支气管扩张剂反应性的患病率、诊断实用性及相关特征
2023/12/20
摘要
背景：支气管扩张剂反应性（BDR）在现实生活中的患病率和诊断效用尚不清楚。我们在年龄≥12岁的患者中探讨了这种不确定性，这些患者由医生指定诊断为哮喘、哮喘和慢性阻塞性肺病，或在NOVELTY中诊断为慢性阻塞性肺疾病，这是一项在18个国家进行的一级和二级护理的前瞻性队列研究。
方法：使用2005年（∆FEV1或∆FVC≥12%且≥200mL）和2021年（预测∆FEV1/∆FVC>10%）ERS/ATS标准计算每种诊断类别中BDR检测呈阳性的患者比例。
结果：我们研究了3519名医生指定诊断为哮喘的患者、833名哮喘+慢性阻塞性肺病患者和2436名慢性阻塞性肺疾病患者。根据2005年的标准，BDR的患病率分别为19.7%（哮喘）、29.6%（哮喘+COPD）和24.7%（COPD）；使用2021标准分别为18.1%、23.3%和18.0%。使用2021年的标准，在诊断为哮喘的患者中，BDR与较高的FeNO、较低的肺功能、较高的症状负担、更频繁的住院、更多地使用三联疗法、口服皮质类固醇或生物制品有关；在被诊断为COPD的患者中，BDR（2021）与较低的肺功能和较高的症状负担有关。
结论：接受治疗的慢性呼吸道疾病患者的BDR患病率在18-30%之间，与2005年ERS/ATS标准相比，2021年的BDR发病率略低，并且与肺功能较低和症状负担较大有关。这些观察结果质疑BDR作为临床实践中治疗哮喘的关键诊断工具或作为哮喘临床试验的标准纳入标准的有效性，相反，BDR被认为是慢性呼吸道疾病的一种可治疗特征。
Prevalence, Diagnostic Utility and Associated Characteristics of Bronchodilator Responsiveness
Richard Beasley, Rod Hughes, Alvar Agusti, Peter Calverley, Bradley Chipps, Ricardo Del Olmo, Alberto Papi, David Price, Helen Reddel, Hana Mullerova, Eleni Rapsomaniki
Abstract
Background: The prevalence and diagnostic utility of bronchodilator responsiveness (BDR) in a real-life setting is unclear. We explored this uncertainty in patients aged ≥12 years with physician-assigned diagnoses of asthma, asthma and COPD, or COPD in NOVELTY, a prospective cohort study in primary and secondary care in 18 countries.
Methods: The proportion of patients with a positive BDR test in each diagnostic category was calculated using 2005 (∆FEV1 or ∆FVC ≥12% and ≥200mL) and 2021 (∆FEV1 or ∆FVC >10% predicted) ERS/ATS criteria.
Results: We studied 3,519 patients with physician-assigned diagnosis of asthma, 833 with asthma+COPD, and 2,436 with COPD. The prevalence of BDR was 19.7% (asthma), 29.6% (asthma+COPD) and 24.7% (COPD) using 2005 criteria; 18.1%, 23.3% and 18.0% respectively using 2021 criteria. Using 2021 criteria, in patients diagnosed with asthma, BDR was associated with higher FeNO, lower lung function, higher symptom burden, more frequent hospital admissions, greater use of triple therapy, oral corticosteroids or biologics; in patients diagnosed with COPD, BDR (2021) was associated with lower lung function and higher symptom burden.
Conclusions: BDR prevalence in patients with chronic airway diseases on treatment ranges from 18-30%, being modestly lower with the 2021 compared with 2005 ERS/ATS criteria, and is associated with lower lung function and greater symptom burden. These observations question the validity of BDR as a key diagnostic tool for asthma managed in clinical practice or as a standard inclusion criterion for clinical trials of asthma, and instead suggest BDR be considered a treatable trait for chronic airways disease.
