难治性哮喘的新观点；基于性别和年龄的哮喘发病表型
2020/07/13
摘要
背景：哮喘是一种可影响不同年龄和性别的疾病。然而，目前尚不清楚性别、哮喘发病年龄和/或它们之间的相互作用是如何影响成人“难治性”哮喘的临床表现的。
目的：通过新的表型分类，按哮喘发病的性别和年龄对受试者进行分层，更好地了解真实世界中难治性哮喘的临床特征。
方法：英国的一项纵向难治性哮喘临床队列研究（Wessex难治性哮喘队列；观察）的参与者，（n=501）根据哮喘发病的性别和年龄（早发<18岁或成人≥18岁）分为4个难治性哮喘表型，并与临床和病理生理特征相关。
结果：该队列有更多的女性受访者（65%），但早发或成人发病的参与者比例相似。早发女性哮喘患者最常见（35%），具有高度特应性，肺功能良好，与某些生理合并症有很强的相关性，但心理生理合并症最高。成年发病女性哮喘患者也有相当多的心理-生理合并症，肥胖率最高，特应性最少。在男性受试者中，成人发病的比例更高。早发男性哮喘患者最罕见（14%），肺功能最差，与吸烟、过敏和真菌过敏有关。尽管疾病持续时间最短，成年发病的男性哮喘患者使用维持性口服糖皮质激素的比例最高，肺功能差，吸烟率最高，FeNO水平也最高。
结论：本研究表明，性别、哮喘发病年龄及其相互作用影响难治性哮喘的不同临床表现，并发现成年发病男性哮喘患者吸烟相关的肺功能丧失和口服糖皮质激素依赖风险增加。
New Perspectives on Difficult Asthma; Sex and Age of Asthma-Onset Based Phenotypes
Adnan Azim, Anna Freeman, Audrey Lavenu, Heena Mistry, Hans Michael Haitchi, Colin Newell, Yueqing Cheng, Yvette Thirlwall, Matthew Harvey, Clair Barber, Katarina Pontoppidan, Paddy Dennison, S Hasan Arshad, Ratko Djukanovic, Peter Howarth, Ramesh J Kurukulaaratchy
Abstract
Background: Asthma is a diverse condition that differs with age and sex. However, it remains unclear how sex, age of asthma-onset, and/or their interaction, influence clinical expression of more problematic adult "difficult" asthma.
Objectives: To better understand the clinical features of difficult asthma within a real-world clinical setting using novel phenotypic classification, stratifying subjects by sex and age of asthma-onset.
Methods: Participants in a longitudinal difficult asthma clinical cohort study (Wessex AsThma CoHort of difficult asthma; WATCH), United Kingdom, (n=501) were stratified into 4 difficult asthma phenotypes based on sex and age of asthma-onset (early<18-years or adult≥18-years) and characterised in relation to clinical and pathophysiological features.
Results: The cohort had more female participants (65%) but had similar proportions of participants with early or adult-onset disease. Early-onset female disease was commonest (35%), highly atopic, with good spirometry and strong associations to some physical comorbidities but highest psychophysiologic comorbidities. Adult-onset females also had considerable psychophysiologic comorbidities, highest obesity, and were least atopic. Amongst male subjects, proportionately more had adult-onset disease. Early-onset male disease was rarest (14%) but associated with worst lung function, high smoking, atopy and fungal sensitisation. Despite shortest disease duration, adult-onset males had highest use of maintenance oral corticosteroid, poor lung function and highest FeNO in spite of highest smoking prevalence.
Conclusion: This study shows that sex, age of asthma-onset, and their interactions influence different clinical manifestations of difficult asthma and identifies a greater risk for lung function loss and oral corticosteroid dependency associated with smoking in adult-onset male subjects.
背景：哮喘是一种可影响不同年龄和性别的疾病。然而，目前尚不清楚性别、哮喘发病年龄和/或它们之间的相互作用是如何影响成人“难治性”哮喘的临床表现的。
目的：通过新的表型分类，按哮喘发病的性别和年龄对受试者进行分层，更好地了解真实世界中难治性哮喘的临床特征。
方法：英国的一项纵向难治性哮喘临床队列研究（Wessex难治性哮喘队列；观察）的参与者，（n=501）根据哮喘发病的性别和年龄（早发<18岁或成人≥18岁）分为4个难治性哮喘表型，并与临床和病理生理特征相关。
结果：该队列有更多的女性受访者（65%），但早发或成人发病的参与者比例相似。早发女性哮喘患者最常见（35%），具有高度特应性，肺功能良好，与某些生理合并症有很强的相关性，但心理生理合并症最高。成年发病女性哮喘患者也有相当多的心理-生理合并症，肥胖率最高，特应性最少。在男性受试者中，成人发病的比例更高。早发男性哮喘患者最罕见（14%），肺功能最差，与吸烟、过敏和真菌过敏有关。尽管疾病持续时间最短，成年发病的男性哮喘患者使用维持性口服糖皮质激素的比例最高，肺功能差，吸烟率最高，FeNO水平也最高。
结论：本研究表明，性别、哮喘发病年龄及其相互作用影响难治性哮喘的不同临床表现，并发现成年发病男性哮喘患者吸烟相关的肺功能丧失和口服糖皮质激素依赖风险增加。
(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)
(J Allergy Clin Immunol Pract. 2020 Jun 13;S2213-2198(20)30594-8. doi: 10.1016/j.jaip.2020.05.053.)
(J Allergy Clin Immunol Pract. 2020 Jun 13;S2213-2198(20)30594-8. doi: 10.1016/j.jaip.2020.05.053.)
New Perspectives on Difficult Asthma; Sex and Age of Asthma-Onset Based Phenotypes
Adnan Azim, Anna Freeman, Audrey Lavenu, Heena Mistry, Hans Michael Haitchi, Colin Newell, Yueqing Cheng, Yvette Thirlwall, Matthew Harvey, Clair Barber, Katarina Pontoppidan, Paddy Dennison, S Hasan Arshad, Ratko Djukanovic, Peter Howarth, Ramesh J Kurukulaaratchy
Abstract
Background: Asthma is a diverse condition that differs with age and sex. However, it remains unclear how sex, age of asthma-onset, and/or their interaction, influence clinical expression of more problematic adult "difficult" asthma.
Objectives: To better understand the clinical features of difficult asthma within a real-world clinical setting using novel phenotypic classification, stratifying subjects by sex and age of asthma-onset.
Methods: Participants in a longitudinal difficult asthma clinical cohort study (Wessex AsThma CoHort of difficult asthma; WATCH), United Kingdom, (n=501) were stratified into 4 difficult asthma phenotypes based on sex and age of asthma-onset (early<18-years or adult≥18-years) and characterised in relation to clinical and pathophysiological features.
Results: The cohort had more female participants (65%) but had similar proportions of participants with early or adult-onset disease. Early-onset female disease was commonest (35%), highly atopic, with good spirometry and strong associations to some physical comorbidities but highest psychophysiologic comorbidities. Adult-onset females also had considerable psychophysiologic comorbidities, highest obesity, and were least atopic. Amongst male subjects, proportionately more had adult-onset disease. Early-onset male disease was rarest (14%) but associated with worst lung function, high smoking, atopy and fungal sensitisation. Despite shortest disease duration, adult-onset males had highest use of maintenance oral corticosteroid, poor lung function and highest FeNO in spite of highest smoking prevalence.
Conclusion: This study shows that sex, age of asthma-onset, and their interactions influence different clinical manifestations of difficult asthma and identifies a greater risk for lung function loss and oral corticosteroid dependency associated with smoking in adult-onset male subjects.
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