COPD和哮喘早期识别和治疗的患者因素及临床疗效
2025/10/31
摘要
理由：未确诊的COPD和哮喘人群试验表明，呼吸科医生对哮喘和COPD的早期诊断和治疗改善了医疗保健利用率，呼吸道症状和生活质量。
目的：确定早期诊断和治疗对晚期疾病患者或哮喘患者相对于COPD患者的益处是否更大。我们还评估了呼吸科医生指导是否同样有益于哮喘和COPD亚组。
方法：病例为社区中未确诊的慢性呼吸道症状成年人。580名新诊断的COPD或哮喘患者被随机分配到呼吸科医生专科干预或常规照护。圣乔治呼吸问卷（SGRQ）和COPD评估测试（CAT）的低和高疾病负担类别使用基线评分的中位数来定义，MCID阈值用于定义显著的反应。通过评估亚组内的治疗效果和通过亚组相互作用评估治疗来评估呼吸科医生护理的益处。
测量和主要结果：与疾病负担较低的患者相比，诊断时疾病负担较高的患者更有可能从早期诊断和治疗中受益。71%的高疾病负担者在12个月内将其CAT改善≥2分，而低疾病负担者为47%；OR 2.78，95%CI:1.90～4.07，p＜0.001。SGRQ和FEV1改善的结果相似。相反，哮喘患者与COPD患者对早期诊断和治疗的反应相似。随机接受呼吸科医生指导的哮喘患者与随机接受初级保健的患者相比，CAT，SGRQ，SF36和FEV1的一年改善更大。然而，无论COPD患者的治疗是由呼吸科医生还是初级保健提供者管理，他们都经历了类似的改善。疾病相互作用的治疗无统计学意义。
结论：表现为更晚期和症状性哮喘和COPD的疾病负担较大的患者从早期诊断和治疗中获益更多。与COPD患者相比，哮喘患者往往从呼吸科专科医生的指导中获益更多。
Patient Factors and Clinical Efficacy of Early Identification and Treatment of COPD and Asthma
Arianne Tardif, G A Whitmore, Katherine L Vandemheen, Celine Bergeron, Louis-Philippe Boulet, Andréanne Côté, R Andrew McIvor, Erika Penz, Stephen K Field, Catherine Lemière, Irvin Mayers, Mohit Bhutani, Tanweer Azher, M Diane Lougheed, Samir Gupta, Nicole Ezer, Christopher J Licskai, Paul Hernandez, Martha Ainslie, Gonzalo G Alvarez, Sunita Mulpuru, Shawn D Aaron
Abstract
Rationale: The Undiagnosed COPD and Asthma Population trial showed that early diagnosis and treatment of asthma and COPD by pulmonologists improved healthcare utilization, respiratory symptoms, and quality of life.
Objectives: To determine if the benefits of early diagnosis and treatment were greater in individuals with more advanced disease, or in individuals with asthma as opposed to COPD. We also assessed whether pulmonologist-directed care benefited asthma and COPD subgroups equally.
Methods: Case finding was used to identify undiagnosed adults with chronic respiratory symptoms in the community. Five hundred and eight newly diagnosed participants with COPD or asthma were randomized to a pulmonologist-care intervention or usual care. Low and high disease-burden categories for St. Georges Respiratory Questionnaire (SGRQ) and COPD Assessment Test (CAT) were defined using a median-split of baseline scores, and MCID thresholds were used to define significant responses. Benefits of pulmonologist care were assessed by evaluating treatment effects within subgroups and by assessing treatment-by-subgroup interactions.
Measurements and main results: Patients with higher disease burden at diagnosis were more likely to benefit from early diagnosis and treatment compared to those with lower disease-burden. 71% of those with high disease-burden improved their CAT by ≥ 2 points over 12 months compared to 47% with low disease burden; OR 2.78, 95% CI: 1.90 to 4.07, p<0.001. Similar results were seen for SGRQ and FEV1 improvements. In contrast, responses to early diagnosis and treatment were similar for those with asthma vs COPD. Individuals with asthma randomized to pulmonologist-directed care showed greater one-year improvements in CAT, SGRQ, SF36 and FEV1 compared to individuals randomized to primary care. However, individuals with COPD experienced similar improvements regardless of whether their treatment was managed by a pulmonologist or primary care provider. Treatment-by-disease interaction terms were not statistically significant.
Conclusions: Patients with greater disease burden who exhibited more advanced and symptomatic asthma and COPD at the time of diagnosis, benefited more from earlier diagnosis and treatment. Patients with asthma tended to derive greater benefit from pulmonologist-directed care than patients with COPD.
