支气管热成形术减少了由多次呼吸氮冲洗技术测量的通气异质性
2020/12/17
摘要
背景:尽管证实了支气管热成形术(BT)的症状益处，但其潜在的病理生理益处尚不明确。本研究的目的是将BT治疗后的临床疗效与肺生理变化联系起来，重点研究使用多次呼吸氮冲洗技术(MBNW)评估通气均匀性，以及这是如何受到气道容量和阻力变化的影响。
方法:连续21例严重哮喘患者(n=21)计划接受BT治疗，在基线、治疗结束后6周和6个月进行评估。评估包括哮喘控制问卷(ACQ)、药物使用、加重频率、肺活量测定、体积描记和MBNW。
其中18名患者接受了详细的CT评估，以估计基线时和在左肺接受BT治疗后，在右肺治疗之前的气道容积。数据取均值±方差。
结果:BT治疗后患者的ACQ从基线的3.4±0.8提高到6个月后的2.0±1.1(p<0.001)。急性加重期需要激素治疗从BT前6个月的3.1±2.9下降到BT后的1.4±1.7(p<0.001)。维持口服类固醇剂量和短效激动剂的使用显著减少。治疗后CT扫描测得的气道容积明显增加。FEV1从1.34±0.65 l改善到1.52±0.76 l (p=0.024)。残余体积从2.87±0.89 l下降到2.71±0.93 l (p=0.008)，总气道阻力(Raw)从10.58±6.56 cmh2 .s下降到7.64±3.74 cmh2 .s。l−1 (p = 0.020)。肺清除率(LCI)在基线时为187±63%，治疗后由12.7±3.3提高到11.8±2.4 (p=0.049)。LCI的改善与Raw的改善相关(r=0.463, p=0.035)。
结论:BT治疗后的临床益处伴随着肺生理的改善，包括肺均匀性的正常化，这似乎是由气道扩张和阻力降低所致。
Bronchial thermoplasty reduces ventilation heterogeneity measured by multiple breath nitrogen washout
Langton D, Bennetts K, Thien F, et al.
Abstract
BACKGROUND:Despite demonstrated symptomatic beneft from bronchial thermoplasty (BT), the underlying pathophysiological benefts have been uncertain. The purpose of the present study was to relate clinical beneft after BT to changes in lung physiology, focusing on ventilation homogeneity assessed using multiple breath nitrogen washout (MBNW), and how this may be afected by changes in airway volume and resistance.
Methods: Consecutive patients (n=21) with severe asthma scheduled for BT, were evaluated at baseline, 6 weeks and 6 months after completion of treatment. Assessments included the Asthma Control Questionnaire (ACQ), medication usage, exacerbation frequency, spirometry, plethysmography and MBNW. Eighteen of these patients underwent detailed CT evaluation for the estimation of airway volume at baseline and then after the left lung had received BT treatment but prior to right lung treatment. Data are mean±STDEV.
Results: Patients responded to BT with an improvement in ACQ from 3.4±0.8 at baseline to 2.0±1.1 at 6 months(p<0.001). Steroid requiring exacerbations fell from 3.1±2.9 in the 6 months prior to BT to 1.4±1.7 following BT (p<0.001). Signifcant reductions in maintenance oral steroid dosing and short acting beta agonist use were observed. Airway volume measured by CT scanning significantly increased after treatment. The FEV1 improved from 1.34±0.65 l to 1.52±0.76 l (p=0.024). The Residual Volume fell from 2.87±0.89 l to 2.71±0.93 l (p=0.008) and Total Airway Resistance (Raw) from 10.58±6.56 to 7.64±3.74 cmH2O.s.l−1 (p=0.020). The Lung Clearance Index (LCI) was 187±63% predicted at baseline and improved after treatment from 12.7±3.3 to 11.8±2.4 (p=0.049). The improvement in LCI correlated with the improvement in Raw (r=0.463, p=0.035)
Conclusion: Clinical beneft after BT is accompanied by improvements in lung physiology, including normalisation of lung homogeneity that seems to be driven by airway dilation and reduced resistance.
