中重度哮喘成人和儿童中新冠肺炎严重结局的风险：一项系统回顾和荟萃分析
2022/11/22
摘要
背景：英国疫苗和免疫联合委员会要求进行证据综合，以探明哮喘与新型冠状病毒相关疾病（COVID-19）结局之间的关系。
目的：本研究通过系统回顾和荟萃分析，总结了有证据表明未控制哮喘或有重症哮喘标志物的患者发生严重新型冠状病毒相关疾病的风险。
方法：按照国际或国家哮喘指南，使用大剂量吸入性糖皮质激素（ICS）或口服糖皮质激素（OCS）作为重症哮喘的标志物。使用Joanna Briggs Institute工具评估偏差风险。提取随机效应荟萃分析和亚组分析的调整点估计。
结果：筛选后，12项研究（成人11项，儿童1项）符合合格标准。应用大剂量ICS或OCS的成年人的合并校正危险比（aHR）为1.33（95%可信区间1.06-1.67，I2=0%），而COVID-19死亡率的aHR为1.22（95%CI 0.90-1.65，I2=70%）。在亚组分析中，我们发现尚无足够的证据表明COVID-19死亡率相关标记物之间存在关联。
结论：与未使用者相比，患有重症哮喘的成年人感染COVID-19的风险更高。本研究分析强调了各研究缺乏对哮喘儿童与COVID-19结局严重程度之间相关性的研究。
Risk of serious COVID-19 outcomes among adults and children with moderate-to-severe asthma: a systematic review and meta-analysis.
Lee B, Lewis G, Agyei-Manu E, Atkins N, Bhattacharyya U, Dozier M, Rostron J, Sheikh A, McQuillan R, Theodoratou E; Usher Network for COVID-19 Evidence Reviews (UNCOVER) group.
Abstract
BACKGROUND:The Joint Committee on Vaccination and Immunisation in the United Kingdom requested an evidence synthesis to investigate the relationship between asthma and coronavirus disease 2019 (COVID-19) outcomes.
OBJECTIVES: We conducted a systematic review and meta-analysis to summarise evidence on the risk of severe COVID-19 outcomes in people with uncontrolled asthma or markers of asthma severity.
METHODS:High-dose inhaled corticosteroids (ICS) or oral corticosteroids (OCS) were used as markers of asthma severity, following international or national asthma guidelines. Risk of bias was assessed using Joanna Briggs Institute tools. Adjusted point estimates were extracted for random-effects meta-analyses and subgroup analyses.
RESULTS:After screening, 12 studies (11 in adults and one in children) met the eligibility criteria. Adults using high-dose ICS or OCS had a pooled adjusted hazard ratio (aHR) of 1.33 (95% CI 1.06-1.67, I2=0%) for hospitalisation and an aHR of 1.22 (95% CI 0.90-1.65, I2=70%) for mortality for COVID-19. We found insufficient evidence for associations between markers on COVID-19 mortality in the subgroup analyses.
CONCLUSIONS:Adults with severe asthma are at increased risk of COVID-19 hospitalisation compared to nonusers. Our analysis highlighted the dearth of studies in children with asthma investigating serious COVID-19 outcomes.
背景：英国疫苗和免疫联合委员会要求进行证据综合，以探明哮喘与新型冠状病毒相关疾病（COVID-19）结局之间的关系。
目的：本研究通过系统回顾和荟萃分析，总结了有证据表明未控制哮喘或有重症哮喘标志物的患者发生严重新型冠状病毒相关疾病的风险。
方法：按照国际或国家哮喘指南，使用大剂量吸入性糖皮质激素（ICS）或口服糖皮质激素（OCS）作为重症哮喘的标志物。使用Joanna Briggs Institute工具评估偏差风险。提取随机效应荟萃分析和亚组分析的调整点估计。
结果：筛选后，12项研究（成人11项，儿童1项）符合合格标准。应用大剂量ICS或OCS的成年人的合并校正危险比（aHR）为1.33（95%可信区间1.06-1.67，I2=0%），而COVID-19死亡率的aHR为1.22（95%CI 0.90-1.65，I2=70%）。在亚组分析中，我们发现尚无足够的证据表明COVID-19死亡率相关标记物之间存在关联。
结论：与未使用者相比，患有重症哮喘的成年人感染COVID-19的风险更高。本研究分析强调了各研究缺乏对哮喘儿童与COVID-19结局严重程度之间相关性的研究。
(中日友好医院呼吸与危重症医学科 张婧媛 摘译 林江涛 审校)
(Eur Respir Rev. 2022 Nov 2;31(166):220066. doi: 10.1183/16000617.0066-2022.)
(Eur Respir Rev. 2022 Nov 2;31(166):220066. doi: 10.1183/16000617.0066-2022.)
Risk of serious COVID-19 outcomes among adults and children with moderate-to-severe asthma: a systematic review and meta-analysis.
Lee B, Lewis G, Agyei-Manu E, Atkins N, Bhattacharyya U, Dozier M, Rostron J, Sheikh A, McQuillan R, Theodoratou E; Usher Network for COVID-19 Evidence Reviews (UNCOVER) group.
Abstract
BACKGROUND:The Joint Committee on Vaccination and Immunisation in the United Kingdom requested an evidence synthesis to investigate the relationship between asthma and coronavirus disease 2019 (COVID-19) outcomes.
OBJECTIVES: We conducted a systematic review and meta-analysis to summarise evidence on the risk of severe COVID-19 outcomes in people with uncontrolled asthma or markers of asthma severity.
METHODS:High-dose inhaled corticosteroids (ICS) or oral corticosteroids (OCS) were used as markers of asthma severity, following international or national asthma guidelines. Risk of bias was assessed using Joanna Briggs Institute tools. Adjusted point estimates were extracted for random-effects meta-analyses and subgroup analyses.
RESULTS:After screening, 12 studies (11 in adults and one in children) met the eligibility criteria. Adults using high-dose ICS or OCS had a pooled adjusted hazard ratio (aHR) of 1.33 (95% CI 1.06-1.67, I2=0%) for hospitalisation and an aHR of 1.22 (95% CI 0.90-1.65, I2=70%) for mortality for COVID-19. We found insufficient evidence for associations between markers on COVID-19 mortality in the subgroup analyses.
CONCLUSIONS:Adults with severe asthma are at increased risk of COVID-19 hospitalisation compared to nonusers. Our analysis highlighted the dearth of studies in children with asthma investigating serious COVID-19 outcomes.
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极端温度引发的哮喘：从流行病学证据到生物学合理性
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