在特异性吸入激发试验期间持续吸入皮质类固醇治疗对诊断职业性哮喘的影响
2024/08/28
摘要
背景：特异性吸入激发试验(SIC)仍然是诊断致敏物诱发的职业性哮喘(SIOA)的参考试验。欧洲呼吸学会建议在SIC前72小时停止吸入皮质类固醇(ICS)。
目的：评估SIC期间持续的ICS治疗对暴露于疑似病原体后FEV1最大下降、甲基胆碱PC20变化以及痰嗜酸性粒细胞计数的影响。
方法：我们对1999年至2022年向我们中心提交的疑似SIOA病例数据库进行回顾性分析。将SIC期间接受ICS治疗的受试者与天然类固醇受试者的SIC结果进行比较。
结果：671例患者在实验室接受了SIC治疗。318例接受ICS治疗，353例接受类固醇治疗。在接受ICS治疗的受试者中，SIC阳性的比例更高(39.6%)，而天然类固醇组(27.5%，p<0.001)。ICS治疗不影响SIC的结果。在类固醇治疗和天然类固醇受试者之间，SIC后PC20或痰嗜酸性粒细胞百分比的变化没有差异。
结论：在SIC期间持续的ICS治疗不会影响哮喘反应的发生，长期接受ICS治疗的受试者暴露于可疑病原体后气道反应性的变化或嗜酸性粒细胞炎症为受影响。
Impact of ongoing treatment with inhaled corticosteroids during specific inhalation challenges for diagnosing occupational asthma
Gabriel Lavoie, Catherine Lemière
Abstract
Background: Specific inhalation challenge tests (SIC) are still the reference test for diagnosing sensitizer-induced occupational asthma (SIOA). The European Respiratory Society recommends the cessation of inhaled corticosteroids (ICS) 72h prior to SIC.
Objective: To assess the effect of an ongoing ICS treatment during SIC on the maximum fall in FEV1, change in methacholine PC20 as well as sputum eosinophil counts after exposure to the suspected agent.
Methods: We performed a retrospective analysis using a database of cases referred to our center for suspected SIOA from 1999 to 2022. The results of the SIC were compared between subjects treated with ICS during SIC and steroid-naïve subjects.
Results: Six-hundred and seventy-one individuals underwent SIC in the laboratory. Three hundred and eighteen were treated with ICS, whereas 353 were steroid naïve. The proportion of subjects with a positive SIC was greater among ICS treated subjects (39. 6%) compared to steroid-naïve subjects (27.5%, p<0.001). A treatment with ICS did not influence the outcome of the SIC. There was no difference in the change in PC20 or percentage of sputum eosinophils after SIC between steroid-treated and steroid-naïve subjects.
Conclusion: An ongoing ICS treatment during a SIC did not affect the occurrence of an asthmatic reaction, the change in airway responsiveness or eosinophilic inflammation after exposure to the suspected agent in subjects who have been treated with ICS for a long period of time.
背景：特异性吸入激发试验(SIC)仍然是诊断致敏物诱发的职业性哮喘(SIOA)的参考试验。欧洲呼吸学会建议在SIC前72小时停止吸入皮质类固醇(ICS)。
目的：评估SIC期间持续的ICS治疗对暴露于疑似病原体后FEV1最大下降、甲基胆碱PC20变化以及痰嗜酸性粒细胞计数的影响。
方法：我们对1999年至2022年向我们中心提交的疑似SIOA病例数据库进行回顾性分析。将SIC期间接受ICS治疗的受试者与天然类固醇受试者的SIC结果进行比较。
结果：671例患者在实验室接受了SIC治疗。318例接受ICS治疗，353例接受类固醇治疗。在接受ICS治疗的受试者中，SIC阳性的比例更高(39.6%)，而天然类固醇组(27.5%，p<0.001)。ICS治疗不影响SIC的结果。在类固醇治疗和天然类固醇受试者之间，SIC后PC20或痰嗜酸性粒细胞百分比的变化没有差异。
结论：在SIC期间持续的ICS治疗不会影响哮喘反应的发生，长期接受ICS治疗的受试者暴露于可疑病原体后气道反应性的变化或嗜酸性粒细胞炎症为受影响。
(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 31:S2213-2198(24)00771-2. doi: 10.1016/j.jaip.2024.07.021.)
(J Allergy Clin Immunol Pract. 2024 Jul 31:S2213-2198(24)00771-2. doi: 10.1016/j.jaip.2024.07.021.)
Impact of ongoing treatment with inhaled corticosteroids during specific inhalation challenges for diagnosing occupational asthma
Gabriel Lavoie, Catherine Lemière
Abstract
Background: Specific inhalation challenge tests (SIC) are still the reference test for diagnosing sensitizer-induced occupational asthma (SIOA). The European Respiratory Society recommends the cessation of inhaled corticosteroids (ICS) 72h prior to SIC.
Objective: To assess the effect of an ongoing ICS treatment during SIC on the maximum fall in FEV1, change in methacholine PC20 as well as sputum eosinophil counts after exposure to the suspected agent.
Methods: We performed a retrospective analysis using a database of cases referred to our center for suspected SIOA from 1999 to 2022. The results of the SIC were compared between subjects treated with ICS during SIC and steroid-naïve subjects.
Results: Six-hundred and seventy-one individuals underwent SIC in the laboratory. Three hundred and eighteen were treated with ICS, whereas 353 were steroid naïve. The proportion of subjects with a positive SIC was greater among ICS treated subjects (39. 6%) compared to steroid-naïve subjects (27.5%, p<0.001). A treatment with ICS did not influence the outcome of the SIC. There was no difference in the change in PC20 or percentage of sputum eosinophils after SIC between steroid-treated and steroid-naïve subjects.
Conclusion: An ongoing ICS treatment during a SIC did not affect the occurrence of an asthmatic reaction, the change in airway responsiveness or eosinophilic inflammation after exposure to the suspected agent in subjects who have been treated with ICS for a long period of time.
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