重度哮喘患者的烟草暴露和生物治疗的疗效:来自丹麦重度哮喘登记的一项全国性研究
2023/10/25
摘要
背景：生物制剂在严重、不受控制的哮喘中的随机试验排除了累计吸烟超过10包年的患者。因此，我们对吸烟暴露对严重哮喘生物制剂临床效果的影响的了解仍然不完整。然而，由于许多哮喘患者现在或曾经是吸烟者，因此调查烟草暴露对生物治疗效果的潜在影响在临床上具有重要意义。
目的：探讨现实生活中重度哮喘患者吸烟史和烟草暴露对生物治疗效果的影响。
方法：我们利用了丹麦严重哮喘登记(DSAR)的数据，该数据来自于全国范围内使用生物制剂的严重哮喘患者。我们根据吸烟史和累积烟草暴露情况对患者进行了分组，并分析了基线和12个月生物治疗后的数据。
结果：在DSAR中共发现724例生物初治患者，其中398例(55%)为从不吸烟者，316例(44%)为既往吸烟者，10例(1%)为当前吸烟者。在现在和以前的吸烟者中，37%的人有1-9包年的烟草暴露，26%有10-19包年的烟草暴露，37%有20包年的烟草暴露。与0包年的患者相比，接触烟草的患者在急性发作次数、维持口服皮质类固醇使用减少和哮喘症状改善方面也有类似的减少。
结论：既往吸烟史和终生烟草暴露不影响生物制剂对严重哮喘患者的疗效。
Tobacco exposure and efficacy of biologic therapy in patients with severe asthma: A nationwide study from the Danish Severe Asthma Register
M. B. Soendergaard, S. Hansen, A. S. Bjerrum, A. von Bulow, K. E. Julius Haakansson, O. Hilberg, et al.
Abstract
BACKGROUND:Randomized trials of biologics in severe, uncontrolled asthma have excluded patients with a cumulative tobacco exposure of more than 10 pack years. Therefore, our knowledge of the impact of smoking exposure on the clinical effects of biologics in severe asthma remains incomplete. However, since many patients with asthma are current or former smokers, investigating the potential impacts of tobacco exposure on the effects of biological treatment is clinically important.
OBJECTIVE: To investigate the impact of smoking history and tobacco exposure on the effectiveness of biologic therapy in real-life patients with severe asthma.
METHOD: We utilized data from a complete nationwide cohort of patients with severe asthma on biologics, the Danish Severe Asthma Register (DSAR). We divided patients according to smoking history and cumulative tobacco exposure and analysed data at baseline and after 12 months of biological treatment.
RESULT:A total of 724 bio-naive patients were identified in DSAR, of whom 398 (55%) were never smokers, 316 (44%) were previous smokers, and 10 (1%) were current smokers. Within the group of current and former smokers, 37% had 1-9 pack years of tobacco exposure, 26% had 10-19 pack years, and 37% had >/=20 pack years of tobacco exposure. Patients with tobacco exposure had similar reductions in the number of exacerbations, reductions in maintenance oral corticosteroid use, and improvements in asthma symptoms compared to patients with zero pack years.
CONCLUSION:Former smoking history and lifetime tobacco exposure do not impact the efficacy of biologics in patients with severe asthma.
背景：生物制剂在严重、不受控制的哮喘中的随机试验排除了累计吸烟超过10包年的患者。因此，我们对吸烟暴露对严重哮喘生物制剂临床效果的影响的了解仍然不完整。然而，由于许多哮喘患者现在或曾经是吸烟者，因此调查烟草暴露对生物治疗效果的潜在影响在临床上具有重要意义。
目的：探讨现实生活中重度哮喘患者吸烟史和烟草暴露对生物治疗效果的影响。
方法：我们利用了丹麦严重哮喘登记(DSAR)的数据，该数据来自于全国范围内使用生物制剂的严重哮喘患者。我们根据吸烟史和累积烟草暴露情况对患者进行了分组，并分析了基线和12个月生物治疗后的数据。
结果：在DSAR中共发现724例生物初治患者，其中398例(55%)为从不吸烟者，316例(44%)为既往吸烟者，10例(1%)为当前吸烟者。在现在和以前的吸烟者中，37%的人有1-9包年的烟草暴露，26%有10-19包年的烟草暴露，37%有20包年的烟草暴露。与0包年的患者相比，接触烟草的患者在急性发作次数、维持口服皮质类固醇使用减少和哮喘症状改善方面也有类似的减少。
结论：既往吸烟史和终生烟草暴露不影响生物制剂对严重哮喘患者的疗效。
（中日友好医院呼吸与危重症医学科 李春晓 摘译 林江涛 审校）
（J Allergy Clin Immunol Pract 2023 DOI: 10.1016/j.jaip.2023.10.012）
（J Allergy Clin Immunol Pract 2023 DOI: 10.1016/j.jaip.2023.10.012）
Tobacco exposure and efficacy of biologic therapy in patients with severe asthma: A nationwide study from the Danish Severe Asthma Register
M. B. Soendergaard, S. Hansen, A. S. Bjerrum, A. von Bulow, K. E. Julius Haakansson, O. Hilberg, et al.
Abstract
BACKGROUND:Randomized trials of biologics in severe, uncontrolled asthma have excluded patients with a cumulative tobacco exposure of more than 10 pack years. Therefore, our knowledge of the impact of smoking exposure on the clinical effects of biologics in severe asthma remains incomplete. However, since many patients with asthma are current or former smokers, investigating the potential impacts of tobacco exposure on the effects of biological treatment is clinically important.
OBJECTIVE: To investigate the impact of smoking history and tobacco exposure on the effectiveness of biologic therapy in real-life patients with severe asthma.
METHOD: We utilized data from a complete nationwide cohort of patients with severe asthma on biologics, the Danish Severe Asthma Register (DSAR). We divided patients according to smoking history and cumulative tobacco exposure and analysed data at baseline and after 12 months of biological treatment.
RESULT:A total of 724 bio-naive patients were identified in DSAR, of whom 398 (55%) were never smokers, 316 (44%) were previous smokers, and 10 (1%) were current smokers. Within the group of current and former smokers, 37% had 1-9 pack years of tobacco exposure, 26% had 10-19 pack years, and 37% had >/=20 pack years of tobacco exposure. Patients with tobacco exposure had similar reductions in the number of exacerbations, reductions in maintenance oral corticosteroid use, and improvements in asthma symptoms compared to patients with zero pack years.
CONCLUSION:Former smoking history and lifetime tobacco exposure do not impact the efficacy of biologics in patients with severe asthma.
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