按需使用SABA单药治疗的哮喘患者的小气道功能障碍:一场完美风暴
2023/04/21
摘要
背景：短效β受体激动剂(SABA)治疗与哮喘控制不良和不良临床结果相关。小气道功能障碍(SAD)在哮喘中的重要性日益得到认可，但在仅使用SABA治疗的患者中却鲜为人知。
目的：我们的目的是调查SAD对哮喘控制的影响，研究对象为60名经医生诊断为间歇性哮喘的成年人，按需接受SABA单药治疗。
方法：所有患者在第一次就诊时均进行了标准的肺功能测量和脉冲振荡测量(IOS)，并根据是否存在由IOS定义的SAD(阻力下降5-20 Hz [R5-R20]>0.07 kPa×s*L-1)进行分层。采用单变量和多变量分析来评估临床变量与SAD之间的横断面关系。
结果：73%的队列中存在SAD。与无SAD患者相比，成年SAD患者严重发作次数更高(65.9%vs25.0%，p < 0.05)，年度SABA瓶数使用率更高(中位数(IQR)， 3(1.75-3)vs1 (1-2)，p < 0.001)，哮喘控制良好程度明显较低(11.7%vs75.0%，p < 0.001)。IOS定义的SAD患者和无SAD患者的肺功能参数相似。多变量logistic回归分析显示，运动诱发支气管收缩症状(EIB,OR31.18;95%CI:4.85～365.00)和哮喘所致夜间觉醒(OR 30.30;95%CI:2.61-1141.00)是SAD的独立预测因子，包含这些基线预测因子的模型具有较高的预测能力(AUC 0.92)。
结论：按需使用SABA单药治疗的哮喘患者中，EIB和夜间症状是SAD的强有力预测因素，有助于在无法进行IOS时区分哮喘SAD患者。
Small airway dysfunction in asthmatic patients treated with as-needed SABA monotherapy: A perfect storm.
Cottini M, Lombardi C, Comberiati P
Abstrast
Background: Short-acting beta agonist (SABA)-only treatment is associated with poor asthma control and adverse clinical outcomes. The importance of small airway dysfunction (SAD) is increasingly recognized in asthma, but less is known in patients using SABA-only therapy.
Objective: We aimed to investigate the impact of SAD on asthma control in an unselected cohort of 60 adults with physician-diagnosed intermittent asthma treated with as-needed SABA monotherapy.
Methods: All patients underwent standard spirometry and impulse oscillometry (IOS) at the first visit and were stratified by the presence of SAD defined by IOS (fall in resistance 5-20 Hz [R5-R20]>0.07 kPa×s*L-1). Univariable and multivariable analyses were used to analyze cross-sectional relationships between clinical variables and SAD.
Results: SAD was present in 73% of the cohort. Compared with patients without SAD, adults with SAD had a higher number of severe exacerbations (65.9% versus 25.0%, p < 0.05), higher use of annual SABA canisters (median (IQR), 3 (1.75-3) versus 1 (1-2), p < 0.001), and significantly less well-controlled asthma (11.7% versus 75.0%, p < 0.001). Spirometry parameters were similar between patients with IOS-defined SAD and those without SAD. The multivariable logistic regression analysis showed that exercise-induced bronchoconstriction symptoms (EIB, odds ratio [OR] 31.18; 95%CI:4.85-365.00) and night awakenings due to asthma (OR 30.30; 95%CI:2.61-1141.00) were independent predictors of SAD, with a high predictive power of the model incorporating these baseline predictors (AUC 0.92).
Conclusions: EIB and nocturnal symptoms are strong predictors of SAD in asthmatic patients using as-needed SABA-monotherapy, helping to distinguish subjects with SAD among patients with asthma when IOS cannot be performed.
