通过用力振荡技术评估的支气管舒张效应比肺量计测定可更敏感地识别出较差的哮喘控制
2021/05/19
摘要
背景：哮喘诊断后仍持续存在的支气管舒张效应（Bronchodilator response，BDR）是一种认识不足的可治疗特征，常常与更差的肺功能和哮喘控制相关。用力振荡技术（Forced oscillation technique，FOT）可测量呼吸系统的阻抗，并且BDR截点值已被建议用于健康成年人，但是，其与哮喘的相关性尚不清楚。因此，我们分别使用FOT和肺量计测定法在哮喘病人中比较BDR截点值及与哮喘控制的关系。
方法：回顾性地分析了在三级医疗机构就诊，并且就诊前至少停用支气管扩张药8h的病人数据。所有受试者在给予沙丁胺醇前后都进行了FOT和肺活量测定，并完成了哮喘控制测试。检查的FOT参数包括5 Hz时的呼吸阻抗（R5）和电抗（X5），以及电抗曲线下的面积（AX）。 BDR在肺量计测定中根据标准推荐定义，在FOT中基于健康成年人BDR的95％进行定义。
结果：共纳入52例受试者（18例男性；均数年龄为53±18岁）。与肺量计测定法相比，FOT识别BDR的频率更高（占受试者的54％比27％）。 X5和AX评估的BDR，与肺量计评估的BDR相关（χ，P < .01），并且与哮喘控制相关（X5：rs = –0.36，P < .01; AX：rs = 0.34，P = .01）。而R5评估的BDR并无相关性。通过电抗参数测得的BDR比肺量计测定法能发现更多控制较差的哮喘受试者（AX，69％ vs. 肺量计测定，41％）。
结论：通过FOT评估的BDR可识别哮喘控制不佳。在确定哮喘控制不佳方面，电抗参数比肺量计测定法更敏感，故支持在哮喘临床管理中使用FOT作为肺量计测定法的补充方法。
Bronchodilator Response Assessed by the Forced Oscillation Technique Identifies Poor Asthma Control With Greater Sensitivity Than Spirometry
Alice M. Cottee; Leigh M. Seccombe; Cindy Thamrin; Gregory G. King; Matthew J. Peters; and Claude S. Farah
CHEST 2020; 157(6):1435-1441
Abstract
Background：Persistent bronchodilator response (BDR) following diagnosis of asthma is an underrecognized treatable trait, associated with worse lung function and asthma control. The forced oscillation technique (FOT) measures respiratory system impedance, and BDR cutoffs have been proposed for healthy adults; however, the relevance in asthma is unknown. We compared BDR cutoffs, using FOT and spirometry, in asthma and the relationship with asthma control.
Methods：Data from patients with asthma who withheld bronchodilator medication for at least 8 h before a tertiary airway clinic visit were reviewed. All subjects performed FOT and spirometry before and after salbutamol administration, and completed the Asthma Control Test. FOT parameters examined included respiratory system resistance (R5) and reactance (X5) at 5 Hz, and area under the reactance curve (AX). BDR was defined by standard recommendations for spirometry and based on the 95th percentile of BDR in healthy adults for FOT.
Results：Fifty-two subjects (18 men; mean age, 53±18 years) were included. BDR was identified more frequently by FOT than spirometry (54% vs 27% of subjects). BDR assessed by X5 and AX, but not R5, was associated with spirometric BDR (χ, P < .01) and correlated with asthma control (X5: rs = –0.36, P < .01; AX: rs = 0.34, P = .01). BDR measured by reactance parameters identified more subjects with poor asthma control than did spirometry (AX, 69% vs spirometry, 41%).
Conclusions：BDR assessed by FOT can identify poor asthma control. Reactance parameters were more sensitive in identifying poor asthma control than spirometry, supporting the use of FOT to complement spirometry in the clinical management of asthma.
