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
2023/10/25
摘要
背景：本研究旨在确定支气管扩张剂反应性（BDR）的四种不同定义与众多哮喘控制不佳患者的哮喘控制和症状负担之间的关系。
方法：我们研究了 931 名哮喘控制不佳的参与者对沙丁胺醇的 FEV1 和 FVC 基线变化，这些参与者来自美国肺脏协会-气道疾病临床研究中心进行的三项临床试验。我们根据四种定义对 BDR 进行了定义，并分析了每种定义与哮喘控制（通过哮喘控制测试或哮喘控制问卷评估）以及哮喘症状负担（通过哮喘症状效用指数评估）之间的关联。
结果：根据所使用的定义，31%-42% 的参与者存在 BDR。不同参与者的回答具有良好的一致性（kappa系数为 0.73 至 0.87），但仅有 56% 的参与者符合 BDR 的所有四个定义。BDR 在男性中比在女性中更常见，在黑人中比在白人中更常见，在非吸烟者中比吸烟者中更常见，在非肥胖者中比肥胖者更常见。在哮喘控制不佳的人群中，35% 的人患有BDR，而在哮喘控制良好的人群中，只有 25% 的人患有 BDR；在症状负担较重的人群中，34% 的人患有 BDR，而在症状负担较轻的人群中，只有 28% 的人患有 BDR。在调整了年龄、性别、身高、种族、肥胖和基线肺功能后，这四种定义都与哮喘控制或症状负担无关。
结论：在哮喘控制不佳的患者中，无论使用哪种 BDR 定义，BDR 都与哮喘控制或症状无关。这些发现对 BDR 在评估哮喘控制和症状方面的临床实用性提出了质疑。
Bronchodilator response does not associate with asthma control or symptom burden among patients with poorly controlled asthma
Kaminsky, D. A., He, J., Henderson, R., Dixon, A. E., Irvin, C. G., Mastronarde, J., Smith, L. J., Sugar, E. A., Wise, R. A., & Holbrook, J. T.
Abstract
Background:The purpose of this study was to determine how four different definitions of bronchodilator response (BDR) relate to asthma control and asthma symptom burden in a large population of participants with poorly controlled asthma.
Methods:We examined the baseline change in FEV1 and FVC in response to albuterol among 931 participants with poorly controlled asthma pooled from three clinical trials conducted by the American Lung Association - Airways Clinical Research Centers. We defined BDR based on four definitions and analyzed the association of each with asthma control as measured by the Asthma Control Test or Asthma Control Questionnaire, and asthma symptom burden as measured by the Asthma Symptom Utility Index.
Results:A BDR was seen in 31-42% of all participants, depending on the definition used. There was good agreement among responses (kappa coefficient 0.73 to 0.87), but only 56% of participants met all four definitions for BDR. A BDR was more common in men than women, in Blacks compared to Whites, in non-smokers compared to smokers, and in non-obese compared to obese participants. Among those with poorly controlled asthma, 35% had a BDR compared to 25% of those with well controlled asthma, and among those with a high symptom burden, 34% had a BDR compared to 28% of those with a low symptom burden. After adjusting for age, sex, height, race, obesity and baseline lung function, none of the four definitions was associated with asthma control or symptom burden.
Conclusion:A BDR is not associated with asthma control or symptoms in people with poorly controlled asthma, regardless of the definition of BDR used. These findings question the clinical utility of a BDR in assessing asthma control and symptoms.
背景：本研究旨在确定支气管扩张剂反应性（BDR）的四种不同定义与众多哮喘控制不佳患者的哮喘控制和症状负担之间的关系。
方法：我们研究了 931 名哮喘控制不佳的参与者对沙丁胺醇的 FEV1 和 FVC 基线变化，这些参与者来自美国肺脏协会-气道疾病临床研究中心进行的三项临床试验。我们根据四种定义对 BDR 进行了定义，并分析了每种定义与哮喘控制（通过哮喘控制测试或哮喘控制问卷评估）以及哮喘症状负担（通过哮喘症状效用指数评估）之间的关联。
结果：根据所使用的定义，31%-42% 的参与者存在 BDR。不同参与者的回答具有良好的一致性（kappa系数为 0.73 至 0.87），但仅有 56% 的参与者符合 BDR 的所有四个定义。BDR 在男性中比在女性中更常见，在黑人中比在白人中更常见，在非吸烟者中比吸烟者中更常见，在非肥胖者中比肥胖者更常见。在哮喘控制不佳的人群中，35% 的人患有BDR，而在哮喘控制良好的人群中，只有 25% 的人患有 BDR；在症状负担较重的人群中，34% 的人患有 BDR，而在症状负担较轻的人群中，只有 28% 的人患有 BDR。在调整了年龄、性别、身高、种族、肥胖和基线肺功能后，这四种定义都与哮喘控制或症状负担无关。
结论：在哮喘控制不佳的患者中，无论使用哪种 BDR 定义，BDR 都与哮喘控制或症状无关。这些发现对 BDR 在评估哮喘控制和症状方面的临床实用性提出了质疑。
(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)
(Respir Med. 2023 Aug; DOI: 10.1016/j.rmed.2023.107375)
(Respir Med. 2023 Aug; DOI: 10.1016/j.rmed.2023.107375)
Bronchodilator response does not associate with asthma control or symptom burden among patients with poorly controlled asthma
Kaminsky, D. A., He, J., Henderson, R., Dixon, A. E., Irvin, C. G., Mastronarde, J., Smith, L. J., Sugar, E. A., Wise, R. A., & Holbrook, J. T.
Abstract
Background:The purpose of this study was to determine how four different definitions of bronchodilator response (BDR) relate to asthma control and asthma symptom burden in a large population of participants with poorly controlled asthma.
Methods:We examined the baseline change in FEV1 and FVC in response to albuterol among 931 participants with poorly controlled asthma pooled from three clinical trials conducted by the American Lung Association - Airways Clinical Research Centers. We defined BDR based on four definitions and analyzed the association of each with asthma control as measured by the Asthma Control Test or Asthma Control Questionnaire, and asthma symptom burden as measured by the Asthma Symptom Utility Index.
Results:A BDR was seen in 31-42% of all participants, depending on the definition used. There was good agreement among responses (kappa coefficient 0.73 to 0.87), but only 56% of participants met all four definitions for BDR. A BDR was more common in men than women, in Blacks compared to Whites, in non-smokers compared to smokers, and in non-obese compared to obese participants. Among those with poorly controlled asthma, 35% had a BDR compared to 25% of those with well controlled asthma, and among those with a high symptom burden, 34% had a BDR compared to 28% of those with a low symptom burden. After adjusting for age, sex, height, race, obesity and baseline lung function, none of the four definitions was associated with asthma control or symptom burden.
Conclusion:A BDR is not associated with asthma control or symptoms in people with poorly controlled asthma, regardless of the definition of BDR used. These findings question the clinical utility of a BDR in assessing asthma control and symptoms.
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儿童和青少年哮喘患者鼻上皮基因表达和总IgE
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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）