背景：短效β受体激动剂(SABA)治疗与哮喘控制不良和不良临床结果相关。小气道功能障碍(SAD)在哮喘中的重要性日益得到认可，但在仅使用SABA治疗的患者中却鲜为人知。
目的：我们的目的是调查SAD对哮喘控制的影响，研究对象为60名经医生诊断为间歇性哮喘的成年人，按需接受SABA单药治疗。
方法：所有患者在第一次就诊时均进行了标准的肺功能测量和脉冲振荡测量(IOS)，并根据是否存在由IOS定义的SAD(阻力下降5-20 Hz [R5-R20]>0.07 kPa×s*L-1)进行分层。采用单变量和多变量分析来评估临床变量与SAD之间的横断面关系。
结果：73%的队列中存在SAD。与无SAD患者相比，成年SAD患者严重发作次数更高(65.9%vs25.0%，p < 0.05)，年度SABA瓶数使用率更高(中位数(IQR)， 3(1.75-3)vs1 (1-2)，p < 0.001)，哮喘控制良好程度明显较低(11.7%vs75.0%，p < 0.001)。IOS定义的SAD患者和无SAD患者的肺功能参数相似。多变量logistic回归分析显示，运动诱发支气管收缩症状(EIB,OR31.18;95%CI:4.85～365.00)和哮喘所致夜间觉醒(OR 30.30;95%CI:2.61-1141.00)是SAD的独立预测因子，包含这些基线预测因子的模型具有较高的预测能力(AUC 0.92)。
结论：按需使用SABA单药治疗的哮喘患者中，EIB和夜间症状是SAD的强有力预测因素，有助于在无法进行IOS时区分哮喘SAD患者。
(中日友好医院呼吸与危重症医学科 万静萱 摘译 林江涛 审校)
(Respir Med. 2023 Apr;209; doi: 10.1016/j.rmed.2023.107154IF: 3.095)
(Respir Med. 2023 Apr;209; doi: 10.1016/j.rmed.2023.107154IF: 3.095)
Small airway dysfunction in asthmatic patients treated with as-needed SABA monotherapy: A perfect storm.
Cottini M, Lombardi C, Comberiati P
Abstrast
Background: Short-acting beta agonist (SABA)-only treatment is associated with poor asthma control and adverse clinical outcomes. The importance of small airway dysfunction (SAD) is increasingly recognized in asthma, but less is known in patients using SABA-only therapy.
Objective: We aimed to investigate the impact of SAD on asthma control in an unselected cohort of 60 adults with physician-diagnosed intermittent asthma treated with as-needed SABA monotherapy.
Methods: All patients underwent standard spirometry and impulse oscillometry (IOS) at the first visit and were stratified by the presence of SAD defined by IOS (fall in resistance 5-20 Hz [R5-R20]>0.07 kPa×s*L-1). Univariable and multivariable analyses were used to analyze cross-sectional relationships between clinical variables and SAD.
Results: SAD was present in 73% of the cohort. Compared with patients without SAD, adults with SAD had a higher number of severe exacerbations (65.9% versus 25.0%, p < 0.05), higher use of annual SABA canisters (median (IQR), 3 (1.75-3) versus 1 (1-2), p < 0.001), and significantly less well-controlled asthma (11.7% versus 75.0%, p < 0.001). Spirometry parameters were similar between patients with IOS-defined SAD and those without SAD. The multivariable logistic regression analysis showed that exercise-induced bronchoconstriction symptoms (EIB, odds ratio [OR] 31.18; 95%CI:4.85-365.00) and night awakenings due to asthma (OR 30.30; 95%CI:2.61-1141.00) were independent predictors of SAD, with a high predictive power of the model incorporating these baseline predictors (AUC 0.92).
Conclusions: EIB and nocturnal symptoms are strong predictors of SAD in asthmatic patients using as-needed SABA-monotherapy, helping to distinguish subjects with SAD among patients with asthma when IOS cannot be performed.
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经支气管热成形术治疗成人哮喘急性发作的减少
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臭氧引起的幼儿哮喘和喘息的生命过程:中国北方的一个前瞻性出生队列