理由：未确诊的COPD和哮喘人群试验表明，呼吸科医生对哮喘和COPD的早期诊断和治疗改善了医疗保健利用率，呼吸道症状和生活质量。
目的：确定早期诊断和治疗对晚期疾病患者或哮喘患者相对于COPD患者的益处是否更大。我们还评估了呼吸科医生指导是否同样有益于哮喘和COPD亚组。
方法：病例为社区中未确诊的慢性呼吸道症状成年人。580名新诊断的COPD或哮喘患者被随机分配到呼吸科医生专科干预或常规照护。圣乔治呼吸问卷（SGRQ）和COPD评估测试（CAT）的低和高疾病负担类别使用基线评分的中位数来定义，MCID阈值用于定义显著的反应。通过评估亚组内的治疗效果和通过亚组相互作用评估治疗来评估呼吸科医生护理的益处。
测量和主要结果：与疾病负担较低的患者相比，诊断时疾病负担较高的患者更有可能从早期诊断和治疗中受益。71%的高疾病负担者在12个月内将其CAT改善≥2分，而低疾病负担者为47%；OR 2.78，95%CI:1.90～4.07，p＜0.001。SGRQ和FEV1改善的结果相似。相反，哮喘患者与COPD患者对早期诊断和治疗的反应相似。随机接受呼吸科医生指导的哮喘患者与随机接受初级保健的患者相比，CAT，SGRQ，SF36和FEV1的一年改善更大。然而，无论COPD患者的治疗是由呼吸科医生还是初级保健提供者管理，他们都经历了类似的改善。疾病相互作用的治疗无统计学意义。
结论：表现为更晚期和症状性哮喘和COPD的疾病负担较大的患者从早期诊断和治疗中获益更多。与COPD患者相比，哮喘患者往往从呼吸科专科医生的指导中获益更多。
（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）
（Am J Respir Crit Care Med. 2025 Oct 7. doi: 10.1164/rccm.202505-1260OC.）
（Am J Respir Crit Care Med. 2025 Oct 7. doi: 10.1164/rccm.202505-1260OC.）
Patient Factors and Clinical Efficacy of Early Identification and Treatment of COPD and Asthma
Arianne Tardif, G A Whitmore, Katherine L Vandemheen, Celine Bergeron, Louis-Philippe Boulet, Andréanne Côté, R Andrew McIvor, Erika Penz, Stephen K Field, Catherine Lemière, Irvin Mayers, Mohit Bhutani, Tanweer Azher, M Diane Lougheed, Samir Gupta, Nicole Ezer, Christopher J Licskai, Paul Hernandez, Martha Ainslie, Gonzalo G Alvarez, Sunita Mulpuru, Shawn D Aaron
Abstract
Rationale: The Undiagnosed COPD and Asthma Population trial showed that early diagnosis and treatment of asthma and COPD by pulmonologists improved healthcare utilization, respiratory symptoms, and quality of life.
Objectives: To determine if the benefits of early diagnosis and treatment were greater in individuals with more advanced disease, or in individuals with asthma as opposed to COPD. We also assessed whether pulmonologist-directed care benefited asthma and COPD subgroups equally.
Methods: Case finding was used to identify undiagnosed adults with chronic respiratory symptoms in the community. Five hundred and eight newly diagnosed participants with COPD or asthma were randomized to a pulmonologist-care intervention or usual care. Low and high disease-burden categories for St. Georges Respiratory Questionnaire (SGRQ) and COPD Assessment Test (CAT) were defined using a median-split of baseline scores, and MCID thresholds were used to define significant responses. Benefits of pulmonologist care were assessed by evaluating treatment effects within subgroups and by assessing treatment-by-subgroup interactions.
Measurements and main results: Patients with higher disease burden at diagnosis were more likely to benefit from early diagnosis and treatment compared to those with lower disease-burden. 71% of those with high disease-burden improved their CAT by ≥ 2 points over 12 months compared to 47% with low disease burden; OR 2.78, 95% CI: 1.90 to 4.07, p<0.001. Similar results were seen for SGRQ and FEV1 improvements. In contrast, responses to early diagnosis and treatment were similar for those with asthma vs COPD. Individuals with asthma randomized to pulmonologist-directed care showed greater one-year improvements in CAT, SGRQ, SF36 and FEV1 compared to individuals randomized to primary care. However, individuals with COPD experienced similar improvements regardless of whether their treatment was managed by a pulmonologist or primary care provider. Treatment-by-disease interaction terms were not statistically significant.
Conclusions: Patients with greater disease burden who exhibited more advanced and symptomatic asthma and COPD at the time of diagnosis, benefited more from earlier diagnosis and treatment. Patients with asthma tended to derive greater benefit from pulmonologist-directed care than patients with COPD.
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通过协作和护理协调改善食物过敏和哮喘管理中的依从性
