哮喘联盟

   摘要
   目的：我们假设，与对照组相比，重症哮喘患者吸入糖皮质激素或长效β-受体激动剂治疗的同时服用他汀类药物,哮喘症状的控制更好且肺功能得到改善。
   研究设计：在2001年至2008年，对165例重症哮喘患者进行了回顾性、横断面研究，多层线性模型和逻辑回归模型被用于模拟拟合。
   受试者：筛选出612例患者，有223例符合要求，其中165例成年患者最终被纳入研究(N=165; 他汀类使用者31 例和未使用他汀类者134例)。
   主要终点和次要终点的评价：主要终点是通过哮喘控制测试(ACT评分表)评价哮喘控制，次要终点是评价肺功能、哮喘症状、糖皮质激素的使用需求和外周嗜酸性粒细胞计数。
   结果：基线时，他汀类药物使用者与未使用他汀类者相比，年龄更大，肺功能更差(预计FEV1%、FEV1、最大肺活量和FEF25%-75%)、共病的患病率更高。且他汀类药物的使用与更多阿司匹林、异丙托溴铵气雾剂的使用相关。两组患者均属于肥胖(体重指数≥30)。他汀类药物使用者与未使用他汀类者相比，哮喘症状控制更好（校正的平均ACT评分更高：2.2±0.94点，p<0.02)。两组使用他汀类药物的中位时间均为1年。两组间的肺功能、糖皮质激素、支气管扩张剂的应用或外周嗜酸性粒细胞计数均无统计学差异。
   结论：在我们的重症哮喘患者中,已使用吸入控制器治疗的他汀类药物使用者与未使用他汀类者相比，能够实现更好的哮喘控制。该研究表明，重症哮喘患者很有可能受益于他汀类药物的添加。因为我们的研究人群都属于肥胖者，严重的肥胖的重症哮喘患者可能是需进一步研究的人群。尚需前瞻性、随机的临床研究评价重症哮喘患者使用他汀类药物的安全和疗效。
 

（林江涛 审校）
BMJ Open. 2013 Aug 13;3(8). pii: e003314. doi: 10.1136/bmjopen-2013-003314.

 

Statin use and asthma control in patients with severe asthma.
 

Zeki AA, Oldham J, Wilson M, Fortenko O, Goyal V, Last M, Last A, Patel A, Last JA, Kenyon NJ.
 

Abstract

OBJECTIVES: We hypothesised that severe asthmatics taking a statin drug, in addition to inhaled corticosteroids/long-acting β-agonist inhaler therapy, would have better asthma symptom control and improved lung function compared to their controls.
STUDY DESIGN: A retrospective, cross-sectional study of 165 patients with severe asthma seen from 2001-2008. Hierarchical linear and logistic regression models were used for modelling fitting.
PARTICIPANTS: 612 screened, 223 eligible and 165 adult patients were included in the final study (N=165; 31 statin users and 134 non-users).
PRIMARY AND SECONDARY OUTCOME MEASURES: The primary endpoint was asthma control as measured by the Asthma Control Test (ACT). The secondary endpoints included lung function, symptoms and the need for corticosteroid burst and peripheral eosinophil count.
RESULTS: At baseline, statin users compared to non-users were older, had lower lung function (FEV1% predicted, FEV1, forced vital capacity and FEF25-75%) and had a higher prevalence of comorbid conditions. Statin use was associated with more aspirin and ipratropium inhaler use than in non-users. Patients in both groups were obese (body mass index ≥ 30). Statin users had better asthma symptom control compared to non-users (higher adjusted mean ACT score by 2.2±0.94 points, p<0.02). Median statin use was for 1 year. There were no statistically significant differences in lung function, corticosteroid or rescue bronchodilator use or peripheral eosinophilia between the two groups.
CONCLUSIONS: In our severe asthma referral population, statin users already taking inhaled controller therapy achieved better asthma control compared to non-users. The implications of this study is that patients with severe asthma could potentially benefit from added statin treatment. Because our study population was on average obese, the obese severe asthmatic may be a viable asthma subphenotype for further studies. Prospective randomised clinical trials evaluating the safety and efficacy of statins in severe asthma are warranted.
 

BMJ Open. 2013 Aug 13;3(8). pii: e003314. doi: 10.1136/bmjopen-2013-003314.