30年以上队列成人哮喘的缓解和严重程度变化
2020/12/17
摘要
背景：哮喘特征明确的成年人的长期随访研究很少。
目的：我们的目的是检查30年以上成人哮喘长期缓解和疾病严重程度的变化。
方法：根据病史和客观评估，纳入丹麦呼吸和过敏诊所1974-1990年间诊断为哮喘的125例患者。在随访（2017-19）中，参与者完成了问卷调查，并测量了肺活量，支气管扩张剂可逆性，气道反应性和血液生物标志物。根据这些评估，参与者被分类为活动性哮喘，临床缓解（去年没有症状或处方哮喘药物）或完全缓解（FeNO<50 ppb，无支气管扩张剂可逆性，无气道高反应性，无气流受限）。根据症状控制和目前处方药的GINA指南确定严重程度的变化。
结果：随访时，25%（n=31）和15%（n=19）分别有临床和完全缓解。我们的分析显示，初始评估前症状持续时间较长（OR 0.86, 95%CI 0.75-0.98）与哮喘缓解的可能性较低有关。在随访中，30%的患者哮喘控制良好，而基线时没有。女性，既往严重发作和基线年龄较大与随访时哮喘未控制相关。血液嗜酸性粒细胞计数（≥0.3x109/l）和基线处方ICS与随访时处方中/高剂量ICS相关。
结论：尽管经过30年的随访，成人哮喘很少缓解，特别是在持续时间较长且病情可能更严重的个体中。在随访中，明显的疾病活动的最初迹象与未控制的哮喘有关。
Remission and changes in severity over 30 years in an adult asthma cohort
Oliver Djurhuus Tupper, Kjell Erik Julius Håkansson, Charlotte Suppli Ulrik
Abstract
Background: Long-term follow-up studies of adults with well-characterised asthma are sparse.
Objective: We aimed to examine long-term remission and change in disease severity over 30 years in adults with asthma.
Methods: 125 individuals diagnosed with asthma between 1974-1990 at a Danish respiratory and allergy clinic, based on history and objective assessments, were included. At follow-up (2017-19), participants completed questionnaires and had spirometry, bronchodilator reversibility, airway responsiveness and blood biomarkers measured. Based on these assessments, participants were classified as having either active asthma, clinical remission (no symptoms or prescribed asthma medication within the last year) or complete remission (FeNO <50 ppb, no bronchodilator reversibility, no airway hyperresponsiveness and no airflow limitation). Changes in severity were determined according to GINA guidelines based on symptom control and currently prescribed medication.
Results: At follow-up, 25% (n=31) and 15% (n=19), respectively, had clinical and complete remission. Our analyses showed that longer duration of symptoms before the initial assessment (OR 0.86, 95% CI 0.75-0.98) was associated with a lower chance of asthma remission. At follow-up, 30% had well-controlled asthma compared with none at baseline. Female sex, previous severe exacerbation(s), and older age at baseline were associated with uncontrolled asthma at follow-up. Blood-eosinophil count (≥0.3x109/l) and prescribed ICS at baseline were associated with being prescribed medium/high dose ICS at follow-up
Conclusion: Despite 30 years of follow-up, asthma rarely remits in adults, especially in individuals with longer duration and presumably more severe disease. Initial signs of pronounced disease activity were associated with uncontrolled asthma at follow-up.
背景：哮喘特征明确的成年人的长期随访研究很少。
目的：我们的目的是检查30年以上成人哮喘长期缓解和疾病严重程度的变化。
方法：根据病史和客观评估，纳入丹麦呼吸和过敏诊所1974-1990年间诊断为哮喘的125例患者。在随访（2017-19）中，参与者完成了问卷调查，并测量了肺活量，支气管扩张剂可逆性，气道反应性和血液生物标志物。根据这些评估，参与者被分类为活动性哮喘，临床缓解（去年没有症状或处方哮喘药物）或完全缓解（FeNO<50 ppb，无支气管扩张剂可逆性，无气道高反应性，无气流受限）。根据症状控制和目前处方药的GINA指南确定严重程度的变化。
结果：随访时，25%（n=31）和15%（n=19）分别有临床和完全缓解。我们的分析显示，初始评估前症状持续时间较长（OR 0.86, 95%CI 0.75-0.98）与哮喘缓解的可能性较低有关。在随访中，30%的患者哮喘控制良好，而基线时没有。女性，既往严重发作和基线年龄较大与随访时哮喘未控制相关。血液嗜酸性粒细胞计数（≥0.3x109/l）和基线处方ICS与随访时处方中/高剂量ICS相关。
结论：尽管经过30年的随访，成人哮喘很少缓解，特别是在持续时间较长且病情可能更严重的个体中。在随访中，明显的疾病活动的最初迹象与未控制的哮喘有关。
(中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校)
(J Allergy Clin Immunol Pract. 2020 Nov 18; S2213-2198(20)31233-2. doi: 10.1016/j.jaip.2020.11.013.)
(J Allergy Clin Immunol Pract. 2020 Nov 18; S2213-2198(20)31233-2. doi: 10.1016/j.jaip.2020.11.013.)
Remission and changes in severity over 30 years in an adult asthma cohort
Oliver Djurhuus Tupper, Kjell Erik Julius Håkansson, Charlotte Suppli Ulrik
Abstract
Background: Long-term follow-up studies of adults with well-characterised asthma are sparse.
Objective: We aimed to examine long-term remission and change in disease severity over 30 years in adults with asthma.
Methods: 125 individuals diagnosed with asthma between 1974-1990 at a Danish respiratory and allergy clinic, based on history and objective assessments, were included. At follow-up (2017-19), participants completed questionnaires and had spirometry, bronchodilator reversibility, airway responsiveness and blood biomarkers measured. Based on these assessments, participants were classified as having either active asthma, clinical remission (no symptoms or prescribed asthma medication within the last year) or complete remission (FeNO <50 ppb, no bronchodilator reversibility, no airway hyperresponsiveness and no airflow limitation). Changes in severity were determined according to GINA guidelines based on symptom control and currently prescribed medication.
Results: At follow-up, 25% (n=31) and 15% (n=19), respectively, had clinical and complete remission. Our analyses showed that longer duration of symptoms before the initial assessment (OR 0.86, 95% CI 0.75-0.98) was associated with a lower chance of asthma remission. At follow-up, 30% had well-controlled asthma compared with none at baseline. Female sex, previous severe exacerbation(s), and older age at baseline were associated with uncontrolled asthma at follow-up. Blood-eosinophil count (≥0.3x109/l) and prescribed ICS at baseline were associated with being prescribed medium/high dose ICS at follow-up
Conclusion: Despite 30 years of follow-up, asthma rarely remits in adults, especially in individuals with longer duration and presumably more severe disease. Initial signs of pronounced disease activity were associated with uncontrolled asthma at follow-up.
上一篇：
支气管哮喘的新冠肺炎易感性
下一篇：
中重度哮喘中过敏性，嗜酸性粒细胞和2型炎症亚型的重叠
