支气管扩张和哮喘：来自欧洲支气管扩张登记处（EMBARC）的数据
2024/03/26
摘要
背景：支气管扩张的患者常合并哮喘。
目的：本研究的目的是评估支气管扩张合并哮喘的患者与不伴有哮喘患者相比是否具有不同的临床表型和不同的结局。
方法：前瞻性观察性泛欧注册(EMBARC)纳入了28个国家的患者。CT确诊为支气管扩张的成年患者在基线和年度随访时使用电子病例报告表进行审查。哮喘是由当地调查员诊断出来的。随访数据采用负二项回归模型探讨两组间恶化频率的差异。生存分析采用cox -比例风险回归。
结果：对纳入的16963例支气管扩张患者进行分析。5267例患者(31.0%)报告有哮喘。支气管扩张合并哮喘(BE+A)的患者更年轻，更可能是女性，从不吸烟，BMI高于无哮喘的支气管扩张患者。BE+A与鼻窦炎和鼻息肉以及嗜酸性粒细胞增多和曲霉致敏的较高患病率相关。BE+A组有相似的微生物学特征，但用支气管扩张严重程度指数(BSI)衡量，BE+A组的疾病严重程度明显较低。在调整疾病严重程度和多重混杂因素后，BE+A组的恶化风险增加。与没有哮喘且未接受吸入皮质类固醇治疗的对照人群相比，BE+A患者使用吸入皮质类固醇可降低死亡率(校正风险比0.78(0.63-0.95))和住院风险(比率比0.67(0.67-0.86))。
结论：支气管扩张症和哮喘合并很常见且恶化风险增加，并与吸入性皮质类固醇使用后结局改善有关。出乎意料的是，我们发现支气管扩张症和哮喘患者的死亡率显着降低。
Polverino E, Dimakou K, Traversi L,
Abstrast
Background: Asthma is commonly reported in patients with a diagnosis of bronchiectasis.
Objective：The aim of this study was to evaluate if patients with asthma and bronchiectasis had a different clinical phenotype and different outcomes compared to patients with bronchiectasis without concomitant asthma.
Methods: Prospective observational pan-European registry (EMBARC) enrolling patients across 28 countries. Adult patients with CT confirmed bronchiectasis were reviewed at baseline and annual follow-up visits using an electronic case report form. Asthma was diagnosed by the local investigator. Follow-up data were used to explore differences in exacerbation frequency between groups using a negative binomial regression model. Survival analysis utilised Cox-proportional hazards regression.
Results: 16963 patients with bronchiectasis were included for analysis. 5267 patients (31.0%) had investigator reported asthma. Patients with bronchiectasis and asthma (BE+A) were younger, more likely to be female and never smokers, and had a higher BMI than patients with bronchiectasis without asthma. BE+A was associated with a higher prevalence of rhinosinusitis and nasal polyps as well as eosinophilia and Aspergillus sensitization. BE+A had similar microbiology, but significantly lower severity of disease using the bronchiectasis severity index (BSI). The BE+A group were at increased risk of exacerbation after adjustment for severity of disease and multiple confounders. Inhaled corticosteroid use was associated with reduced mortality in BE+A patients (adjusted hazard ratio 0.78 (0.63-0.95)) and reduced risk of hospitalization, (rate ratio 0.67 (0.67-0.86)) compared to a control population without asthma and not receiving inhaled corticosteroid.
Conclusions: Combined bronchiectasis and asthma was common and was associated with an increased risk of exacerbations and improved outcomes with inhaled corticosteroid use. Unexpectedly we identified significantly lower mortality in patients with bronchiectasis and asthma.
背景：支气管扩张的患者常合并哮喘。
目的：本研究的目的是评估支气管扩张合并哮喘的患者与不伴有哮喘患者相比是否具有不同的临床表型和不同的结局。
方法：前瞻性观察性泛欧注册(EMBARC)纳入了28个国家的患者。CT确诊为支气管扩张的成年患者在基线和年度随访时使用电子病例报告表进行审查。哮喘是由当地调查员诊断出来的。随访数据采用负二项回归模型探讨两组间恶化频率的差异。生存分析采用cox -比例风险回归。
结果：对纳入的16963例支气管扩张患者进行分析。5267例患者(31.0%)报告有哮喘。支气管扩张合并哮喘(BE+A)的患者更年轻，更可能是女性，从不吸烟，BMI高于无哮喘的支气管扩张患者。BE+A与鼻窦炎和鼻息肉以及嗜酸性粒细胞增多和曲霉致敏的较高患病率相关。BE+A组有相似的微生物学特征，但用支气管扩张严重程度指数(BSI)衡量，BE+A组的疾病严重程度明显较低。在调整疾病严重程度和多重混杂因素后，BE+A组的恶化风险增加。与没有哮喘且未接受吸入皮质类固醇治疗的对照人群相比，BE+A患者使用吸入皮质类固醇可降低死亡率(校正风险比0.78(0.63-0.95))和住院风险(比率比0.67(0.67-0.86))。
结论：支气管扩张症和哮喘合并很常见且恶化风险增加，并与吸入性皮质类固醇使用后结局改善有关。出乎意料的是，我们发现支气管扩张症和哮喘患者的死亡率显着降低。
(中日友好医院呼吸与危重症医学科 万静萱 摘译 林江涛 审校)
(J Allergy Clin Immunol 2024 Feb 22;doi: 10.1016/j.jaci.2024.01.027.IF: 10.228)
Bronchiectasis and asthma: Data from The European Bronchiectasis Registry (EMBARC).(J Allergy Clin Immunol 2024 Feb 22;doi: 10.1016/j.jaci.2024.01.027.IF: 10.228)
Polverino E, Dimakou K, Traversi L,
Abstrast
Background: Asthma is commonly reported in patients with a diagnosis of bronchiectasis.
Objective：The aim of this study was to evaluate if patients with asthma and bronchiectasis had a different clinical phenotype and different outcomes compared to patients with bronchiectasis without concomitant asthma.
Methods: Prospective observational pan-European registry (EMBARC) enrolling patients across 28 countries. Adult patients with CT confirmed bronchiectasis were reviewed at baseline and annual follow-up visits using an electronic case report form. Asthma was diagnosed by the local investigator. Follow-up data were used to explore differences in exacerbation frequency between groups using a negative binomial regression model. Survival analysis utilised Cox-proportional hazards regression.
Results: 16963 patients with bronchiectasis were included for analysis. 5267 patients (31.0%) had investigator reported asthma. Patients with bronchiectasis and asthma (BE+A) were younger, more likely to be female and never smokers, and had a higher BMI than patients with bronchiectasis without asthma. BE+A was associated with a higher prevalence of rhinosinusitis and nasal polyps as well as eosinophilia and Aspergillus sensitization. BE+A had similar microbiology, but significantly lower severity of disease using the bronchiectasis severity index (BSI). The BE+A group were at increased risk of exacerbation after adjustment for severity of disease and multiple confounders. Inhaled corticosteroid use was associated with reduced mortality in BE+A patients (adjusted hazard ratio 0.78 (0.63-0.95)) and reduced risk of hospitalization, (rate ratio 0.67 (0.67-0.86)) compared to a control population without asthma and not receiving inhaled corticosteroid.
Conclusions: Combined bronchiectasis and asthma was common and was associated with an increased risk of exacerbations and improved outcomes with inhaled corticosteroid use. Unexpectedly we identified significantly lower mortality in patients with bronchiectasis and asthma.
上一篇：
屋尘螨 SCIT 可降低哮喘风险并显着改善长期鼻炎和哮喘控制-一项 RWE 研究
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