控制性哮喘患者停用吸入糖皮质激素：DISCO研究
2021/04/23
摘要
背景：尽管吸入糖皮质激素（ICSs）是治疗哮喘的首选一线治疗方法，但对轻度哮喘患者决定继续还是停止ICS治疗仍然是临床医生面临的挑战。多项研究表明，轻度持续性哮喘患者在ICS停药后仍能保持良好的控制状态。然而，ICS退出的长期结果尚未确定。
目的：探讨轻度哮喘患者停用ICS的临床疗效。
方法：我们调查了控制良好的轻度哮喘患者中断ICSs的临床结果，并比较了停止ICS治疗（ICS停药组，IWG）和持续治疗（ICS持续组，CIG）3年的患者失去控制（LOC）的时间。
结果：IWG组与CIG组发生LOC的时间有显著性差异（危险比[HR]，2.56；95%可信区间[CI]，1.52-4.33；P<0.001）。呼出气一氧化氮水平和痰嗜酸性粒细胞计数（%）增高显示与CIG中LOC风险之间存在微弱但显著的相关性。LOC组痰嗜酸性粒细胞计数和血清总免疫球蛋白E水平明显高于非LOC组。
结论：维持ICS治疗有助于控制哮喘。此外，LOC患者的CIG痰嗜酸性粒细胞计数明显高于非LOC组。因此，轻度、控制良好的哮喘患者持续使用ICS可获得良好的临床效果。
Discontinuation of inhaled corticosteroids in patients with controlled asthma: The DISCO study
Jung-Hyun Kim, Juhae Jin, Seo Young Park, So-Young Park, Hyo-Jung Kim, Min-Hye Kim, Hyouk-Soo Kwon, Woo-Jung Song, Sae-Hoon Kim, Heung-Woo Park, Yoon-Seok Chang, You Sook Cho, Young-Joo Cho, Sang-Heon Cho, Hee-Bom Moon, Tae-Bum Kim
Abstract
Background: Although inhaled corticosteroids (ICSs) are the recommended first-line therapy for asthma, determining whether to continue or discontinue ICS treatment in patients with mild asthma remains challenging for clinicians. Several studies have demonstrated that patients with mild-persistent asthma maintained a well-controlled state after ICS withdrawal. However, the long-term outcomes of ICS withdrawal have not yet been determined.
Objective: We aimed to determine the possible clinical outcomes of the discontinuation of ICS in patients with well-controlled mild asthma.
Methods: We investigated the clinical outcomes of discontinuing ICSs in patients with well-controlled mild asthma and compared the time to loss of control (LOC) between patients who stopped ICS treatment (ICS withdrawal group, IWG) and those who continued treatment for three years (continuous ICS group, CIG).
Results: A significant difference in the time to LOC was observed between the IWG and CIG (hazard ratio [HR], 2.56; 95% confidence interval [CI], 1.52-4.33; P < 0.001). Increasing fractional exhaled nitric oxide levels and sputum eosinophil counts (%) revealed a weak but significant association with LOC risk in the CIG. The sputum eosinophil counts and serum total immunoglobulin E levels were significantly higher in the LOC group than in the non-LOC group of the CIG.
Conclusion: Our results suggest that the maintenance of ICS treatment may help keep patients' asthma under control. Furthermore, patients with LOC had significantly higher sputum eosinophil counts in the CIG than those in the non-LOC group. Therefore, continuous ICS use by patients with mild, well-controlled asthma could be associated with good clinical outcomes.
背景：尽管吸入糖皮质激素（ICSs）是治疗哮喘的首选一线治疗方法，但对轻度哮喘患者决定继续还是停止ICS治疗仍然是临床医生面临的挑战。多项研究表明，轻度持续性哮喘患者在ICS停药后仍能保持良好的控制状态。然而，ICS退出的长期结果尚未确定。
目的：探讨轻度哮喘患者停用ICS的临床疗效。
方法：我们调查了控制良好的轻度哮喘患者中断ICSs的临床结果，并比较了停止ICS治疗（ICS停药组，IWG）和持续治疗（ICS持续组，CIG）3年的患者失去控制（LOC）的时间。
结果：IWG组与CIG组发生LOC的时间有显著性差异（危险比[HR]，2.56；95%可信区间[CI]，1.52-4.33；P<0.001）。呼出气一氧化氮水平和痰嗜酸性粒细胞计数（%）增高显示与CIG中LOC风险之间存在微弱但显著的相关性。LOC组痰嗜酸性粒细胞计数和血清总免疫球蛋白E水平明显高于非LOC组。
结论：维持ICS治疗有助于控制哮喘。此外，LOC患者的CIG痰嗜酸性粒细胞计数明显高于非LOC组。因此，轻度、控制良好的哮喘患者持续使用ICS可获得良好的临床效果。
(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)
(Ann Allergy Asthma Immunol. 2021 Apr 2;S1081-1206(21)00263-5. doi: 10.1016/j.anai.2021.03.031.)
(Ann Allergy Asthma Immunol. 2021 Apr 2;S1081-1206(21)00263-5. doi: 10.1016/j.anai.2021.03.031.)
Discontinuation of inhaled corticosteroids in patients with controlled asthma: The DISCO study
Jung-Hyun Kim, Juhae Jin, Seo Young Park, So-Young Park, Hyo-Jung Kim, Min-Hye Kim, Hyouk-Soo Kwon, Woo-Jung Song, Sae-Hoon Kim, Heung-Woo Park, Yoon-Seok Chang, You Sook Cho, Young-Joo Cho, Sang-Heon Cho, Hee-Bom Moon, Tae-Bum Kim
Abstract
Background: Although inhaled corticosteroids (ICSs) are the recommended first-line therapy for asthma, determining whether to continue or discontinue ICS treatment in patients with mild asthma remains challenging for clinicians. Several studies have demonstrated that patients with mild-persistent asthma maintained a well-controlled state after ICS withdrawal. However, the long-term outcomes of ICS withdrawal have not yet been determined.
Objective: We aimed to determine the possible clinical outcomes of the discontinuation of ICS in patients with well-controlled mild asthma.
Methods: We investigated the clinical outcomes of discontinuing ICSs in patients with well-controlled mild asthma and compared the time to loss of control (LOC) between patients who stopped ICS treatment (ICS withdrawal group, IWG) and those who continued treatment for three years (continuous ICS group, CIG).
Results: A significant difference in the time to LOC was observed between the IWG and CIG (hazard ratio [HR], 2.56; 95% confidence interval [CI], 1.52-4.33; P < 0.001). Increasing fractional exhaled nitric oxide levels and sputum eosinophil counts (%) revealed a weak but significant association with LOC risk in the CIG. The sputum eosinophil counts and serum total immunoglobulin E levels were significantly higher in the LOC group than in the non-LOC group of the CIG.
Conclusion: Our results suggest that the maintenance of ICS treatment may help keep patients' asthma under control. Furthermore, patients with LOC had significantly higher sputum eosinophil counts in the CIG than those in the non-LOC group. Therefore, continuous ICS use by patients with mild, well-controlled asthma could be associated with good clinical outcomes.
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