哮喘联盟

   摘要
   目的：前瞻性人群研究显示，FEV1检测的肺功能是患者死亡的独立预测因子。此外，数项研究发现，哮喘患者的全因死亡率高于非哮喘患者。然而，前期试验并未研究支气管高反应性（BHR；哮喘的一个关键特征）是否可作为死亡的一个预测因子。本试验旨在基于人群的成人队列中分析BHR、FEV1和全因死亡率之间的关系。
   方法：在横断面调查ECRHS-I Erfurt (1990-92)中，对1162名20～65岁的成人进行肺功能检测，检测内容包括肺活量和BHR（采用累积剂量为2 mg的乙酰甲胆碱吸入）。基于FEV1下降≥ 20%时雾化吸入乙酰甲胆碱的剂量来评价BHR。20年的随访后，评价基线肺功能、BHR和死亡之间的关系。
   结果：平均随访期为17.4年(SD=2.4)，其中85名受试者(7.3%)死亡。FEV1（而非FVC）是死亡的预测因子。在男性患者中，BHR能增加死亡风险（经年龄和BMI校正的OR=2.6, 95% CI 1.3-5.3）。额外对哮喘进行校正不影响结果（OR=2.4; 95% CI 1.2-5.0）。然而，在对每年吸烟量和气道阻塞进行校正后，该相关性不复存在（OR=1.8; 95% CI: 0.8-4.0 ； OR=1.9; 95% CI 0.9-4.3）。
   结论：BHR与男性患者死亡风险增加有关。该相关性的潜在解释因素为吸烟、COPD或哮喘。因此，BHR可能是全因死亡率的一个间接预测因子。FEV1是全因死亡率的一个独立预测因子。
 

（苏楠 审校）
J Asthma. 2013 Jan 23. [Epub ahead of print]

 

Bronchial responsiveness, spirometry and mortality in a cohort of adults.
 
Becker EC, Wölke G, Heinrich J.

Source
Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute of Epidemiology I , Neuherberg , Germany.

Abstract 
OBJECTIVE: Prospective population studies have reported that pulmonary function, measured by FEV1, is an independent predictor for mortality. Besides, several studies found that death from all causes is higher in asthmatics than in non-asthmatics. However, none of these studies examined whether bronchial hyperresponsiveness (BHR), one of the key features in asthma, can be used as a predictor for mortality. Thus, the aim of this study was to analyse the association between BHR, FEV(1) and all-cause mortality in a population-based cohort of adults.
METHODS: Within the cross-sectional survey ECRHS-I Erfurt (1990-92) 1162 adults aged 20-65 years performed lung function tests, including spirometry and BHR testing by methacholine inhalation up to a cumulative dose of 2 mg. BHR was assessed from the methacholine dose nebulized at a ≥ 20% fall of FEV(1). After circa 20 years of follow-up, the association between baseline lung function, BHR and mortality was investigated.
RESULTS: A total of 85 individuals (7.3%) died during a mean follow-up period of 17.4 years (SD=2.4). FEV(1), but not FVC, was a predictor for mortality. In men BHR increased the mortality risk (OR=2.6, 95% CI 1.3-5.3; adjusted for age and BMI). Additional adjustment for asthma did not change the results (OR=2.4; 95% CI 1.2-5.0). However, after additional adjustment for pack years of cigarette smoking or airway obstruction the association was not statistically significant anymore (OR=1.8; 95% CI: 0.8-4.0 resp. OR=1.9; 95% CI 0.9-4.3).
CONCLUSIONS: BHR was associated with an increased mortality risk in men. Potential explanatory factors for this association are cigarette smoking, COPD or asthma. Thus, BHR might be an indirect predictor for all-cause mortality. FEV(1) was an independent predictor for all-cause mortality.

J Asthma. 2013 Jan 23. [Epub ahead of print]