小气道功能障碍在哮喘控制和恶化中的作用：一项使用亚特兰蒂斯研究数据的纵向观察分析
2022/03/17
摘要
背景：尽管小气道疾病是哮喘的一个特征，但其与相关哮喘预后的关系尚不清楚。亚特兰蒂斯研究旨在自横断面和纵向方面，以生理和影像学变量为组合，测量哮喘小气道疾病的存在和程度。在这项纵向分析中，我们评估了哪些小气道参数与哮喘控制、病情恶化和生活质量最密切相关。
方法：在这项观察性队列研究中，2014年6月30日至2017年3月3日期间，通过全球九个国家的医学数据库和广告招募了轻度、中度或重度稳定型哮喘患者。符合条件的参与者年龄在18-65岁之间，临床诊断为哮喘至少6个月。参与者被随访1年，分别在基线、6个月和12个月时进行随访。生理测试包括肺活量测定、肺容量、脉冲振荡法、多次呼气氮冲洗（MBNW）和乙酰甲胆碱激发期间用力肺活量的百分比下降。CT密度测定用于评估小气道疾病。我们使用单变量和多变量分析，研究了这些测量与哮喘恶化、哮喘控制和生活质量之间的关系。构建了一个综合序数得分，包括预测的R5-20（中小气道电阻）、AX（电抗面积）和X5（更中心、传导频率为5Hz的小气道电抗）的百分比。
结果：773名参与者（中位年龄46岁[IQR 34-54]；450名[58%]女性）被纳入这项纵向研究。单变量分析显示，脉冲振荡法、肺容量、MBNW和FVC为25-75%时的用力呼气流量与哮喘控制和加重显著相关（Spearman相关系数0.20-0.25，Bonferroni校正后p<0.0001）。作为脉冲振荡法的一种组合，序数评分在多变量分析中独立预测哮喘控制和恶化。CT参数与哮喘控制、病情恶化或生活质量无显著相关性。
解释：根据生理测试，小气道疾病与临床上重要的哮喘结果（如哮喘控制和加重）纵向相关。
The role of small airway dysfunction in asthma control and exacerbations: a longitudinal, observational analysis using data from the ATLANTIS study
Monica Kraft, Matthew Richardson, Brian Hallmark, Dean Billheimer, Maarten Van den Berge, Leonardo M Fabbri, Thys Van der Molen, Gabriele Nicolini, Alberto Papi, Klaus F Rabe, Dave Singh, Chris Brightling, Salman Siddiqui, ATLANTIS study group
Abstract
Background: Although small airway disease is a feature of asthma, its association with relevant asthma outcomes remains unclear. The ATLANTIS study was designed to identify the combination of physiological and imaging variables that best measure the presence and extent of small airway disease in asthma, both cross-sectionally and longitudinally. In this longitudinal analysis, we evaluated which small airway parameters studied were most strongly associated with asthma control, exacerbations, and quality of life.
Methods: In this observational cohort study, participants with mild, moderate, or severe stable asthma were recruited between June 30, 2014, and March 3, 2017, via medical databases and advertisements in nine countries worldwide. Eligible participants were aged 18-65 years with a clinical asthma diagnosis for at least 6 months. Participants were followed up for 1 year, with visits at baseline, 6 months, and 12 months. Physiological tests included spirometry, lung volumes, impulse oscillometry, multiple breath nitrogen washout (MBNW), and percentage decrease in forced vital capacity during methacholine challenge. CT densitometry was performed to evaluate small airway disease. We examined the associations between these measurements and asthma exacerbations, asthma control, and quality of life using univariate and multivariate analyses. A composite ordinal score comprising percent predicted R5-20 (resistance of small-to-mid-sized airways), AX (area of reactance), and X5 (reactance of more central, conducting small airways at 5 Hz) was constructed.
Findings: 773 participants (median age 46 years [IQR 34-54]; 450 [58%] female) were included in this longitudinal study. Univariate analyses showed that components of impulse oscillometry, lung volumes, MBNW, and forced expiratory flow at 25-75% of FVC were significantly correlated with asthma control and exacerbations (Spearman correlations 0·20-0·25, p<0·0001 after Bonferroni correction). As a composite of impulse oscillometry, the ordinal score independently predicted asthma control and exacerbations in a multivariate analysis with known exacerbation predictors. CT parameters were not significantly correlated with asthma control, exacerbation, or quality of life.
Interpretation: Small airway disease, as measured by physiological tests, is longitudinally associated with clinically important asthma outcomes, such as asthma control and exacerbations.
