支气管热成形术治疗成人哮喘急性发作的减少
2023/05/25
摘要
背景：支气管热成形术（BT）在随机对照试验中被证明是有效的，该试验针对的是使用大剂量吸入性皮质激素和支气管扩张剂都无法达到疾病控制的严重哮喘患者。然而，BT在现实世界的临床环境中的有效性，特别是在亚洲人中的有效性还没有确定。
目的：使用全国数据库评估BT的有效性。
方法：利用日本诊断程序组合数据库中的住院和门诊数据，我们采用了自我控制的病例系列设计，评估了BT前后1年内入院和急诊科就诊以及全身皮质类固醇剂量的综合结果变化。我们还根据患者的情况进行了亚组分析。
结果：在2014年9月至2020年3月期间接受BT治疗的561名哮喘患者中，分析了102名至少有一个结果的患者。BT与入院和急诊科就诊的综合结果改善显著相关（发生率比，0.53；95%置信区间，0.44-0.64）。全身皮质类固醇的使用在BT疗程后有所减少（每人每年激素量从1931.5 [1341.2-3725.3] mg到641.3 [134.2-1691.1] mg（P<0.001））。尽管在亚组分析中，所有组别都显示出综合结果的明显改善，但在年龄大于65岁的老年人和体重指数较高（大于25公斤/平方米）的人中，BT的效果往往较差。
结论：目前使用真实世界数据的研究表明，BT可以改善哮喘控制，但BT的有效性可能因患者基线情况而异。
Reduced asthma exacerbations in adult patients treated with bronchial thermoplasty
Akaba, T., Jo, T., Iwagami, M., Hashimoto, Y., Matsui, H., Fushimi, K., Tagaya, E., & Yasunaga, H.
Abstract
BACKGROUND：Bronchial thermoplasty (BT) has been shown to be effective in randomized controlled trials of patients with severe asthma who failed to achieve disease control with high-dose inhaled corticosteroids combined with bronchodilators. However, the effectiveness of BT in real-world clinical settings, especially among the Asian population has not been determined.
OBJECTIVE：To evaluate the effectiveness of BT using a nationwide database.
METHODS:Using the inpatient and outpatient data from the Japanese Diagnosis Procedure Combination database, we applied a self-controlled case series design to evaluate changes in the composite outcome of hospital admissions and emergency department visits, as well as systemic corticosteroid dose, between 1 year before and after BT. We also conducted subgroup analyses based on patients' profiles.
RESULTS:Among the 561 patients with asthma who underwent BT treatment between September 2014 and March 2020, 102 patients with at least one outcome were analyzed. BT was significantly associated with an improvement in the composite outcome of hospital admission and emergency department visits (incidence rate ratio, 0.53; 95% confidence interval, 0.44-0.64). Systemic corticosteroid use was reduced after BT sessions (1931.5 [1341.2-3725.3] mg to 641.3 [134.2-1691.1] mg per person-year (p<0.001)). Although all groups showed a significant improvement in the composite outcome in the subgroup analyses, BT tended to be less effective among older people aged > 65 years and those with higher body mass index (> 25 kg/m2).
CONCLUSION:The present study using real-world data suggests that BT may improve asthma control, however the effectiveness of BT can vary depending on patient baseline profiles.
背景：支气管热成形术（BT）在随机对照试验中被证明是有效的，该试验针对的是使用大剂量吸入性皮质激素和支气管扩张剂都无法达到疾病控制的严重哮喘患者。然而，BT在现实世界的临床环境中的有效性，特别是在亚洲人中的有效性还没有确定。
目的：使用全国数据库评估BT的有效性。
方法：利用日本诊断程序组合数据库中的住院和门诊数据，我们采用了自我控制的病例系列设计，评估了BT前后1年内入院和急诊科就诊以及全身皮质类固醇剂量的综合结果变化。我们还根据患者的情况进行了亚组分析。
结果：在2014年9月至2020年3月期间接受BT治疗的561名哮喘患者中，分析了102名至少有一个结果的患者。BT与入院和急诊科就诊的综合结果改善显著相关（发生率比，0.53；95%置信区间，0.44-0.64）。全身皮质类固醇的使用在BT疗程后有所减少（每人每年激素量从1931.5 [1341.2-3725.3] mg到641.3 [134.2-1691.1] mg（P<0.001））。尽管在亚组分析中，所有组别都显示出综合结果的明显改善，但在年龄大于65岁的老年人和体重指数较高（大于25公斤/平方米）的人中，BT的效果往往较差。
结论：目前使用真实世界数据的研究表明，BT可以改善哮喘控制，但BT的有效性可能因患者基线情况而异。
(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)
(J Allergy Clin Immunol Pract. 2023 May 9. DOI: 10.1016/j.jaip.2023.04.036)
(J Allergy Clin Immunol Pract. 2023 May 9. DOI: 10.1016/j.jaip.2023.04.036)
Reduced asthma exacerbations in adult patients treated with bronchial thermoplasty
Akaba, T., Jo, T., Iwagami, M., Hashimoto, Y., Matsui, H., Fushimi, K., Tagaya, E., & Yasunaga, H.
Abstract
BACKGROUND：Bronchial thermoplasty (BT) has been shown to be effective in randomized controlled trials of patients with severe asthma who failed to achieve disease control with high-dose inhaled corticosteroids combined with bronchodilators. However, the effectiveness of BT in real-world clinical settings, especially among the Asian population has not been determined.
OBJECTIVE：To evaluate the effectiveness of BT using a nationwide database.
METHODS:Using the inpatient and outpatient data from the Japanese Diagnosis Procedure Combination database, we applied a self-controlled case series design to evaluate changes in the composite outcome of hospital admissions and emergency department visits, as well as systemic corticosteroid dose, between 1 year before and after BT. We also conducted subgroup analyses based on patients' profiles.
RESULTS:Among the 561 patients with asthma who underwent BT treatment between September 2014 and March 2020, 102 patients with at least one outcome were analyzed. BT was significantly associated with an improvement in the composite outcome of hospital admission and emergency department visits (incidence rate ratio, 0.53; 95% confidence interval, 0.44-0.64). Systemic corticosteroid use was reduced after BT sessions (1931.5 [1341.2-3725.3] mg to 641.3 [134.2-1691.1] mg per person-year (p<0.001)). Although all groups showed a significant improvement in the composite outcome in the subgroup analyses, BT tended to be less effective among older people aged > 65 years and those with higher body mass index (> 25 kg/m2).
CONCLUSION:The present study using real-world data suggests that BT may improve asthma control, however the effectiveness of BT can vary depending on patient baseline profiles.
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美国婴儿期呼吸道合胞病毒感染与儿童期支气管哮喘（INSPIRE）研究：一项基于人群的前瞻性出生队列研究
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