020/01/07
摘要
背景：迄今为止，国际上重症哮喘人群的临床特征仍不清楚。区域/国家重症哮喘登记处各异的数据阻碍各国间的比较。我们的目的是描述美国、欧洲及亚太地区重症哮喘患者的人口统计学及临床特征。
方法：在国际重症哮喘注册(ISAR)对重症哮喘患者(年龄≥18周岁)，即接受GINA5级治疗或GINA4级仍不能控制，进行回顾性及前瞻性数据收集。基线人口统计学及临床数据来自从2014年12月至2017年12月收集的美国、英国、韩国、意大利及SAWD（包括澳大利亚、新加坡及新西兰）注册中心。
结果：研究包括4990名患者。平均年龄55.0 (SD: 15.9)岁，哮喘发病年龄30.7 (SD: 17.7)岁。患者主要为女性(59.3%)、白色人种(72.6%)、无吸烟史(60.5%)及超重/肥胖(70.4%)患者。34.9% 达GINA 5级治疗。57.2%疾病控制不佳。51.1%患者规律使用OCS，25.4%患者使用生物制剂(其中72.6% 处于GINA 5级)。平均急性发作率1.7 (SD: 2.7)/年。在临床特点、诊疗规则及生物标志物方面可见看到各国之间存在差异。
结论：使用共同的数据组和定义，本研究首次描述了多个重症哮喘登记中包含大量患者的重症哮喘特征，并确定国家间差异的存在。这些是否与潜在的流行病学、环境因素、表型、哮喘管理系统、治疗途径和/或文化因素有关需要进一步研究。
Characterization of severe asthma worldwide: data from the International Severe Asthma Registry(ISAR).
Eileen W, Wechsler ME, Tran TN, Heaney LG, Jones RC, Menzies-Gow AN, Busby J, Jackson DJ, Pfeffer PE, Rhee CK, Cho YS, Canonica GW, Heffler E, Gibson PG, Hew M, Peters M, Harvey ES, Alacqua M, Zangrilli J, Bulathsinhala L, Carter VA, Chaudhry I, Eleangovan N, Hosseini N, Murray RB, Price DB.
Abstract
BACKGROUND: To date, clinical characteristics of the international severe asthma population are unknown. Inter-country comparisons are hindered by variable data collection within regional/national severe asthma registries. Our aim was to describe demographic and clinical characteristics of patients managed in severe asthma services in the USA, Europe, and Asia/Pacific region.
METHODS:The International Severe Asthma Registry (ISAR) retrospectively and prospectively collected data on severe asthma patients (≥18 years old), receiving GINA Step 5 treatment or remaining uncontrolled on GINA Step 4. Baseline demographic and clinical data were collected from the U.S., UK, South Korea, Italy, and the SAWD registry (including Australia, Singapore and New Zealand) from December 2014-December 2017.
RESULTS:4,990 patients were included. Average age was 55.0 (SD: 15.9) years, and age at asthma onset 30.7 (SD: 17.7) years. Patients were predominantly female (59.3%), white (72.6%), had never smoked (60.5%) and were over-weight/obese (70.4%). 34.9% were on GINA Step 5. 57.2% had poorly controlled disease. 51.1% of patients were on regular intermittent OCS and 25.4% were on biologics (72.6% for those on GINA Step 5). Mean exacerbation rate was 1.7 (SD: 2.7) per year. Inter-country variation was observed in clinical characteristics, prescribed treatments and biomarker profiles.
CONCLUSIONS:Using a common dataset and definitions, this study is the first to describe severe asthma characteristics of a large cohort of patients included in multiple severe asthma registries, and to identify country differences. Whether these are related to underlying epidemiological, environmental factors, phenotype,asthma management systems, treatment access and/or cultural factors requires further study.