背景：尽管小气道疾病是哮喘的一个特征，但其与相关哮喘预后的关系尚不清楚。亚特兰蒂斯研究旨在自横断面和纵向方面，以生理和影像学变量为组合，测量哮喘小气道疾病的存在和程度。在这项纵向分析中，我们评估了哪些小气道参数与哮喘控制、病情恶化和生活质量最密切相关。
方法：在这项观察性队列研究中，2014年6月30日至2017年3月3日期间，通过全球九个国家的医学数据库和广告招募了轻度、中度或重度稳定型哮喘患者。符合条件的参与者年龄在18-65岁之间，临床诊断为哮喘至少6个月。参与者被随访1年，分别在基线、6个月和12个月时进行随访。生理测试包括肺活量测定、肺容量、脉冲振荡法、多次呼气氮冲洗（MBNW）和乙酰甲胆碱激发期间用力肺活量的百分比下降。CT密度测定用于评估小气道疾病。我们使用单变量和多变量分析，研究了这些测量与哮喘恶化、哮喘控制和生活质量之间的关系。构建了一个综合序数得分，包括预测的R5-20（中小气道电阻）、AX（电抗面积）和X5（更中心、传导频率为5Hz的小气道电抗）的百分比。
结果：773名参与者（中位年龄46岁[IQR 34-54]；450名[58%]女性）被纳入这项纵向研究。单变量分析显示，脉冲振荡法、肺容量、MBNW和FVC为25-75%时的用力呼气流量与哮喘控制和加重显著相关（Spearman相关系数0.20-0.25，Bonferroni校正后p<0.0001）。作为脉冲振荡法的一种组合，序数评分在多变量分析中独立预测哮喘控制和恶化。CT参数与哮喘控制、病情恶化或生活质量无显著相关性。
解释：根据生理测试，小气道疾病与临床上重要的哮喘结果（如哮喘控制和加重）纵向相关。
(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)
(Lancet Respir Med. 2022 Mar 2;S2213-2600(21)00536-1. doi: 10.1016/S2213-2600(21)00536-1.)
(Lancet Respir Med. 2022 Mar 2;S2213-2600(21)00536-1. doi: 10.1016/S2213-2600(21)00536-1.)
The role of small airway dysfunction in asthma control and exacerbations: a longitudinal, observational analysis using data from the ATLANTIS study
Monica Kraft, Matthew Richardson, Brian Hallmark, Dean Billheimer, Maarten Van den Berge, Leonardo M Fabbri, Thys Van der Molen, Gabriele Nicolini, Alberto Papi, Klaus F Rabe, Dave Singh, Chris Brightling, Salman Siddiqui, ATLANTIS study group
Abstract
Background: Although small airway disease is a feature of asthma, its association with relevant asthma outcomes remains unclear. The ATLANTIS study was designed to identify the combination of physiological and imaging variables that best measure the presence and extent of small airway disease in asthma, both cross-sectionally and longitudinally. In this longitudinal analysis, we evaluated which small airway parameters studied were most strongly associated with asthma control, exacerbations, and quality of life.
Methods: In this observational cohort study, participants with mild, moderate, or severe stable asthma were recruited between June 30, 2014, and March 3, 2017, via medical databases and advertisements in nine countries worldwide. Eligible participants were aged 18-65 years with a clinical asthma diagnosis for at least 6 months. Participants were followed up for 1 year, with visits at baseline, 6 months, and 12 months. Physiological tests included spirometry, lung volumes, impulse oscillometry, multiple breath nitrogen washout (MBNW), and percentage decrease in forced vital capacity during methacholine challenge. CT densitometry was performed to evaluate small airway disease. We examined the associations between these measurements and asthma exacerbations, asthma control, and quality of life using univariate and multivariate analyses. A composite ordinal score comprising percent predicted R5-20 (resistance of small-to-mid-sized airways), AX (area of reactance), and X5 (reactance of more central, conducting small airways at 5 Hz) was constructed.
Findings: 773 participants (median age 46 years [IQR 34-54]; 450 [58%] female) were included in this longitudinal study. Univariate analyses showed that components of impulse oscillometry, lung volumes, MBNW, and forced expiratory flow at 25-75% of FVC were significantly correlated with asthma control and exacerbations (Spearman correlations 0·20-0·25, p<0·0001 after Bonferroni correction). As a composite of impulse oscillometry, the ordinal score independently predicted asthma control and exacerbations in a multivariate analysis with known exacerbation predictors. CT parameters were not significantly correlated with asthma control, exacerbation, or quality of life.
Interpretation: Small airway disease, as measured by physiological tests, is longitudinally associated with clinically important asthma outcomes, such as asthma control and exacerbations.
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早期宠物饲养与哮喘和过敏性致敏的关系：对欧盟儿童队列网络中超过77000名儿童的荟萃分析
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痰炎症表型对哮喘小气道功能障碍和疾病转归的纵向影响
