哮喘医疗负担评分的发展：作为严重程度的衡量标准和缓解预测指标在SARP III和U-BIOPRED中的应用：来自两个主要
2025/03/03
哮喘医疗负担评分的发展：作为严重程度的衡量标准和缓解预测指标在SARP III和U-BIOPRED中的应用：来自两个主要纵向哮喘队列的结果
摘要
背景：目前的哮喘指南，包括欧洲呼吸学会（ERS）和美国胸科学会（ATS）的指南，在预测哮喘缓解、疾病严重程度和医疗资源利用方面表现不佳。我们旨在建立一种基于哮喘医疗负担数据的新方法来评估哮喘严重程度。
方法：我们分析了前瞻性收集的数据，这些数据来自美国的重度哮喘研究计划III（SARP III）和欧洲的呼吸疾病结果预测无偏生物标志物（U-BIOPRED；11个欧洲国家），以计算基于哮喘急性发作和医疗资源利用的综合负担评分，该评分经过修改，包括使用短效β激动剂（SABAs）以反映哮喘症状负担。
结果：在SARP III中，528名成年哮喘参与者被随访了平均4·4（标准差1·6）年，根据ERS-ATS定义，312名（59%）患有重度哮喘。在205名每天使用急救SABAs的哮喘参与者中，90名每天使用两次或更多次。在U-BIOPRED中，509名成年哮喘参与者被随访了1年，421名（83%）患有重度哮喘。在312名SARP III参与者中，106名（34%）和421名U-BIOPRED重度哮喘参与者中80名（19%）的负担评分低于每患者年1·29。相比之下，负担评分高于中位数的有58名（28%）SARP III和24名（27%）U-BIOPRED非重度哮喘参与者。在两个队列中，负担评分与肺功能、哮喘控制和生活质量呈负相关。负担评分为0·15或更低预测哮喘缓解的敏感性大于91%，特异性为99%。
结论：我们的研究结果突显了当前哮喘严重程度定义与我们的负担评分之间的显著差异。尽管ERS-ATS和全球哮喘倡议（GINA）提出的重度哮喘定义基于处方的哮喘药物，我们的个性化医疗负担评分包括反映疾病严重程度的以患者为中心的数据，并准确预测哮喘缓解。在得到前瞻性验证的前提下，负担评分可能有助于优化高风险哮喘患者的管理。
背景：目前的哮喘指南，包括欧洲呼吸学会（ERS）和美国胸科学会（ATS）的指南，在预测哮喘缓解、疾病严重程度和医疗资源利用方面表现不佳。我们旨在建立一种基于哮喘医疗负担数据的新方法来评估哮喘严重程度。
方法：我们分析了前瞻性收集的数据，这些数据来自美国的重度哮喘研究计划III（SARP III）和欧洲的呼吸疾病结果预测无偏生物标志物（U-BIOPRED；11个欧洲国家），以计算基于哮喘急性发作和医疗资源利用的综合负担评分，该评分经过修改，包括使用短效β激动剂（SABAs）以反映哮喘症状负担。
结果：在SARP III中，528名成年哮喘参与者被随访了平均4·4（标准差1·6）年，根据ERS-ATS定义，312名（59%）患有重度哮喘。在205名每天使用急救SABAs的哮喘参与者中，90名每天使用两次或更多次。在U-BIOPRED中，509名成年哮喘参与者被随访了1年，421名（83%）患有重度哮喘。在312名SARP III参与者中，106名（34%）和421名U-BIOPRED重度哮喘参与者中80名（19%）的负担评分低于每患者年1·29。相比之下，负担评分高于中位数的有58名（28%）SARP III和24名（27%）U-BIOPRED非重度哮喘参与者。在两个队列中，负担评分与肺功能、哮喘控制和生活质量呈负相关。负担评分为0·15或更低预测哮喘缓解的敏感性大于91%，特异性为99%。
结论：我们的研究结果突显了当前哮喘严重程度定义与我们的负担评分之间的显著差异。尽管ERS-ATS和全球哮喘倡议（GINA）提出的重度哮喘定义基于处方的哮喘药物，我们的个性化医疗负担评分包括反映疾病严重程度的以患者为中心的数据，并准确预测哮喘缓解。在得到前瞻性验证的前提下，负担评分可能有助于优化高风险哮喘患者的管理。
（中日友好医院呼吸与危重症医学科 沈焜路 摘译 林江涛 审校）
（Lancet Respir Med. 2025 Jan; DOI: 10.1016/S2213-2600(24)00250-9）
Development of an asthma health-care burden score as a measure of severity and predictor of remission in SARP III and U-BIOPRED: results from two major longitudinal asthma cohorts
Zein JG, Zounemat-Kerman N, Adcock IM, Hu B, Attaway A, Castro M, Dahlén SE, Denlinger LC, Erzurum SC, Fahy JV, Gaston B, Hastie AT, Israel E, Jarjour NN, Levy BD, Mauger DT, Moore W, Peters MC, Sumino K, Townsend E, Woodruff P, Ortega VE, Wenzel SE, Meyers DA, Chung KF, Bleecker ER.
