哮喘联盟

   摘要
   背景：哮喘在人群中的患病率高达5%～10%，通过四项指标评估其疾病严重程度，包括肺功能、哮喘症状发生的频率、吸入性药物的使用以及哮喘病情恶化的次数。哮喘逐渐被认为是一种临床综合征，而不是一种单一的疾病。但是，目前的分类系统并不能反应该疾病特征的异质性。
   方法：我们对139名轻度、中度和重度持续性哮喘的患者进行回顾性分析。对病人进行分型的变量包括基础和最大第一秒用力呼气量（占预计值的百分比），以及哮喘发病的年龄。
   结果：我们根据结果将病人分为了5型，与危重哮喘研究计划类似。其中第1型（32例）和第2型（47例）患者为早发型变应性哮喘，肺功能下降，但是其对药物治疗的需求及医疗保健的利用不同。第3型患者（32例）为发病年龄较晚、较弱特异反应性、第一秒用力呼气量轻度下降的年长肥胖症女性。第4型患者（20例）和第5型患者（8例）为变应性哮喘合并严重的气道阻塞症状，但是其对支气管扩张剂的反应性、发病年龄及口服性皮质类固醇激素的使用情况不同。与危重哮喘研究计划中患者相比，本研究中的研究对象年龄较大，非裔美国人所占的比例更大，较多肥胖症患者，并且哮喘的严重程度较低（P < 0.05）。本研究的患者分类与危重哮喘研究计划中的患者分类情况有以下几点不同：（1）1型患者和2型患者哮喘急性加重的发作频率更高，药物使用量更大。（2）3型患者和4型患者的药物使用情况更低。（3）虽然3型患者总的医疗保健使用情况与危重哮喘研究计划相似，但本研究中患者的急诊就诊率显著下降（P < 0.05）。
   结论：危重哮喘研究计划中的分类规则也许可用于对哮喘患者异质性进行可重复的临床分型。
 

 （杨冬 审校）
Am J Med Sci. 2014 Oct 14. [Epub ahead of print]

 

Identification of Asthma Phenotypes in a Tertiary Care Medical Center.
 

Kuhlen JL Jr1, Wahlquist AE, Nietert PJ, Bains SN.
 

ABSTRACT
BACKGROUND:Asthma affects 5% to 10% of the population and its severity is assessed using 4 parameters: lung function, symptom frequency, rescue inhaler use, and number of asthma exacerbations. Asthma is increasingly recognized as a clinical syndrome rather than a single disease. However, the current classification system fails to reflect the heterogeneous characteristics of the disease.
METHODS:A retrospective chart review of 139 patients with mild, moderate, and severe persistent asthma was performed. Variables including baseline and maximal forced expiratory volume over first second (percent predicted), and age of asthma onset were used to classify patients.
RESULTS:This yielded 5 clusters similar to Severe Asthma Research Program (SARP). Subjects in cluster 1 (n = 32) and cluster 2 (n = 47) had early-onset atopic asthma and reduced lung function but differed in medication requirement and health care utilization. Cluster 3 (n = 32) consisted of older obese women with late-onset asthma, less atopy, and mildly reduced forced expiratory volume over first second. Members of cluster 4 (n = 20) and cluster 5 (n = 8) had atopic asthma with severe obstruction but differed in bronchodilator response, age of onset, and oral corticosteroid use. Compared with SARP, our subjects were older, had a higher percentage of African Americans and obesity, and less severe asthma (P < 0.05). The observed clusters differed from SARP clusters in the following: (1) more frequent asthma exacerbations and medication use among cluster 1 and cluster 2; (2) lower medication use in cluster 3 and cluster 4; (3) although total health care utilization was similar, there were fewer emergency department visits in cluster 3 (P < 0.05).
CONCLUSIONS:The SARP algorithm may be used to classify diverse asthmatic populations into a clinically reproducible phenotypic cluster.
 

Am J Med Sci. 2014 Oct 14. [Epub ahead of print]