哮喘恶化与肺功能下降有关：一项基于人群的纵向研究
2022/08/19
摘要
背景：哮喘患者肺功能（LF）进行性下降会导致哮喘恶化，还是哮喘恶化会导致肺功能下降。证据有限，结果参差不齐。
方法：这项针对 Optimum Patient Care Research Database 中哮喘患者群体的历史队列研究，纳入符合条件的18岁以后出生并记录了峰值呼气流速 (PEF)（初步分析）或第一秒用力呼气流速（FEV1)（敏感性分析）的哮喘患者。调整后的线性增长模型测试了平均年恶化率 (AER) 和 LF 轨迹之间的关联。
结果：我们研究了109182 名患者，随访时间从5年到50年不等，其中75280名患者的所有变量都包含在调整后的分析中。每增加一次恶化，估计每年额外损失-1.34 L/min PEF（95% CI -1.23，-1.50）。与 AER 为0的患者相比，AER > 2/年且基线年龄为18-24 岁的患者额外损失了-5.95 L/min PEF/年（95% CI -8.63，-3.28）。随着基线年龄的增加，AER组间LF下降率的差异逐渐变小。使用FEV1测定结果与上述结果一致。
结论：据我们所知，这项研究是同类研究中规模最大的全国性队列研究，表明哮喘恶化与 LF下降速度加快有关。这在年轻患者中更为突出，但当与较低的起始LF相关时，则在老年患者中更为明显，这表明随着时间的推移，成年期会出现持续恶化的表型。对年轻哮喘患者进行适当管理的早期干预可能有助于防止LF过度下降。
Asthma exacerbations are associated with a decline in lung function: a longitudinal population-based study.
Seyi Soremekun, Liam G Heaney, Derek Skinner
Abstrast
Background：Progressive lung function (LF) decline in patients with asthma contributes to worse outcomes. Asthma exacerbations are thought to contribute to this decline; however, evidence is limited with mixed results.
Methods：This historical cohort study of a broad asthma patient population in the Optimum Patient Care Research Database, examined asthma patients with 3+eligible post-18th birthday peak expiratory flow rate (PEF) records (primary analysis) or records of forced expiratory flow in 1 s (FEV) (sensitivity analysis). Adjusted linear growth models tested the association between mean annual exacerbation rate (AER) and LF trajectory.
Results：We studied 1 09 182 patients with follow-up ranging from 5 to 50 years, of which 75 280 had data for all variables included in the adjusted analyses. For each additional exacerbation, an estimated additional -1.34 L/min PEF per year (95% CI -1.23 to -1.50) were lost. Patients with AERs >2/year and aged 18-24 years at baseline lost an additional -5.95 L/min PEF/year (95% CI -8.63 to -3.28) compared with those with AER 0. These differences in the rate of LF decline between AER groups became progressively smaller as age at baseline increased. The results using FEV were consistent with the above.
Conclusion：To our knowledge, this study is the largest nationwide cohort of its kind and demonstrates that asthma exacerbations are associated with faster LF decline. This was more prominent in younger patients but was evident in older patients when it was related to lower starting LF, suggesting a persistent deteriorating phenotype that develops in adulthood over time. Earlier intervention with appropriate management in younger patients with asthma could be of value to prevent excessive LF decline.
背景：哮喘患者肺功能（LF）进行性下降会导致哮喘恶化，还是哮喘恶化会导致肺功能下降。证据有限，结果参差不齐。
方法：这项针对 Optimum Patient Care Research Database 中哮喘患者群体的历史队列研究，纳入符合条件的18岁以后出生并记录了峰值呼气流速 (PEF)（初步分析）或第一秒用力呼气流速（FEV1)（敏感性分析）的哮喘患者。调整后的线性增长模型测试了平均年恶化率 (AER) 和 LF 轨迹之间的关联。
结果：我们研究了109182 名患者，随访时间从5年到50年不等，其中75280名患者的所有变量都包含在调整后的分析中。每增加一次恶化，估计每年额外损失-1.34 L/min PEF（95% CI -1.23，-1.50）。与 AER 为0的患者相比，AER > 2/年且基线年龄为18-24 岁的患者额外损失了-5.95 L/min PEF/年（95% CI -8.63，-3.28）。随着基线年龄的增加，AER组间LF下降率的差异逐渐变小。使用FEV1测定结果与上述结果一致。
结论：据我们所知，这项研究是同类研究中规模最大的全国性队列研究，表明哮喘恶化与 LF下降速度加快有关。这在年轻患者中更为突出，但当与较低的起始LF相关时，则在老年患者中更为明显，这表明随着时间的推移，成年期会出现持续恶化的表型。对年轻哮喘患者进行适当管理的早期干预可能有助于防止LF过度下降。
(中日友好医院呼吸与危重症医学科 万静萱 摘译 林江涛 审校)
(Thorax 2022 Aug 03; doi:10.1136/thorax-2021-217032 IF：9.102)
(Thorax 2022 Aug 03; doi:10.1136/thorax-2021-217032 IF：9.102)
Asthma exacerbations are associated with a decline in lung function: a longitudinal population-based study.
Seyi Soremekun, Liam G Heaney, Derek Skinner
Abstrast
Background：Progressive lung function (LF) decline in patients with asthma contributes to worse outcomes. Asthma exacerbations are thought to contribute to this decline; however, evidence is limited with mixed results.
Methods：This historical cohort study of a broad asthma patient population in the Optimum Patient Care Research Database, examined asthma patients with 3+eligible post-18th birthday peak expiratory flow rate (PEF) records (primary analysis) or records of forced expiratory flow in 1 s (FEV) (sensitivity analysis). Adjusted linear growth models tested the association between mean annual exacerbation rate (AER) and LF trajectory.
Results：We studied 1 09 182 patients with follow-up ranging from 5 to 50 years, of which 75 280 had data for all variables included in the adjusted analyses. For each additional exacerbation, an estimated additional -1.34 L/min PEF per year (95% CI -1.23 to -1.50) were lost. Patients with AERs >2/year and aged 18-24 years at baseline lost an additional -5.95 L/min PEF/year (95% CI -8.63 to -3.28) compared with those with AER 0. These differences in the rate of LF decline between AER groups became progressively smaller as age at baseline increased. The results using FEV were consistent with the above.
Conclusion：To our knowledge, this study is the largest nationwide cohort of its kind and demonstrates that asthma exacerbations are associated with faster LF decline. This was more prominent in younger patients but was evident in older patients when it was related to lower starting LF, suggesting a persistent deteriorating phenotype that develops in adulthood over time. Earlier intervention with appropriate management in younger patients with asthma could be of value to prevent excessive LF decline.
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住宅绿化与中国幼儿过敏性疾病之间的关系:一项出生队列研究
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哮喘持续气流限制表型的预测因子和相关性：ATLANTIS研究的事后分析
