重症和非重症哮喘的共患病负担：一项全国性观察性研究（FINASTHMA）
2023/10/25
摘要
背景：哮喘影响着全球3.3亿多人，与高发病率、死亡率和社会经济成本有关。
目的：在这项横断面研究中，我们分析了重症哮喘患者与非重症哮喘患者的合并症负担，并研究了皮质类固醇的使用对合并症风险的作用。
方法：对2014年至2017年间诊断为哮喘（国际疾病分类-第10版代码J45.x）的所有成年人（≥18岁）进行鉴定，并在2018年之前从芬兰全国登记处收集数据。根据每年分配的吸入皮质类固醇、口服皮质类固醇和住院情况，哮喘被定义为持续或间歇重症或非重症。
结果：在193730名被诊断为哮喘的成年患者中，86.3%患有非重症哮喘，8.1%患有间歇重症哮喘，5.6%患有持续重症哮喘。在调整了年龄和性别后，与非重症患者相比，持续性（22%）和间歇性重症哮喘患者（14%）的肺炎患病率过高。白内障、骨质疏松、肥胖、心力衰竭和心房颤动在重症哮喘患者中也更常见。吸入和/或口服皮质类固醇会以剂量依赖的方式增加几种合并症的风险，特别是肺炎、骨质疏松、肥胖、心力衰竭和心房颤动。高口服皮质类固醇使用率和合并症的存在与医疗资源使用增加有关。
结论：重症哮喘患者合并症负担较高，尤其是肺炎。许多合并症与吸入和口服皮质类固醇治疗具有强烈的剂量依赖性，这表明在临床实践中应仔细评估皮质类固醇剂量。
Comorbidity burden in severe and non-severe asthma: a nationwide observational study (FINASTHMA)
Hannu Kankaanranta, Arja Viinanen, Pinja Ilmarinen, Hanna Hisinger-Mölkänen, Juha Mehtälä, Tero Ylisaukko-Oja, Juhana J Idänpään-Heikkilä, Lauri Lehtimäki
Abstract
Background: Asthma, affecting more than 330 million people worldwide, is associated with a high level of morbidity, mortality, and socioeconomic costs.
Objective: In this cross-sectional study, we analyzed the comorbidity burden in patients with severe asthma compared to non-severe asthma and investigated the role of corticosteroid use on the risk of comorbidities.
Methods: All adults (≥18 years) with a diagnosis of asthma (International Classification of Diseases - 10th revision code J45.x) between 2014 and 2017 were identified and data were collected until 2018 from Finnish nationwide registers. Asthma was defined as continuously or transiently severe or non-severe based on annual dispensed inhaled corticosteroids, oral corticosteroids, and hospitalizations.
Results: Of 193,730 adult identified patients diagnosed with asthma, 86.3% had non-severe, 8.1% transiently severe, and 5.6% continuously severe asthma. Excess prevalence of pneumonia was observed in continuously (22%) and transiently severe (14%) compared with non-severe patients after adjusting for age and sex. Cataract, osteoporosis, obesity, heart failure, and atrial fibrillation were also more frequent in severe asthma patients. Inhaled and/or oral corticosteroid use contributed to the risk of several comorbidities in a dose-dependent manner, particularly pneumonia, osteoporosis, obesity, heart failure, and atrial fibrillation. High oral corticosteroid use and the presence of comorbidities were associated with increased healthcare resource use.
Conclusion: Patients with severe asthma have a high burden of comorbidities, especially pneumonia. Many of the comorbidities have a strong dose-dependent association with inhaled and oral corticosteroid treatment, suggesting that corticosteroid doses should be carefully evaluated in clinical practice.
背景：哮喘影响着全球3.3亿多人，与高发病率、死亡率和社会经济成本有关。
目的：在这项横断面研究中，我们分析了重症哮喘患者与非重症哮喘患者的合并症负担，并研究了皮质类固醇的使用对合并症风险的作用。
方法：对2014年至2017年间诊断为哮喘（国际疾病分类-第10版代码J45.x）的所有成年人（≥18岁）进行鉴定，并在2018年之前从芬兰全国登记处收集数据。根据每年分配的吸入皮质类固醇、口服皮质类固醇和住院情况，哮喘被定义为持续或间歇重症或非重症。
结果：在193730名被诊断为哮喘的成年患者中，86.3%患有非重症哮喘，8.1%患有间歇重症哮喘，5.6%患有持续重症哮喘。在调整了年龄和性别后，与非重症患者相比，持续性（22%）和间歇性重症哮喘患者（14%）的肺炎患病率过高。白内障、骨质疏松、肥胖、心力衰竭和心房颤动在重症哮喘患者中也更常见。吸入和/或口服皮质类固醇会以剂量依赖的方式增加几种合并症的风险，特别是肺炎、骨质疏松、肥胖、心力衰竭和心房颤动。高口服皮质类固醇使用率和合并症的存在与医疗资源使用增加有关。
结论：重症哮喘患者合并症负担较高，尤其是肺炎。许多合并症与吸入和口服皮质类固醇治疗具有强烈的剂量依赖性，这表明在临床实践中应仔细评估皮质类固醇剂量。
(中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校)
(J Allergy Clin Immunol Pract. 2023 Oct 3:S2213-2198(23)01066-8. doi: 10.1016/j.jaip.2023.09.034.)
(J Allergy Clin Immunol Pract. 2023 Oct 3:S2213-2198(23)01066-8. doi: 10.1016/j.jaip.2023.09.034.)
Comorbidity burden in severe and non-severe asthma: a nationwide observational study (FINASTHMA)
Hannu Kankaanranta, Arja Viinanen, Pinja Ilmarinen, Hanna Hisinger-Mölkänen, Juha Mehtälä, Tero Ylisaukko-Oja, Juhana J Idänpään-Heikkilä, Lauri Lehtimäki
Abstract
Background: Asthma, affecting more than 330 million people worldwide, is associated with a high level of morbidity, mortality, and socioeconomic costs.
Objective: In this cross-sectional study, we analyzed the comorbidity burden in patients with severe asthma compared to non-severe asthma and investigated the role of corticosteroid use on the risk of comorbidities.
Methods: All adults (≥18 years) with a diagnosis of asthma (International Classification of Diseases - 10th revision code J45.x) between 2014 and 2017 were identified and data were collected until 2018 from Finnish nationwide registers. Asthma was defined as continuously or transiently severe or non-severe based on annual dispensed inhaled corticosteroids, oral corticosteroids, and hospitalizations.
Results: Of 193,730 adult identified patients diagnosed with asthma, 86.3% had non-severe, 8.1% transiently severe, and 5.6% continuously severe asthma. Excess prevalence of pneumonia was observed in continuously (22%) and transiently severe (14%) compared with non-severe patients after adjusting for age and sex. Cataract, osteoporosis, obesity, heart failure, and atrial fibrillation were also more frequent in severe asthma patients. Inhaled and/or oral corticosteroid use contributed to the risk of several comorbidities in a dose-dependent manner, particularly pneumonia, osteoporosis, obesity, heart failure, and atrial fibrillation. High oral corticosteroid use and the presence of comorbidities were associated with increased healthcare resource use.
Conclusion: Patients with severe asthma have a high burden of comorbidities, especially pneumonia. Many of the comorbidities have a strong dose-dependent association with inhaled and oral corticosteroid treatment, suggesting that corticosteroid doses should be carefully evaluated in clinical practice.
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支气管扩张剂反应性与哮喘控制不佳患者的哮喘控制或症状负担无关
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SARS-CoV-2大流行与哮喘：我们已经了解了什么以及什么仍然不清楚