背景：支气管扩张剂反应性（BDR）在现实生活中的患病率和诊断效用尚不清楚。我们在年龄≥12岁的患者中探讨了这种不确定性，这些患者由医生指定诊断为哮喘、哮喘和慢性阻塞性肺病，或在NOVELTY中诊断为慢性阻塞性肺疾病，这是一项在18个国家进行的一级和二级护理的前瞻性队列研究。
方法：使用2005年（∆FEV1或∆FVC≥12%且≥200mL）和2021年（预测∆FEV1/∆FVC>10%）ERS/ATS标准计算每种诊断类别中BDR检测呈阳性的患者比例。
结果：我们研究了3519名医生指定诊断为哮喘的患者、833名哮喘+慢性阻塞性肺病患者和2436名慢性阻塞性肺疾病患者。根据2005年的标准，BDR的患病率分别为19.7%（哮喘）、29.6%（哮喘+COPD）和24.7%（COPD）；使用2021标准分别为18.1%、23.3%和18.0%。使用2021年的标准，在诊断为哮喘的患者中，BDR与较高的FeNO、较低的肺功能、较高的症状负担、更频繁的住院、更多地使用三联疗法、口服皮质类固醇或生物制品有关；在被诊断为COPD的患者中，BDR（2021）与较低的肺功能和较高的症状负担有关。
结论：接受治疗的慢性呼吸道疾病患者的BDR患病率在18-30%之间，与2005年ERS/ATS标准相比，2021年的BDR发病率略低，并且与肺功能较低和症状负担较大有关。这些观察结果质疑BDR作为临床实践中治疗哮喘的关键诊断工具或作为哮喘临床试验的标准纳入标准的有效性，相反，BDR被认为是慢性呼吸道疾病的一种可治疗特征。
(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)
(Am J Respir Crit Care Med. 2023 Nov 29. doi: 10.1164/rccm.202308-1436OC.)
(Am J Respir Crit Care Med. 2023 Nov 29. doi: 10.1164/rccm.202308-1436OC.)
Prevalence, Diagnostic Utility and Associated Characteristics of Bronchodilator Responsiveness
Richard Beasley, Rod Hughes, Alvar Agusti, Peter Calverley, Bradley Chipps, Ricardo Del Olmo, Alberto Papi, David Price, Helen Reddel, Hana Mullerova, Eleni Rapsomaniki
Abstract
Background: The prevalence and diagnostic utility of bronchodilator responsiveness (BDR) in a real-life setting is unclear. We explored this uncertainty in patients aged ≥12 years with physician-assigned diagnoses of asthma, asthma and COPD, or COPD in NOVELTY, a prospective cohort study in primary and secondary care in 18 countries.
Methods: The proportion of patients with a positive BDR test in each diagnostic category was calculated using 2005 (∆FEV1 or ∆FVC ≥12% and ≥200mL) and 2021 (∆FEV1 or ∆FVC >10% predicted) ERS/ATS criteria.
Results: We studied 3,519 patients with physician-assigned diagnosis of asthma, 833 with asthma+COPD, and 2,436 with COPD. The prevalence of BDR was 19.7% (asthma), 29.6% (asthma+COPD) and 24.7% (COPD) using 2005 criteria; 18.1%, 23.3% and 18.0% respectively using 2021 criteria. Using 2021 criteria, in patients diagnosed with asthma, BDR was associated with higher FeNO, lower lung function, higher symptom burden, more frequent hospital admissions, greater use of triple therapy, oral corticosteroids or biologics; in patients diagnosed with COPD, BDR (2021) was associated with lower lung function and higher symptom burden.
Conclusions: BDR prevalence in patients with chronic airway diseases on treatment ranges from 18-30%, being modestly lower with the 2021 compared with 2005 ERS/ATS criteria, and is associated with lower lung function and greater symptom burden. These observations question the validity of BDR as a key diagnostic tool for asthma managed in clinical practice or as a standard inclusion criterion for clinical trials of asthma, and instead suggest BDR be considered a treatable trait for chronic airways disease.
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烟曲霉变应原的鉴定——与哮喘肺损伤的潜在关联
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疑似哮喘患者接受间接支气管挑战后呼气中挥发性有机化合物的变化
