重度哮喘伴低血嗜酸粒细胞的临床和经济负担
2024/07/30
摘要
背景：2型（T2）重度哮喘表型通常是由于持续的症状导致糖皮质激素治疗过度导致的，通常与哮喘无关，对大剂量糖皮质激素治疗反应不佳。
目的：本研究旨在描述嗜酸性粒细胞计数低(<300个/μl)的重度哮喘患者的特征，并描述其疾病负担和在英国医疗机构中的治疗情况。
方法：采用临床实践研究数据链(CPRD) Aurum-Hospital Episode Statistics (HES)和英国重度哮喘注册(UKSAR)数据对患者最新的血嗜酸性粒细胞计数(BEC)进行索引，对重度哮喘患者进行回顾性队列研究。临床特征、治疗模式、结局和医疗资源使用(HCRU)用基线BEC(≤150和>150～<300个细胞/μl)描述。
结果：CPRD-HES组701例，UKSAR组1,546例；基线BECs≤150个/μl者分别占60.5%和59.4%。在BEC组中，CPRD-HES组中随访时哮喘未得到控制(≥2次发作)的比例为5.4%，UKSAR组为45.2%。在BEC组中，OCS持续应用仍然较高(CPRD-HES: 29.4%;UKSAR: 51.7%)，症状控制仍然较差(CPRD-HES组>200 μg SABA或>500 μg特布他林/d: 48.8%;UKSAR的ACQ-6评分中位数为2.0[1.0-3.3])。BEC组间HCRU差异无统计学意义。
结论：在初级医疗机构接受治疗的患者多为非频发急性加重，而UKSAR患者常为频发急性加重。两组患者中有很大比例的患者症状控制不佳，并继续接受高水平的OCS维持治疗，增加了糖皮质激素诱导的发病风险。这些数据强调了对基础疾病病理学进行严格评估以指导适当治疗的必要性。
Clinical and economic burden of severe asthma with low blood eosinophil counts
John Busby, Shruti Menon, Neil Martin, Joe Lipworth, Ruiqi Zhang, Hassan Burhan, Thomas Brown, Rekha Chaudhuri, Robin Gore, David Jackson, Shamsa Naveed, Thomas Pantin, Paul Pfeffer, Mitesh Patel, Pujan Patel, Hitasha Rupani, Liam G Heaney
Abstract
Background: Type 2 (T2) low severe asthma phenotype is often a result of corticosteroid-overtreated T2-disease due to persistent symptoms, often not related to asthma, and unlikely to respond to high-dose corticosteroid treatment.
Objective: This study aimed to characterise severe asthma patients with low eosinophil counts (<300 cells/μl) and describe their disease burden and treatment across healthcare settings in the UK.
Methods: A retrospective cohort study of severe asthma patients using linked Clinical Practice Research Datalink (CPRD) Aurum-Hospital Episode Statistics (HES) and UK Severe Asthma Registry (UKSAR) data indexed patients on latest blood eosinophil count (BEC). Clinical characteristics, treatment patterns, outcomes, and healthcare resource use (HCRU) were described by baseline BEC (≤150 and >150 to <300 cells/μl).
Results: Analysis included 701 (CPRD-HES) and 1,546 (UKSAR) patients; with 60.5% and 59.4% having BECs ≤150 cells/μl at baseline, respectively. Across BEC groups, the proportion with uncontrolled asthma (≥2 exacerbations) at follow-up (12-months post-index) was 5.4% in CPRD-HES and 45.2% in UKSAR. Maintenance OCS use remained high across BEC groups (CPRD-HES: 29.4%; UKSAR: 51.7%), symptom control remained poor (>200 μg SABA or >500 μg terbutaline/day in CPRD-HES: 48.8%; median ACQ-6 score in UKSAR: 2.0 [1.0-3.3]). HCRU were similar across BEC groups.
Conclusion: Most patients managed in primary care were infrequent exacerbators, whilst UKSAR patients exacerbated frequently. Large proportions of both patient groups had poor symptom control and continued to receive high levels of maintenance OCS, increasing risk of corticosteroid-induced morbidity. These data highlight the need for rigorous assessment of underlying disease pathology to guide appropriate treatment.
