使用倍氯米松/福莫特罗NEXThaler™剂量计和一氧化氮监测评估重度哮喘患者吸入糖皮质激素的依从性和反应性
2024/04/24
摘要
背景：65%的重度哮喘患者和FeNO≥45ppb患者对吸入性糖皮质激素（ICS）依从性差。记录使用时间和吸入技术的数字设备可以识别不依从性和ICS反应性，但尚未广泛使用。由于NEXThaler™剂量计数器仅在 35 L/min 的吸气流量下激活，这可能为识别ICS反应性提供了一种替代方法。目的：使用倍氯米松/福莫特罗（200/6 mcg）NEXThaler™（BFN）剂量计评估重度哮喘患者的ICS依从性和反应性。
方法：邀请FeNO≥45ppb的重度哮喘患者使用BFN代替其常用的ICS/长效β2受体激动剂（LABA）。监测FeNO、ACQ6、肺功能和血嗜酸性粒细胞计数3个月。使用log10ΔFeNO≥0.24来定义FeNO抑制，作为第28天ICS反应性的主要标志。
结果：48名患者中有27名（56%）在第一个月表现出显著的FeNO抑制（中位数，前为114，后为48 ppb，p<0.001）。非抑制性FeNO患者出现了小幅但显着的降低。FeNO抑制患者的ACQ6中位数下降了1.2个单位（p<0.001），非抑制性患者下降了0.5个单位（p=0.025）。这些影响在FeNO抑制患者中持续到第3个月，FEV1和血液嗜酸性粒细胞显着改善。基线ICS/LABA处方补充≥80%的患者中有67%（18/27）是FeNO抑制者，表明尽管处方收集充足，但之前仍存在不依从情况。79%的FeNO抑制患者在从初始剂量计算的平均11.4个月内不需要生物制剂。
结论：BFN剂量计数可确定重度哮喘患者的ICS反应性，这意味着这些患者可能不需要进行生物治疗。
(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. 2024 Mar 20:S2213-2198(24)00288-5. doi: 10.1016/j.jaip.2024.03.026.)
(J Allergy Clin Immunol Pract. 2024 Mar 20:S2213-2198(24)00288-5. doi: 10.1016/j.jaip.2024.03.026.)
Assessing inhaled corticosteroid adherence and responsiveness in severe asthma using beclometasone dipropionate/formoterol NEXThaler™ dose-counting and nitric oxide monitoring
Hnin Ww Aung, Claire E Boddy, Eleanor Hampson, Mark Bell, Lauren A Parnell, Kumaran Balasundaram, Anna C Murphy, Shamsa Naveed, Peter Bradding
Abstract
Background: 65% of people with severe asthma and a FeNO ≥45 ppb are non-adherent to inhaled corticosteroids (ICS). Digital devices recording both time-of-use and inhaler technique identify non-adherence and ICS responsiveness but are not widely available. As the NEXThaler™ dose counter only activates at an inspiratory flow of 35 L/min, this may provide an alternative to identifying ICS responsiveness.
Objective: To assess ICS adherence and responsiveness in severe asthma using beclometasone/formoterol (200/6 mcg) NEXThaler™ (BFN) dose-counting.
Methods: Severe asthmatics with a FeNO ≥45 ppb were invited to use BFN in place of their usual ICS/long-acting β2-agonist (LABA). FeNO, ACQ6, lung function and blood eosinophil count were monitored for 3 months. A log10ΔFeNO ≥0.24 was used to define FeNO suppression as the primary marker of ICS responsiveness at day 28.
Results: 27/48 (56%) patients demonstrated significant FeNO suppression at month 1 (median pre-114, post-48 ppb, p<0.001). A small but significant reduction occurred in FeNO non-suppressors. ACQ6 fell a median 1.2 units in FeNO suppressors (p<0.001) and 0.5 units in non-suppressors (p=0.025). These effects were sustained until month 3 in FeNO suppressors with a significant improvement in FEV1 and blood eosinophils. 67% (18/27) of those with baseline ICS/LABA prescription refills of ≥80% were FeNO suppressors suggesting prior non-adherence despite adequate prescription collection. 79% of FeNO suppressors did not require biologics within mean 11.4 months from initial dose counting.
Conclusion: BFN dose counting identifies ICS responsiveness in severe asthma with the implication that these patients may not need to progress to biological therapies.
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儿童和青少年气道阻塞伴FEV1正常或低下的临床意义
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吸入性皮质类固醇/长效β-受体激动剂治疗的哮喘患者病情加重的频率和经济负担：一项回顾性美国索赔研究
