频繁急性发作—重症哮喘的独特表型
2015/02/25
摘要
背景: 哮喘的急性发作是哮喘发病及死亡的主要因素，有难于控制、难于治疗的突出特征。
目的：本研究的目的是提供哮喘频繁发作这一表型的详细特征，同时找出频繁发作和季节性急性发作的危险因素。
方法：筛选出93例重度哮喘（SA）和76例轻-中度受试者，前瞻性的随访1年(NCT00555607)。病史、基线临床数据和生物标记物用来评估频繁急性发作哮喘患者的危险因素。
结果：在本研究中，SA组记录到104次急性发作，MA组18次。频繁急性发作受试者的特征有：使用较高剂量吸入糖皮质激素(1700 vs.800 ug)及口服糖皮质激素 (6.7 vs. 1.7 mg)，哮喘控制较差(ACQ评分2.3 vs. 1.4)，较低的生活质量(SGRQ评分48.5 vs. 33.3)，痰中嗜酸性粒细胞较高(25.7% vs. 8.2%)以及FEV1/FVC比值下降更快(_0.07 vs. _0.01△FEV1/FVC, P < 0.05)。呼出NO > 45 p.p.b.以及吸烟史与较高风险的频繁急性发作相关(OR值分别为4.32与2.90)。
结论和临床相关性：我们能够区分和描述哮喘受试者的亚表型-频繁急性发作受试者-他们明显更易于急性发作。FeNO > 45 p.p.b.且有吸烟史的患者有较高风险的频繁急性发作，需要在临床实践中密切监测。
Frequent exacerbators – a distinct phenotype of severe asthma
Kupczyk M, ten Brinke A, Sterk P.J, Bel E.H, Papi A, Chanez P, Nizankowska-Mogilnicka E, Gjomarkaj M, Gaga M, Brusselle G, Dahlen B, Dahlen S.-E and on behalf of the BIOAIR investigators.
keywords asthma exacerbation, risk factors for exacerbations, severe asthma
ABSTRACT
BACKGROUND： Exacerbations represent a major source of morbidity and mortality in asthma and are a prominent feature of poorly controlled, difficult-to-treat disease.
OBJECTIVE：The goal of our study was to provide a detailed characterization of the frequent exacerbator phenotype and to identify risk factors associated with frequent and seasonal exacerbations.
METHODS：Ninety-three severe asthmatics (SA) and 76 mild-to-moderate patients (MA) were screened and prospectively followed up for 1 year (NCT00555607). Medical history, baseline clinical data and biomarkers were used to assess risk factors for frequent exacerbations.
RESULTS：During the study, 104 exacerbations were recorded in the SA group and 18 in the MA. Frequent exacerbators were characterized by use of higher doses of inhaled (1700 vs.800ug) and oral (6.7 vs. 1.7 mg) glucocorticosteroids, worse asthma control (ACQ score2.3 vs. 1.4), lower quality of life (SGRQ score 48.5 vs. 33.3), higher sputum eosinophils(25.7% vs. 8.2%) and a more rapid decline in FEV1/FVC ratio (_0.07 vs. _0.01 DFEV1/FVC, frequent vs. non-frequent, respectively, P < 0.05). Exhaled NO > 45 p.p.b. and a history of smoking were associated with an increased risk of frequent exacerbations (odds ratios: 4.32 and 2.90 respectively).
CONCLUSION AND CLINICAL RELEVANCE：We were able to distinguish and characterize a subphenotype of asthma subjects – frequent exacerbators – who are significantly more prone to exacerbations. Patients with FeNO > 45 p.p.b. and a history of smoking are at increased risk of frequent exacerbations and require careful monitoring in clinical practice.