背景：2型（T2）重度哮喘表型通常是由于持续的症状导致糖皮质激素治疗过度导致的，通常与哮喘无关，对大剂量糖皮质激素治疗反应不佳。
目的：本研究旨在描述嗜酸性粒细胞计数低(<300个/μl)的重度哮喘患者的特征，并描述其疾病负担和在英国医疗机构中的治疗情况。
方法：采用临床实践研究数据链(CPRD) Aurum-Hospital Episode Statistics (HES)和英国重度哮喘注册(UKSAR)数据对患者最新的血嗜酸性粒细胞计数(BEC)进行索引，对重度哮喘患者进行回顾性队列研究。临床特征、治疗模式、结局和医疗资源使用(HCRU)用基线BEC(≤150和>150～<300个细胞/μl)描述。
结果：CPRD-HES组701例，UKSAR组1,546例；基线BECs≤150个/μl者分别占60.5%和59.4%。在BEC组中，CPRD-HES组中随访时哮喘未得到控制(≥2次发作)的比例为5.4%，UKSAR组为45.2%。在BEC组中，OCS持续应用仍然较高(CPRD-HES: 29.4%;UKSAR: 51.7%)，症状控制仍然较差(CPRD-HES组>200 μg SABA或>500 μg特布他林/d: 48.8%;UKSAR的ACQ-6评分中位数为2.0[1.0-3.3])。BEC组间HCRU差异无统计学意义。
结论：在初级医疗机构接受治疗的患者多为非频发急性加重，而UKSAR患者常为频发急性加重。两组患者中有很大比例的患者症状控制不佳，并继续接受高水平的OCS维持治疗，增加了糖皮质激素诱导的发病风险。这些数据强调了对基础疾病病理学进行严格评估以指导适当治疗的必要性。
(中日友好医院呼吸与危重症医学科 顾宪民 摘译 林江涛 审校)
(J Allergy Clin Immunol Pract. 2024 Jul 18:S2213-2198(24)00740-2. doi: 10.1016/j.jaip.2024.07.010.)
(J Allergy Clin Immunol Pract. 2024 Jul 18:S2213-2198(24)00740-2. doi: 10.1016/j.jaip.2024.07.010.)
Clinical and economic burden of severe asthma with low blood eosinophil counts
John Busby, Shruti Menon, Neil Martin, Joe Lipworth, Ruiqi Zhang, Hassan Burhan, Thomas Brown, Rekha Chaudhuri, Robin Gore, David Jackson, Shamsa Naveed, Thomas Pantin, Paul Pfeffer, Mitesh Patel, Pujan Patel, Hitasha Rupani, Liam G Heaney
Abstract
Background: Type 2 (T2) low severe asthma phenotype is often a result of corticosteroid-overtreated T2-disease due to persistent symptoms, often not related to asthma, and unlikely to respond to high-dose corticosteroid treatment.
Objective: This study aimed to characterise severe asthma patients with low eosinophil counts (<300 cells/μl) and describe their disease burden and treatment across healthcare settings in the UK.
Methods: A retrospective cohort study of severe asthma patients using linked Clinical Practice Research Datalink (CPRD) Aurum-Hospital Episode Statistics (HES) and UK Severe Asthma Registry (UKSAR) data indexed patients on latest blood eosinophil count (BEC). Clinical characteristics, treatment patterns, outcomes, and healthcare resource use (HCRU) were described by baseline BEC (≤150 and >150 to <300 cells/μl).
Results: Analysis included 701 (CPRD-HES) and 1,546 (UKSAR) patients; with 60.5% and 59.4% having BECs ≤150 cells/μl at baseline, respectively. Across BEC groups, the proportion with uncontrolled asthma (≥2 exacerbations) at follow-up (12-months post-index) was 5.4% in CPRD-HES and 45.2% in UKSAR. Maintenance OCS use remained high across BEC groups (CPRD-HES: 29.4%; UKSAR: 51.7%), symptom control remained poor (>200 μg SABA or >500 μg terbutaline/day in CPRD-HES: 48.8%; median ACQ-6 score in UKSAR: 2.0 [1.0-3.3]). HCRU were similar across BEC groups.
Conclusion: Most patients managed in primary care were infrequent exacerbators, whilst UKSAR patients exacerbated frequently. Large proportions of both patient groups had poor symptom control and continued to receive high levels of maintenance OCS, increasing risk of corticosteroid-induced morbidity. These data highlight the need for rigorous assessment of underlying disease pathology to guide appropriate treatment.
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妊娠期体重增加对儿童哮喘表型的影响:一项前瞻性队列研究
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哮喘合并功能性消化不良表现出IL-33介导的气道神经功能障碍
