合并症与哮喘之间的关联强度：一项荟萃分析
2023/03/21
摘要
背景：合并症和哮喘之间的关联强度从未与合并症在非哮喘人群中的流行率进行过排序。我们调查了合并症与哮喘之间的关联强度。
方法：对报告哮喘和非哮喘人群中合并症数据的观察性研究进行了全面的文献检索。进行了成对的荟萃分析，并通过Cohen's d方法将优势比和95%的置信区间与非哮喘人群的合并症比率锚定在一起，计算关联强度。Cohen's d=0.2、0.5和0.8分别是小、中、大效应的临界值；Cohen's d>0.8则是非常大效应。该综述已在PROSPERO数据库中注册；识别码为CRD42022295657。
结果：对5493776名受试者的数据进行了分析。过敏性鼻炎（OR 4.24，95% CI 3.82-4.71）、过敏性结膜炎（OR 2.63，95% CI 2.22-3.11）、支气管扩张（OR 4.89，95% CI 4.48-5.34）、高血压心肌病（OR 4.24，95% CI 2.06-8.90）和鼻塞（OR 3.30，95% CI 2。 96-3.67）与哮喘密切相关（Cohen's d>0.5和≤0.8）；COPD（OR 6.23，95% CI 4.43-8.77）和其他慢性呼吸道疾病（OR 12.85，95% CI 10.14-16.29）与哮喘非常密切相关（Cohen's d>0.8）。在合并症和严重哮喘之间发现了更强的关联。根据漏斗图和Egger测试，没有出现偏差。
结论：这项荟萃分析支持个体化策略与疾病管理的相关性，而不仅仅局限于哮喘。应采用多维方法来评估症状控制不良是否与哮喘失控或潜在合并症失控有关。
Strength of association between comorbidities and asthma: a meta-analysis
Rogliani P, Laitano R, Ora J, Beasley R, Calzetta L
Abstract
BACKGROUND:The strength of association between comorbidities and asthma has never been ranked in relation to the prevalence of the comorbidity in the nonasthma population. We investigated the strength of association between comorbidities and asthma.
METHODS:A comprehensive literature search was performed for observational studies reporting data on comorbidities in asthma and nonasthma populations. A pairwise meta-analysis was performed and the strength of association calculated by anchoring odds ratios and 95% confidence intervals with the rate of comorbidities in nonasthma populations via Cohen's d method. Cohen's d=0.2, 0.5 and 0.8 were cut-off values for small, medium and large effect sizes, respectively; very large effect size resulted for Cohen's d >0.8. The review was registered in the PROSPERO database; identifier number CRD42022295657.
RESULTS:Data from 5 493 776 subjects were analysed. Allergic rhinitis (OR 4.24, 95% CI 3.82-4.71), allergic conjunctivitis (OR 2.63, 95% CI 2.22-3.11), bronchiectasis (OR 4.89, 95% CI 4.48-5.34), hypertensive cardiomyopathy (OR 4.24, 95% CI 2.06-8.90) and nasal congestion (OR 3.30, 95% CI 2.96-3.67) were strongly associated with asthma (Cohen's d >0.5 and ≤0.8); COPD (OR 6.23, 95% CI 4.43-8.77) and other chronic respiratory diseases (OR 12.85, 95% CI 10.14-16.29) were very strongly associated with asthma (Cohen's d >0.8). Stronger associations were detected between comorbidities and severe asthma. No bias resulted according to funnel plots and Egger's test.
CONCLUSION:This meta-analysis supports the relevance of individualised strategies for disease management that look beyond asthma. A multidimensional approach should be used to assess whether poor symptom control is related to uncontrolled asthma or to uncontrolled underlying comorbidities.
背景：合并症和哮喘之间的关联强度从未与合并症在非哮喘人群中的流行率进行过排序。我们调查了合并症与哮喘之间的关联强度。
方法：对报告哮喘和非哮喘人群中合并症数据的观察性研究进行了全面的文献检索。进行了成对的荟萃分析，并通过Cohen's d方法将优势比和95%的置信区间与非哮喘人群的合并症比率锚定在一起，计算关联强度。Cohen's d=0.2、0.5和0.8分别是小、中、大效应的临界值；Cohen's d>0.8则是非常大效应。该综述已在PROSPERO数据库中注册；识别码为CRD42022295657。
结果：对5493776名受试者的数据进行了分析。过敏性鼻炎（OR 4.24，95% CI 3.82-4.71）、过敏性结膜炎（OR 2.63，95% CI 2.22-3.11）、支气管扩张（OR 4.89，95% CI 4.48-5.34）、高血压心肌病（OR 4.24，95% CI 2.06-8.90）和鼻塞（OR 3.30，95% CI 2。 96-3.67）与哮喘密切相关（Cohen's d>0.5和≤0.8）；COPD（OR 6.23，95% CI 4.43-8.77）和其他慢性呼吸道疾病（OR 12.85，95% CI 10.14-16.29）与哮喘非常密切相关（Cohen's d>0.8）。在合并症和严重哮喘之间发现了更强的关联。根据漏斗图和Egger测试，没有出现偏差。
结论：这项荟萃分析支持个体化策略与疾病管理的相关性，而不仅仅局限于哮喘。应采用多维方法来评估症状控制不良是否与哮喘失控或潜在合并症失控有关。
(中日友好医院呼吸与危重症医学科 沈焜路 摘译 林江涛 审校)
(Eur Respir Rev. 2023 Mar 8; DOI: 10.1183/16000617.0202-2022)
(Eur Respir Rev. 2023 Mar 8; DOI: 10.1183/16000617.0202-2022)
Strength of association between comorbidities and asthma: a meta-analysis
Rogliani P, Laitano R, Ora J, Beasley R, Calzetta L
Abstract
BACKGROUND:The strength of association between comorbidities and asthma has never been ranked in relation to the prevalence of the comorbidity in the nonasthma population. We investigated the strength of association between comorbidities and asthma.
METHODS:A comprehensive literature search was performed for observational studies reporting data on comorbidities in asthma and nonasthma populations. A pairwise meta-analysis was performed and the strength of association calculated by anchoring odds ratios and 95% confidence intervals with the rate of comorbidities in nonasthma populations via Cohen's d method. Cohen's d=0.2, 0.5 and 0.8 were cut-off values for small, medium and large effect sizes, respectively; very large effect size resulted for Cohen's d >0.8. The review was registered in the PROSPERO database; identifier number CRD42022295657.
RESULTS:Data from 5 493 776 subjects were analysed. Allergic rhinitis (OR 4.24, 95% CI 3.82-4.71), allergic conjunctivitis (OR 2.63, 95% CI 2.22-3.11), bronchiectasis (OR 4.89, 95% CI 4.48-5.34), hypertensive cardiomyopathy (OR 4.24, 95% CI 2.06-8.90) and nasal congestion (OR 3.30, 95% CI 2.96-3.67) were strongly associated with asthma (Cohen's d >0.5 and ≤0.8); COPD (OR 6.23, 95% CI 4.43-8.77) and other chronic respiratory diseases (OR 12.85, 95% CI 10.14-16.29) were very strongly associated with asthma (Cohen's d >0.8). Stronger associations were detected between comorbidities and severe asthma. No bias resulted according to funnel plots and Egger's test.
CONCLUSION:This meta-analysis supports the relevance of individualised strategies for disease management that look beyond asthma. A multidimensional approach should be used to assess whether poor symptom control is related to uncontrolled asthma or to uncontrolled underlying comorbidities.
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