系统评估难治性和严重哮喘独立于单克隆生物制剂，可改善预后、减轻口服皮质类固醇的负担
2020/02/11
摘要
背景：指南支持对严重哮喘患者进行系统性评估，数据表明在多方面均有获益。
目的：研究哪些患者对系统评价有反应，以及口服皮质类固醇剂量是否可以独立于单克隆生物制剂而降低。
方法：本中心对专科转诊的难治性哮喘患者进行系统评估。我们对症状控制、生活质量、急性发作和气流阻塞等方面的改善进行了反应分析，并在初步评估后6个月进行评估。对每个方面进行多变量分析，以确定反应的预测因素。同时还监测口服皮质类固醇剂量的变化，在评估期间用是否使用单克隆生物制剂进行分层。
结果：在161名系统评估的患者中，64%的患者急性加重减少，54%的患者在症状控制和生活质量方面达到了最小的临床重要差异，40%的患者FEV1增加≥100ml。总之，87%的哮喘患者至少在一个方面得到了改善。不同方面反应最一致的预测因子是较差的哮喘基线状态。平均口服皮质类固醇剂量（11 mg至5 mg，n=46，p<0.001）显著减少，即使排除了7名使用单克隆生物制剂的患者（11 mg至5.6 mg，n=39，p<0.001），
结论：近90%的重症哮喘患者接受系统评估后，至少有一个关键的哮喘转归有显著改善，几乎没有可靠的反应预测因子。在系统评估期间，口服皮质类固醇剂量减半与单克隆生物制剂无关，且在数量上可比。
Systematic assessment for difficult and severe asthma improves outcomes and halves oral corticosteroid burden independent of monoclonal biologic use.
Denton E; Lee Bhb J; Tay T; Radhakrishna N; Hore-Lacy F; Mackay A; Hoy R; Dabscheck E; O'Hehir RE; Hew M.
The Journal of Allergy & Clinical Immunology in Practice. 2020 Jan 15.
ABSTRACT
BACKGROUND: Guidelines endorse systematic assessment for severe asthma, with data indicating benefit across multiple outcome domains.
OBJECTIVE: We examined which patients respond to systematic assessment and whether oral corticosteroid burden can be decreased independent of monoclonal biologic use.
METHODS: Specialist-referred patients are assessed systematically for difficult asthma at our centre. We undertook a responder analysis for improvements in the domains of symptom control, quality of life, exacerbations and airflow obstruction, assessed six months after initial assessment. Multivariate analyses were performed for each domain to identify predictors of response. Changes in oral corticosteroid burden were also measured, stratified by monoclonal biologics commenced during assessment.
RESULTS: Among 161 patients assessed systematically, 64% had a reduction in exacerbations, 54% achieved minimum clinically important differences for both symptom control and quality of life, and 40% increased their FEV1 by >= 100 ml. Altogether, 87% of asthma patients improved in at least one domain. The most consistent predictor of response across domains was poorer baseline asthma status. There was a substantial reduction in mean chronic oral corticosteroid dose (11 mg to 5 mg, n=46, p<0.001), even after excluding seven patients commenced on monoclonal biologics (11 mg to 5.6 mg, n=39, p<0.001).
CONCLUSION: Almost 90% of patients undergoing systematic assessment for difficult asthma improve significantly in at least one key asthma outcome, with few reliable predictors of response. The halving of oral corticosteroid burden during systematic assessment is independent of, and comparable in magnitude to, that achieved by monoclonal biologics.
背景：指南支持对严重哮喘患者进行系统性评估，数据表明在多方面均有获益。
目的：研究哪些患者对系统评价有反应，以及口服皮质类固醇剂量是否可以独立于单克隆生物制剂而降低。
方法：本中心对专科转诊的难治性哮喘患者进行系统评估。我们对症状控制、生活质量、急性发作和气流阻塞等方面的改善进行了反应分析，并在初步评估后6个月进行评估。对每个方面进行多变量分析，以确定反应的预测因素。同时还监测口服皮质类固醇剂量的变化，在评估期间用是否使用单克隆生物制剂进行分层。
结果：在161名系统评估的患者中，64%的患者急性加重减少，54%的患者在症状控制和生活质量方面达到了最小的临床重要差异，40%的患者FEV1增加≥100ml。总之，87%的哮喘患者至少在一个方面得到了改善。不同方面反应最一致的预测因子是较差的哮喘基线状态。平均口服皮质类固醇剂量（11 mg至5 mg，n=46，p<0.001）显著减少，即使排除了7名使用单克隆生物制剂的患者（11 mg至5.6 mg，n=39，p<0.001），
结论：近90%的重症哮喘患者接受系统评估后，至少有一个关键的哮喘转归有显著改善，几乎没有可靠的反应预测因子。在系统评估期间，口服皮质类固醇剂量减半与单克隆生物制剂无关，且在数量上可比。
(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)
(The Journal of Allergy & Clinical Immunology in Practice. 2020 Jan 15.)
(The Journal of Allergy & Clinical Immunology in Practice. 2020 Jan 15.)
Systematic assessment for difficult and severe asthma improves outcomes and halves oral corticosteroid burden independent of monoclonal biologic use.
Denton E; Lee Bhb J; Tay T; Radhakrishna N; Hore-Lacy F; Mackay A; Hoy R; Dabscheck E; O'Hehir RE; Hew M.
The Journal of Allergy & Clinical Immunology in Practice. 2020 Jan 15.
ABSTRACT
BACKGROUND: Guidelines endorse systematic assessment for severe asthma, with data indicating benefit across multiple outcome domains.
OBJECTIVE: We examined which patients respond to systematic assessment and whether oral corticosteroid burden can be decreased independent of monoclonal biologic use.
METHODS: Specialist-referred patients are assessed systematically for difficult asthma at our centre. We undertook a responder analysis for improvements in the domains of symptom control, quality of life, exacerbations and airflow obstruction, assessed six months after initial assessment. Multivariate analyses were performed for each domain to identify predictors of response. Changes in oral corticosteroid burden were also measured, stratified by monoclonal biologics commenced during assessment.
RESULTS: Among 161 patients assessed systematically, 64% had a reduction in exacerbations, 54% achieved minimum clinically important differences for both symptom control and quality of life, and 40% increased their FEV1 by >= 100 ml. Altogether, 87% of asthma patients improved in at least one domain. The most consistent predictor of response across domains was poorer baseline asthma status. There was a substantial reduction in mean chronic oral corticosteroid dose (11 mg to 5 mg, n=46, p<0.001), even after excluding seven patients commenced on monoclonal biologics (11 mg to 5.6 mg, n=39, p<0.001).
CONCLUSION: Almost 90% of patients undergoing systematic assessment for difficult asthma improve significantly in at least one key asthma outcome, with few reliable predictors of response. The halving of oral corticosteroid burden during systematic assessment is independent of, and comparable in magnitude to, that achieved by monoclonal biologics.
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