Abstract
BACKGROUND:Current asthma guidelines, including those of the European Respiratory Society (ERS) and American Thoracic Society (ATS), suboptimally predict asthma remission, disease severity, and health-care utilisation. We aimed to establish a novel approach to assess asthma severity based on asthma health-care burden data.
METHODS:We analysed prospectively collected data from the Severe Asthma Research Program III (SARP III; USA) and the European Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes (U-BIOPRED; 11 European countries) to calculate a composite burden score based on asthma exacerbations and health-care utilisation, which was modified to include the use of short-acting beta agonists (SABAs) to reflect asthma symptom burden.
RESULTS:In SARP III, 528 adult participants with asthma were followed up for a mean of 4·4 (SD 1·6) years, and 312 (59%) had severe asthma according to the ERS-ATS definition. Among the 205 participants with asthma who used rescue SABAs daily, 90 used these two or more times a day. In U-BIOPRED, 509 adult participants with asthma were followed up for 1 year, and 421 (83%) had severe asthma. The burden score was less than 1·29 per patient-year in 106 (34%) of 312 SARP III participants and in 80 (19%) of 421 U-BIOPRED participants with severe asthma. By contrast, the burden score was above the median value in 58 (28%) SARP III and 24 (27%) U-BIOPRED participants with non-severe asthma. In both cohorts, the burden score negatively correlated with lung function, asthma control, and quality of life. A burden score of 0·15 or lower predicted asthma remission with a sensitivity greater than 91% and a specificity of 99%.
CONCLUSION:Our findings highlight considerable discrepancies between the current definition of asthma severity and our burden score. Although the definition of severe asthma proposed by the ERS-ATS and the and Global Initiative for Asthma (GINA) is based on prescribed asthma medications, our personalised health-care burden score includes patient-centred data that reflect disease severity and accurately predicts asthma remission. Subject to prospective validation, the burden score could help to optimise the management of high-risk individuals with asthma.
Zein JG, Zounemat-Kerman N, Adcock IM, Hu B, Attaway A, Castro M, Dahlén SE, Denlinger LC, Erzurum SC, Fahy JV, Gaston B, Hastie AT, Israel E, Jarjour NN, Levy BD, Mauger DT, Moore W, Peters MC, Sumino K, Townsend E, Woodruff P, Ortega VE, Wenzel SE, Meyers DA, Chung KF, Bleecker ER.
Abstract
BACKGROUND:Current asthma guidelines, including those of the European Respiratory Society (ERS) and American Thoracic Society (ATS), suboptimally predict asthma remission, disease severity, and health-care utilisation. We aimed to establish a novel approach to assess asthma severity based on asthma health-care burden data.
METHODS:We analysed prospectively collected data from the Severe Asthma Research Program III (SARP III; USA) and the European Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes (U-BIOPRED; 11 European countries) to calculate a composite burden score based on asthma exacerbations and health-care utilisation, which was modified to include the use of short-acting beta agonists (SABAs) to reflect asthma symptom burden.
RESULTS:In SARP III, 528 adult participants with asthma were followed up for a mean of 4·4 (SD 1·6) years, and 312 (59%) had severe asthma according to the ERS-ATS definition. Among the 205 participants with asthma who used rescue SABAs daily, 90 used these two or more times a day. In U-BIOPRED, 509 adult participants with asthma were followed up for 1 year, and 421 (83%) had severe asthma. The burden score was less than 1·29 per patient-year in 106 (34%) of 312 SARP III participants and in 80 (19%) of 421 U-BIOPRED participants with severe asthma. By contrast, the burden score was above the median value in 58 (28%) SARP III and 24 (27%) U-BIOPRED participants with non-severe asthma. In both cohorts, the burden score negatively correlated with lung function, asthma control, and quality of life. A burden score of 0·15 or lower predicted asthma remission with a sensitivity greater than 91% and a specificity of 99%.
CONCLUSION:Our findings highlight considerable discrepancies between the current definition of asthma severity and our burden score. Although the definition of severe asthma proposed by the ERS-ATS and the and Global Initiative for Asthma (GINA) is based on prescribed asthma medications, our personalised health-care burden score includes patient-centred data that reflect disease severity and accurately predicts asthma remission. Subject to prospective validation, the burden score could help to optimise the management of high-risk individuals with asthma.
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