哮喘联盟

   摘要
   背景：慢性咳嗽和咳痰（慢性黏液高分泌）是很难描述的一个哮喘临床症状。我们的目标是在吸烟或不吸烟的哮喘患者中，识别与（慢性咳嗽和咳痰）症状相关的临床、免疫学和气道壁厚度CT指标。
   方法：分析来自120例吸烟和不吸烟哮喘患者的横断面数据。比较伴/不伴慢性黏液高分泌病史受试者的临床结局、痰细胞计数、气道壁CT指标（壁厚度、管腔面积和壁面积百分比）。
   结果：慢性黏液高分泌在吸烟哮喘患者中的发生率（56%）高于不吸烟哮喘患者（20%）（p<0.001），有这些症状的患者比例随着哮喘严重程度增加而增加（p = 0.003）。伴有哮喘和慢性黏液高分泌的吸烟患者的临床结局比无这些症状的吸烟者更差[ACQ 评分 2.3 vs.1.6, p = 0.002]。大部分伴慢性黏液高分泌的不吸烟者在过去一年间需要口服皮质激素短期治疗(58% vs. 19%, p = 0.011)。伴/不伴慢性黏液高分泌哮喘患者中痰液的中性粒细胞和嗜酸性粒细胞计数相似。在严重哮喘和慢性黏液高分泌患者中，吸烟者的气道管腔面积与不吸烟者相比显著减少（11.4 mm2 vs. 18.4 mm2; p = 0.017）。
   结论：慢性黏液高分泌常见于成人稳定期哮喘患者，特别是伴严重疾病的吸烟患者。慢性黏液高分泌与吸烟者临床结局较差和不吸烟者哮喘发作增加有关。
 

（刘国梁 审校）
Respir Med. 2013 Oct;107(10):1501-8. doi: 10.1016/j.rmed.2013.07.017. Epub 2013 Aug 6.


 

Chronic cough and sputum production are associated with worse clinical outcomes in stable asthma.
 

Thomson NC, Chaudhuri R, Messow CM, Spears M, Macnee W, Connell M, Murchison JT, Sproule M, McSharry C.
 

ABSTRACT
BACKGROUND: Chronic cough and sputum production (chronic mucus hypersecretion) is a poorly described clinical feature of asthma. Our objective was to identify clinical, immunological and computed tomography (CT) measures of airway wall dimensions associated with these symptoms in smokers and never smokers with asthma.
METHODS: Cross-sectional data was analysed from 120 smokers and never smokers with asthma. Participants with and without a history of chronic mucus hypersecretion were compared for clinical outcomes, sputum differential cell counts and CT measures of airway dimensions (wall thickness, luminal area and percent wall area).
RESULTS: Chronic mucus hypersecretion occurred in a higher proportion of smokers with asthma (56%) than never smokers with asthma (20%), (p < 0.001) and the proportion of patients with these symptoms increased with asthma severity (p = 0.003). Smokers with asthma and chronic mucus hypersecretion had worse current clinical control than smokers without those symptoms [ACQ score 2.3 versus 1.6, p = 0.002]. A greater proportion of never smokers with chronic mucus hypersecretion required short courses of oral corticosteroids in the last year (58% versus 19%, p = 0.011). Sputum neutrophil and eosinophil counts were similar in asthma patients with or without chronic mucus hypersecretion. Of those with severe asthma and chronic mucus hypersecretion, a CT measure of airway lumen area was reduced in smokers compared to never smokers (11.4 mm(2) versus 18.4 mm(2); p = 0.017).
CONCLUSIONS: Chronic mucus hypersecretion occurs frequently in adults with stable asthma, particularly in smokers with severe disease and is associated with worse current clinical control in smokers and more exacerbations in never smokers.
 

Respir Med. 2013 Oct;107(10):1501-8. doi: 10.1016/j.rmed.2013.07.017. Epub 2013 Aug 6.