哮喘联盟

   摘要
   背景：尚未对处于指南推荐的治疗步骤4/5/6的严重或难治性哮喘患者进行过描述。
   目的：描述处于治疗步骤4/5/6的患有严重或难治性哮喘患者的特征，并对未来哮喘发作的预测因子进行评估
   方法：患者年龄≥12岁，基线水平和第12个月药物治疗数据显示被分配到2007年国家心肺和血液研究所指南保健水平的步骤4/5/6。使用描述性统计学方法对处于基线水平和第12个月的人口统计学、过敏性和临床特点进行评估。使用简易哮喘生活质量问卷对哮喘相关的生活质量进行评估，使用哮喘工作生产率和活动障碍问卷对工作和活动障碍进行评估。使用多变量回归生成第12个月的哮喘急性发作风险的比值比（OR）和95%的置信区间。
   结果：共纳入1186名患者。超过三分之二的患者（67.4%）为≥3的长期控制者，55.1%患者由于频繁发作被认为属于难治性哮喘。患者报告，哮喘相关的生活质量评分较低，而总体工作和日常活动障碍明显（分别为21.4%和32.1%）。经协变量调整后，发作史（住院治疗，比值比为6.27[95%置信区间，3.61-10.88]；急诊就诊，比值比 3.84[95%置信区间，2.50-5.91]；皮质类固醇脉冲，比值比 2.89[95%置信区间，2.18-3.82]）及哮喘控制不佳（比值比1.95[95%置信区间，1.41-2.71]相对于控制不佳）与未来发作风险独立相关（所有P<0.01）。
   结论：虽经多个长期控制药物治疗，严重或难治性哮喘的患者在步骤4/5/6治疗阶段具有显著的临床负担和未来哮喘发作的风险。
 

（刘国梁 审校）
JAllergyClinImmunolPract.2014Mar-Apr;2(2):193-200.e3.doi:10.1016/j.jaip.2013.11.013.

 

Clinical Burden and Predictors of Asthma Exacerbations in Patients on Guideline-based Steps 4-6 Asthma Therapy in the TENOR Cohort.
 

Calhoun WJ1, Haselkorn T2, Mink DR3, Miller DP3, Dorenbaum A2, Zeiger RS4.
 

ABSTRACT
BACKGROUND:Patients with severe or difficult-to-treat asthma on guideline-recommended Steps 4/5/6 therapy have not previously been described.
OBJECTIVE: To characterize patients with severe or difficult-to-treat asthma on Steps 4/5/6 therapy and assess predictors of future asthma exacerbations.
METHODS: Patients ages ≥12 years with baseline and month 12 medication data were assigned to Steps 4/5/6 care levels from the 2007 National Heart, Lung, and Blood Institute guidelines. Demographic, atopic, and clinical characteristics at baseline and month 12 were assessed by using descriptive statistics. Asthma-related quality of life was assessed by using the Mini Asthma Quality of Life Questionnaire, and work and activity impairment was assessed by the Work Productivity and Activity Impairment Questionnaire-Asthma. Odds ratios (OR) and 95% CI for asthma exacerbation risk at month 12 were generated by using multivariable logistic regression.
RESULTS: A total of 1186 patients were included. More than two-thirds of the patients (67.4%) were on ≥3 long-term controllers, and 55.1% were considered difficult to treat due to frequent exacerbations. Patients reported low asthma-related quality of life scores and considerable impairment in overall work and daily activity (21.4% and 32.1%, respectively). After adjustment for covariates, exacerbation history (hospitalization, OR 6.27 [95% CI, 3.61-10.88]; emergency department visit, OR 3.84 [95% CI, 2.50-5.91]; corticosteroid burst, OR 2.89 [95% CI, 2.18-3.82]) and very poorly controlled asthma (OR 1.95 [95% CI, 1.41-2.71] vs not well controlled) were independently associated with risk of a future exacerbation (all P < .001).
CONCLUSION: Despite multiple long-term controller medications, patients with severe or difficult-to-treat asthma on Steps 4/5/6 therapy present with significant clinical burden and risk of future asthma exacerbations.
 

JAllergyClinImmunolPract.2014Mar-Apr;2(2):193-200.e3.doi:10.1016/j.jaip.2013.11.013.