背景：迄今为止，国际上重症哮喘人群的临床特征仍不清楚。区域/国家重症哮喘登记处各异的数据阻碍各国间的比较。我们的目的是描述美国、欧洲及亚太地区重症哮喘患者的人口统计学及临床特征。
方法：在国际重症哮喘注册(ISAR)对重症哮喘患者(年龄≥18周岁)，即接受GINA5级治疗或GINA4级仍不能控制，进行回顾性及前瞻性数据收集。基线人口统计学及临床数据来自从2014年12月至2017年12月收集的美国、英国、韩国、意大利及SAWD（包括澳大利亚、新加坡及新西兰）注册中心。
结果：研究包括4990名患者。平均年龄55.0 (SD: 15.9)岁，哮喘发病年龄30.7 (SD: 17.7)岁。患者主要为女性(59.3%)、白色人种(72.6%)、无吸烟史(60.5%)及超重/肥胖(70.4%)患者。34.9% 达GINA 5级治疗。57.2%疾病控制不佳。51.1%患者规律使用OCS，25.4%患者使用生物制剂(其中72.6% 处于GINA 5级)。平均急性发作率1.7 (SD: 2.7)/年。在临床特点、诊疗规则及生物标志物方面可见看到各国之间存在差异。
结论：使用共同的数据组和定义，本研究首次描述了多个重症哮喘登记中包含大量患者的重症哮喘特征，并确定国家间差异的存在。这些是否与潜在的流行病学、环境因素、表型、哮喘管理系统、治疗途径和/或文化因素有关需要进一步研究。
（中日友好医院呼吸与危重症医学科 张鑫 摘译 林江涛 审校）
（Chest. 2019 Nov 27. pii: S0012-3692(19)34295-3.）
（Chest. 2019 Nov 27. pii: S0012-3692(19)34295-3.）
Characterization of severe asthma worldwide: data from the International Severe Asthma Registry(ISAR).
Eileen W, Wechsler ME, Tran TN, Heaney LG, Jones RC, Menzies-Gow AN, Busby J, Jackson DJ, Pfeffer PE, Rhee CK, Cho YS, Canonica GW, Heffler E, Gibson PG, Hew M, Peters M, Harvey ES, Alacqua M, Zangrilli J, Bulathsinhala L, Carter VA, Chaudhry I, Eleangovan N, Hosseini N, Murray RB, Price DB.
Abstract
BACKGROUND: To date, clinical characteristics of the international severe asthma population are unknown. Inter-country comparisons are hindered by variable data collection within regional/national severe asthma registries. Our aim was to describe demographic and clinical characteristics of patients managed in severe asthma services in the USA, Europe, and Asia/Pacific region.
METHODS:The International Severe Asthma Registry (ISAR) retrospectively and prospectively collected data on severe asthma patients (≥18 years old), receiving GINA Step 5 treatment or remaining uncontrolled on GINA Step 4. Baseline demographic and clinical data were collected from the U.S., UK, South Korea, Italy, and the SAWD registry (including Australia, Singapore and New Zealand) from December 2014-December 2017.
RESULTS:4,990 patients were included. Average age was 55.0 (SD: 15.9) years, and age at asthma onset 30.7 (SD: 17.7) years. Patients were predominantly female (59.3%), white (72.6%), had never smoked (60.5%) and were over-weight/obese (70.4%). 34.9% were on GINA Step 5. 57.2% had poorly controlled disease. 51.1% of patients were on regular intermittent OCS and 25.4% were on biologics (72.6% for those on GINA Step 5). Mean exacerbation rate was 1.7 (SD: 2.7) per year. Inter-country variation was observed in clinical characteristics, prescribed treatments and biomarker profiles.
CONCLUSIONS:Using a common dataset and definitions, this study is the first to describe severe asthma characteristics of a large cohort of patients included in multiple severe asthma registries, and to identify country differences. Whether these are related to underlying epidemiological, environmental factors, phenotype,asthma management systems, treatment access and/or cultural factors requires further study.
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过敏性疾病和自身免疫性疾病的长期风险:纵向队列研究和聚类分析
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多种户外环境因素对哮喘发作风险的短期影响:年龄分层时间序列分析
