哮喘联盟

   摘要
   相当比例的患者中哮喘和慢性阻塞性肺疾病共存。哮喘是否增加了气流受限患者的死亡风险仍然存在争议。我们采用基于人群的气道阻塞性疾病队列的Tucson流行病学研究中2121名成人受试者的数据。入选期间（1972年至1973年），受试者完成了问卷和肺功能检查。基于基线时气流受限（AL;用力呼气容积1秒（FEV1）/用力肺活量（FVC）<70％）和医生确诊哮喘的组合将受试者分为四组。通过国家死亡数据库评估受试者2011年1月时的生存状态。Cox比例风险模型被用来测试在四个气流受限/哮喘组中的死亡风险的差异。在多变量Cox模型中，与AL-/哮喘-组（校正HR2.14; 95％CI1.64-2.79）相比，AL+/哮喘+组在随访期间死亡率风险增加了114％。AL-/哮喘+ AL+/哮喘-组相应的风险比分别是1.09（95％CI：0.89-1.34）和1.34（95％CI：1.14-1.57）。在气流受限受试者中，哮喘与死亡风险增加相关（HR1.58，95％CI为1.17-2.12）。然而，该增加的风险经过进一步校正基线FEV1水平后大大降低且不再显著。当气流受限被定义为FEV1 / FVC小于正常值的下限时能得到类似的结果。一项基于人群的队列研究中，伴有气流受限和哮喘的受试者死亡风险增加，这主要与他们的基线肺功能受损有关。
 

（苏欣 审校）
Eur Respir J. 2014 Oct 16. pii: erj01085-2014. [Epub ahead of print]
 

Asthma, airflow limitation and mortality risk in the general population.
 

Huang S1, Vasquez MM1, Halonen M2, Martinez FD2, Guerra S3.
 

ABSTRACT
Asthma and chronic obstructive pulmonary disease co-exist in a significant proportion of patients. Whether asthma increases mortality risk among subjects with airflow limitation remains controversial. We used data from 2121 adult participants in the population-based Tucson Epidemiological Study of Airway Obstructive Disease cohort. At enrolment (1972-1973), participants completed questionnaires and lung function tests. Participants were categorised into four groups based on the combination of airflow limitation (AL; forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) <70%) and physician-confirmed asthma at baseline. Vital status as of January 2011 was assessed through the National Death Index. Cox proportional hazards models were used to test differences in mortality risk across the four airflow limitation/asthma groups. In multivariate Cox models, the AL+/asthma+ group had a 114% increased mortality risk during follow-up compared with the AL-/asthma- group (adjusted HR 2.14; 95% CI 1.64-2.79). The corresponding hazard ratios were 1.09 (95% CI 0.89-1.34) and 1.34 (95% CI 1.14-1.57) for the AL-/asthma+ and AL+/asthma- groups, respectively. Among subjects with airflow limitation, asthma was associated with increased mortality risk (HR 1.58, 95% CI 1.17-2.12). However, this increased risk was substantially reduced and no longer significant after further adjustment for baseline FEV1 levels. Similar results were obtained when airflow limitation was defined as FEV1/FVC less than the lower limit of normal. In a population-based cohort, subjects with concomitant airflow limitation and asthma had an increased risk of dying, which was mainly related to their baseline lung function deficits.
 

Eur Respir J. 2014 Oct 16. pii: erj01085-2014. [Epub ahead of print]