Clinical & Experimental Allergy;2014;44,;212–221
背景: 哮喘的急性发作是哮喘发病及死亡的主要因素，有难于控制、难于治疗的突出特征。
目的：本研究的目的是提供哮喘频繁发作这一表型的详细特征，同时找出频繁发作和季节性急性发作的危险因素。
方法：筛选出93例重度哮喘（SA）和76例轻-中度受试者，前瞻性的随访1年(NCT00555607)。病史、基线临床数据和生物标记物用来评估频繁急性发作哮喘患者的危险因素。
结果：在本研究中，SA组记录到104次急性发作，MA组18次。频繁急性发作受试者的特征有：使用较高剂量吸入糖皮质激素(1700 vs.800 ug)及口服糖皮质激素 (6.7 vs. 1.7 mg)，哮喘控制较差(ACQ评分2.3 vs. 1.4)，较低的生活质量(SGRQ评分48.5 vs. 33.3)，痰中嗜酸性粒细胞较高(25.7% vs. 8.2%)以及FEV1/FVC比值下降更快(_0.07 vs. _0.01△FEV1/FVC, P < 0.05)。呼出NO > 45 p.p.b.以及吸烟史与较高风险的频繁急性发作相关(OR值分别为4.32与2.90)。
结论和临床相关性：我们能够区分和描述哮喘受试者的亚表型-频繁急性发作受试者-他们明显更易于急性发作。FeNO > 45 p.p.b.且有吸烟史的患者有较高风险的频繁急性发作，需要在临床实践中密切监测。
(刘闪闪1 张红萍1 王刚1 四川大学华西医院中西医结合科呼吸病组 610041 摘译)
（Clinical & Experimental Allergy;2014;44,;212–221)
（Clinical & Experimental Allergy;2014;44,;212–221)
Frequent exacerbators – a distinct phenotype of severe asthma
Kupczyk M, ten Brinke A, Sterk P.J, Bel E.H, Papi A, Chanez P, Nizankowska-Mogilnicka E, Gjomarkaj M, Gaga M, Brusselle G, Dahlen B, Dahlen S.-E and on behalf of the BIOAIR investigators.
keywords asthma exacerbation, risk factors for exacerbations, severe asthma
ABSTRACT
BACKGROUND： Exacerbations represent a major source of morbidity and mortality in asthma and are a prominent feature of poorly controlled, difficult-to-treat disease.
OBJECTIVE：The goal of our study was to provide a detailed characterization of the frequent exacerbator phenotype and to identify risk factors associated with frequent and seasonal exacerbations.
METHODS：Ninety-three severe asthmatics (SA) and 76 mild-to-moderate patients (MA) were screened and prospectively followed up for 1 year (NCT00555607). Medical history, baseline clinical data and biomarkers were used to assess risk factors for frequent exacerbations.
RESULTS：During the study, 104 exacerbations were recorded in the SA group and 18 in the MA. Frequent exacerbators were characterized by use of higher doses of inhaled (1700 vs.800ug) and oral (6.7 vs. 1.7 mg) glucocorticosteroids, worse asthma control (ACQ score2.3 vs. 1.4), lower quality of life (SGRQ score 48.5 vs. 33.3), higher sputum eosinophils(25.7% vs. 8.2%) and a more rapid decline in FEV1/FVC ratio (_0.07 vs. _0.01 DFEV1/FVC, frequent vs. non-frequent, respectively, P < 0.05). Exhaled NO > 45 p.p.b. and a history of smoking were associated with an increased risk of frequent exacerbations (odds ratios: 4.32 and 2.90 respectively).
CONCLUSION AND CLINICAL RELEVANCE：We were able to distinguish and characterize a subphenotype of asthma subjects – frequent exacerbators – who are significantly more prone to exacerbations. Patients with FeNO > 45 p.p.b. and a history of smoking are at increased risk of frequent exacerbations and require careful monitoring in clinical practice.
Clinical & Experimental Allergy;2014;44,;212–221
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综合计算机决策支持与人群为中心分析评估两者对哮喘初级护理的影响：一项随机对照试验
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呼吸和有氧运动对中、重度哮喘患者临床控制的比较：一项随机试验