背景：哮喘诊断后仍持续存在的支气管舒张效应（Bronchodilator response，BDR）是一种认识不足的可治疗特征，常常与更差的肺功能和哮喘控制相关。用力振荡技术（Forced oscillation technique，FOT）可测量呼吸系统的阻抗，并且BDR截点值已被建议用于健康成年人，但是，其与哮喘的相关性尚不清楚。因此，我们分别使用FOT和肺量计测定法在哮喘病人中比较BDR截点值及与哮喘控制的关系。
方法：回顾性地分析了在三级医疗机构就诊，并且就诊前至少停用支气管扩张药8h的病人数据。所有受试者在给予沙丁胺醇前后都进行了FOT和肺活量测定，并完成了哮喘控制测试。检查的FOT参数包括5 Hz时的呼吸阻抗（R5）和电抗（X5），以及电抗曲线下的面积（AX）。 BDR在肺量计测定中根据标准推荐定义，在FOT中基于健康成年人BDR的95％进行定义。
结果：共纳入52例受试者（18例男性；均数年龄为53±18岁）。与肺量计测定法相比，FOT识别BDR的频率更高（占受试者的54％比27％）。 X5和AX评估的BDR，与肺量计评估的BDR相关（χ，P < .01），并且与哮喘控制相关（X5：rs = –0.36，P < .01; AX：rs = 0.34，P = .01）。而R5评估的BDR并无相关性。通过电抗参数测得的BDR比肺量计测定法能发现更多控制较差的哮喘受试者（AX，69％ vs. 肺量计测定，41％）。
结论：通过FOT评估的BDR可识别哮喘控制不佳。在确定哮喘控制不佳方面，电抗参数比肺量计测定法更敏感，故支持在哮喘临床管理中使用FOT作为肺量计测定法的补充方法。
(房雪梅1 张红萍2 王刚1 四川大学华西医院中西医结合科呼吸病组 610041 摘译)
（CHEST 2020; 157(6):1435-1441）
（CHEST 2020; 157(6):1435-1441）
Bronchodilator Response Assessed by the Forced Oscillation Technique Identifies Poor Asthma Control With Greater Sensitivity Than Spirometry
Alice M. Cottee; Leigh M. Seccombe; Cindy Thamrin; Gregory G. King; Matthew J. Peters; and Claude S. Farah
CHEST 2020; 157(6):1435-1441
Abstract
Background：Persistent bronchodilator response (BDR) following diagnosis of asthma is an underrecognized treatable trait, associated with worse lung function and asthma control. The forced oscillation technique (FOT) measures respiratory system impedance, and BDR cutoffs have been proposed for healthy adults; however, the relevance in asthma is unknown. We compared BDR cutoffs, using FOT and spirometry, in asthma and the relationship with asthma control.
Methods：Data from patients with asthma who withheld bronchodilator medication for at least 8 h before a tertiary airway clinic visit were reviewed. All subjects performed FOT and spirometry before and after salbutamol administration, and completed the Asthma Control Test. FOT parameters examined included respiratory system resistance (R5) and reactance (X5) at 5 Hz, and area under the reactance curve (AX). BDR was defined by standard recommendations for spirometry and based on the 95th percentile of BDR in healthy adults for FOT.
Results：Fifty-two subjects (18 men; mean age, 53±18 years) were included. BDR was identified more frequently by FOT than spirometry (54% vs 27% of subjects). BDR assessed by X5 and AX, but not R5, was associated with spirometric BDR (χ, P < .01) and correlated with asthma control (X5: rs = –0.36, P < .01; AX: rs = 0.34, P = .01). BDR measured by reactance parameters identified more subjects with poor asthma control than did spirometry (AX, 69% vs spirometry, 41%).
Conclusions：BDR assessed by FOT can identify poor asthma control. Reactance parameters were more sensitive in identifying poor asthma control than spirometry, supporting the use of FOT to complement spirometry in the clinical management of asthma.
