哮喘联盟

   摘要 
   背景：气道高反应性（AHR）是关乎哮喘定义的哮喘病理生理特征，支气管激发试验并非哮喘管理初级护理的常规手段。
   目的：本研究旨在评估直接（乙酰甲胆碱）和间接（甘露醇）支气管激发试验在社区哮喘管理中的潜在价值。
   方法：Tayside和File地区正在接受哮喘治疗的患者被纳入研究，患者信息来自健康信息中心（HIC）。筛选时进行以下试验：肺功能测试，乙酰甲胆碱和甘露醇刺激试验；呼出气一氧化氮测定（FeNO），哮喘控制问卷（ACQ）和简短哮喘生活质量问卷（AQLQ）。
   结果：共3388例哮喘患者接受了HIC鉴定，其中423例有阳性反应，123例完成研究。70%的患者对乙酰甲胆碱(PC20 < 8mg/ml)或甘露醇(PD15 < 635mg)刺激有阳性反应，30%患者对两种刺激均无反应。14%的乙酰甲胆碱阳性反应者(n=74)对甘露醇无反应，16%的甘露醇阳性反应者(n=76)对乙酰甲胆碱无反应。对高剂量皮质醇激素和频繁长效β受体激动剂无反应的患者，肺功能测试、FeVO、ACQ和AQLQ检测结果更好。
   结论和临床相关：我们发现在未经选择的社区哮喘管理患者中，30%的患者激发试验为阴性，可能导致误诊或过度治疗，这提示患者需要在监督下减少治疗。本文章受版权保护。保留版权。

 

       （苏楠 审校） 
Clin Exp Allergy.2014 Jun 10.doi: 10.1111/cea.12352. [Epub ahead of print]

 

The potential role of direct and indirect bronchial challenge testing to identify overtreatment of community managed asthma.
 

Manoharan A1, Lipworth B, Craig E, Jackson C.
 

ABSTRACT
BACKGROUND: Although airway hyperresponsiveness (AHR) is a defining feature of asthma pathophysiology, bronchial challenge testing is not routinely used in primary care asthma management.
OBJECTIVE: The aim of this study was to evaluate the potential role of direct (methacholine) and indirect (mannitol) challenge testing in community managed asthma.
METHODS: Patients currently treated for asthma from Tayside and Fife were identified by the Health Informatics Centre (HIC) and invited to take part in the study. At screening the following tests were carried out: spirometry, methacholine and mannitol challenge; exhaled nitric oxide (FeNO), Asthma Control Questionnaire (ACQ) and Mini Asthma Quality of Life Questionnaire (AQLQ).
RESULTS: A total of 3388 asthmatics were initially identified by HIC with 423 positive responses and 123 completing the study. 70% had either a positive methacholine (PC20 < 8mg/ml) or mannitol challenge (PD15 < 635mg) and 30% were non-responsive to both challenges. 14% of methacholine responders (n=74) were negative to mannitol and 16% of mannitol responders (n=76) were negative to methacholine. Spirometry, FeNO, ACQ and AQLQ were significantly better in the non-responder group who were exposed to high dose inhaled corticosteroids and frequent long-acting beta-agonists.
CONCLUSIONS AND CLINICAL RELEVANCE: We found that 30% of unselected patients with community managed asthma were challenge negative and could be potentially misdiagnosed; or overtreated, in turn suggesting the need for supervised step-down. This article is protected by copyright. All rights reserved.
 

Clin Exp Allergy.2014 Jun 10.doi: 10.1111/cea.12352. [Epub ahead of print]