哮喘联盟

   摘要
   简介：已有研究证明，在动物模型和哮喘患者中短暂的夜间持续气道正压通气（CPAP）能降低气道反应性。但夜间CPAP（nCPAP）在严重的无法控制的非窒息性哮喘患者中的应用效果还不完全清楚。
   目的：在这项开放的前瞻性研究中，我们旨在评价nCPAP对这类患者的呼气峰流速（PEF）的变异率和哮喘控制的影响。
   方法：对10例使用CPAP的患有严重长期哮喘但无阻塞性睡眠呼吸暂停的患者进行连续7晚的观察，研究期间CPAP在自动设置下被使用。从干预前2周到nCPAP治疗结束后两周监测患者每日呼气峰流速（PEF）。PEF的变化幅度和一周以上的24小时内晨间下降平均幅度作为PEF变异率的监测指标。哮喘控制测试表（ACT）和欧洲生存质量调查（euroQol）问卷分别在基线、一个月后和在基线、CPAP结束时被评估。
   结果：在CPAP过程中和nCPAP停止后的第一周，PEF变化幅度较基线明显降低（分别为19.8±7.5%, 23.9±9.1%和28.9±11.5%，P<0.05）。在nCPAP期间，PEF晨间下降幅度较基线明显降低（p<0.001）。与基础值相比，nCPAP后的ACT和euroQol明显提高。
   结论：该初步研究表明，短期nCPAP能降低严重非窒息性哮喘患者的PEF变异率，提高哮喘控制情况。但更长时间的评估和较大规模的受试者研究还有待进一步证实。

(苏楠 审校)
Clin Respir J. 2013 Dec 6. doi: 10.1111/crj.12088. [Epub ahead of print]

Nocturnal continuous positive airway pressure in severe non apneic asthma. A pilot study.
 

D Amato M, Stanziola AA, de Laurentiis G, Radicella D, Russo C, Maniscalco M, D Amato G, Sofia M.

ABSTRACT
INTRODUCTION: It has been demonstrated that brief periods of nocturnal continuous positive airway pressure (CPAP) reduce airway reactivity in animal models and in patients with asthma. The effects of nocturnal CPAP (nCPAP) in severe uncontrolled non apnoeic asthmatic patients are not well known.
AIM: In this open pilot study we aimed to assess the effect nCPAP on peak flow (PEF) variability and asthma control in this type of patients.
METHODS: CPAP was applied to ten patients with severe longstanding asthma without obstructive sleep apnoea for seven consecutive nights. CPAP was titrated in auto setting and applied to the patients. Daily peak flow (PEF), was measured from two weeks before the intervention to two weeks after the end of nCPAP treatment. PEF amplitude and PEF morning dip over 24 h periods averaged over one week were calculated as indexes of PEF variability. Asthma control test (ACT) and EuroQol questionnaire were measured at baseline and after one month and at baseline and at the end of CPAP period, respectively.
RESULTS: The PEF amplitude significantly decreased both during CPAP period and in the first week after nCPAP discontinuation as compared to the baseline (19.8±7.5%, 23.9±9.1% and 28.9±11.5% respectively, always p<0.05). PEF morning dip significantly decreased during nCPAP in comparison to the baseline (p<0.001). The ACT and euroQol significantly improved after nCPAP in comparison to the basal value.
CONCLUSIONS: In this preliminary report, brief period of nCPAP reduces PEF variability and improves control in severe non apnoeic asthma at a short-term evaluation. Further studies with longer term evaluation and larger number of patients are warranted.

Clin Respir J. 2013 Dec 6. doi: 10.1111/crj.12088. [Epub ahead of print]