严重发作预示哮喘患者的额外肺功能下降
2008/02/07
严重哮喘发作是一个强烈气道炎症的过程，并被假定与气道的结构改变有关。果真如此，相比没有频繁发作的哮喘患者，频繁发作者在肺功能下降方面将更为显著。
为了证实这一假说，Bai等在93例不吸烟的中重度哮喘患者中，进行了一项队列研究调查严重发作对气道阻塞的关系。这些患者均采用吸入激素治疗，随访期超过5年，平均11年。共有56例（60.2%）患者发生了至少1次严重发作（平均0.1次/年）。使用口服激素和基础气道阻塞严重者的发作率增高。此外，与没有频繁发作的哮喘患者相比，频繁发作的哮喘患者每年肺功能的下降更显著，二者FEV1的年下降平均差异为16.9mL/年(95%CI 1.5–32.2mL/年)。哮喘发作率预示着FEV1的额外下降，每年1次严重发作使FEV1的年下降增加30.2 mL。
作者认为，这些数据支持了这一假说，即哮喘发作不仅提示气道炎症的间断性恶化，更与哮喘患者过度的肺功能下降有关。
（韩伟 青岛大学附属青岛市立医院呼吸科 266071 摘译）
（ Eur Respir J 2007; 30: 452–456）
Severe exacerbations predict excess lungfunction decline in asthma
T.R. Bai*, J.M. Vonk#, D.S. Postma" and H.M. Boezen#
ABSTRACT: Severe asthma exacerbations are periods of intense airway inflammation that have been hypothesised to contribute to structural changes in the airways. If so, accelerated lung function decline over time should be more prevalent in adult patients with asthma who have frequent exacerbations than those without, but to date this has not been demonstrated.
A cohort study was performed in order to investigate the effect of severe exacerbations on the progression of airway obstruction in 93 nonsmoking asthmatics with moderate-to-severe disease prior to treatment with inhaled corticosteroids. Subjects were followed for o5 yrs (median followup 11 yrs).
In total, 56 (60.2%) subjects experienced at least one severe exacerbation (median rate 0.10yr-1). Oral corticosteroid use and more severe airway obstruction at baseline were associated with a higher exacerbation rate. Independent of these variables, asthma patients with frequent exacerbations had a significantly larger annual decline in forced expiratory volume in one second
(FEV1; median difference (95% confidence interval) 16.9 (1.5–32.2) mLyr-1). Exacerbation rate significantly predicted an excess decline in FEV1, such that one severe exacerbation per year was associated with a 30.2 mL greater annual decline in FEV1. These data support the hypothesis that exacerbations, indicating intermittent periods of worsening airway inflammation, are associated with excess lung function decline in asthma.
Bai T.R., Vonk J.M., Postma D.S. et al. Eur Respir J 2007; 30: 452–456
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