背景:尽管证实了支气管热成形术(BT)的症状益处，但其潜在的病理生理益处尚不明确。本研究的目的是将BT治疗后的临床疗效与肺生理变化联系起来，重点研究使用多次呼吸氮冲洗技术(MBNW)评估通气均匀性，以及这是如何受到气道容量和阻力变化的影响。
方法:连续21例严重哮喘患者(n=21)计划接受BT治疗，在基线、治疗结束后6周和6个月进行评估。评估包括哮喘控制问卷(ACQ)、药物使用、加重频率、肺活量测定、体积描记和MBNW。
其中18名患者接受了详细的CT评估，以估计基线时和在左肺接受BT治疗后，在右肺治疗之前的气道容积。数据取均值±方差。
结果:BT治疗后患者的ACQ从基线的3.4±0.8提高到6个月后的2.0±1.1(p<0.001)。急性加重期需要激素治疗从BT前6个月的3.1±2.9下降到BT后的1.4±1.7(p<0.001)。维持口服类固醇剂量和短效激动剂的使用显著减少。治疗后CT扫描测得的气道容积明显增加。FEV1从1.34±0.65 l改善到1.52±0.76 l (p=0.024)。残余体积从2.87±0.89 l下降到2.71±0.93 l (p=0.008)，总气道阻力(Raw)从10.58±6.56 cmh2 .s下降到7.64±3.74 cmh2 .s。l−1 (p = 0.020)。肺清除率(LCI)在基线时为187±63%，治疗后由12.7±3.3提高到11.8±2.4 (p=0.049)。LCI的改善与Raw的改善相关(r=0.463, p=0.035)。
结论:BT治疗后的临床益处伴随着肺生理的改善，包括肺均匀性的正常化，这似乎是由气道扩张和阻力降低所致。
（中日友好医院呼吸与危重症医学科 李春晓 摘译 林江涛 审校）
（Respir Res, 2020, 21(1): 308.）
（Respir Res, 2020, 21(1): 308.）
Bronchial thermoplasty reduces ventilation heterogeneity measured by multiple breath nitrogen washout
Langton D, Bennetts K, Thien F, et al.
Abstract
BACKGROUND:Despite demonstrated symptomatic beneft from bronchial thermoplasty (BT), the underlying pathophysiological benefts have been uncertain. The purpose of the present study was to relate clinical beneft after BT to changes in lung physiology, focusing on ventilation homogeneity assessed using multiple breath nitrogen washout (MBNW), and how this may be afected by changes in airway volume and resistance.
Methods: Consecutive patients (n=21) with severe asthma scheduled for BT, were evaluated at baseline, 6 weeks and 6 months after completion of treatment. Assessments included the Asthma Control Questionnaire (ACQ), medication usage, exacerbation frequency, spirometry, plethysmography and MBNW. Eighteen of these patients underwent detailed CT evaluation for the estimation of airway volume at baseline and then after the left lung had received BT treatment but prior to right lung treatment. Data are mean±STDEV.
Results: Patients responded to BT with an improvement in ACQ from 3.4±0.8 at baseline to 2.0±1.1 at 6 months(p<0.001). Steroid requiring exacerbations fell from 3.1±2.9 in the 6 months prior to BT to 1.4±1.7 following BT (p<0.001). Signifcant reductions in maintenance oral steroid dosing and short acting beta agonist use were observed. Airway volume measured by CT scanning significantly increased after treatment. The FEV1 improved from 1.34±0.65 l to 1.52±0.76 l (p=0.024). The Residual Volume fell from 2.87±0.89 l to 2.71±0.93 l (p=0.008) and Total Airway Resistance (Raw) from 10.58±6.56 to 7.64±3.74 cmH2O.s.l−1 (p=0.020). The Lung Clearance Index (LCI) was 187±63% predicted at baseline and improved after treatment from 12.7±3.3 to 11.8±2.4 (p=0.049). The improvement in LCI correlated with the improvement in Raw (r=0.463, p=0.035)
Conclusion: Clinical beneft after BT is accompanied by improvements in lung physiology, including normalisation of lung homogeneity that seems to be driven by airway dilation and reduced resistance.
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支气管热成形术与美泊利单抗：在严重哮喘门诊的结局比较
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青少年和成人哮喘管理：国家哮喘教育和预防计划2020年哮喘指南更新
