Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults
Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults
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DOI：
10.3109/13693786.2012.738312
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发表时间：
2013-05-01
期刊：
影响因子：
2.9
通讯作者：
Cole, Donald C.
中科院分区：
文献类型：
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作者：
Denning, David W.;Pleuvry, Alex;Cole, Donald C.
过敏性支气管肺曲霉病 (ABPA) 会使哮喘复杂化，并可能导致慢性肺曲霉病 (CPA)，但每种疾病的全球负担从未被估计过。抗真菌治疗在 ABPA 的治疗中占有一席之地，并且是 CPA 治疗的基石，可降低发病率和死亡率。我们将全球哮喘倡议 (GINA) 报告中的特定国家哮喘患病率应用于人口估计，以计算成人哮喘病例。从五个转诊队列（中国、爱尔兰、新西兰、沙特阿拉伯和南非）中，我们估计成人哮喘患者中 ABPA 的患病率为 2.5%（范围 0.72-3.5%）（范围审查）。从 ABPA 病例系列来看，肺空化发生率为 10%（范围 7 -20%），因此可以使用基于确定性场景的模型来估计全球 CPA 患病率。在全球 1.93 亿患有活动性哮喘的成年人中，我们估计有 4,837,000 名患者（范围 1,354,000 -6,772,000）患有 ABPA。按世卫组织区域划分，ABPA 负担估计为： 欧洲 1,062,000；美洲，1,461,000；东地中海，351,000；非洲，389,900；西太平洋，823,200；东南亚，720,400。我们计算出全球 CPA 并发 ABPA 病例负担为 411,100 例（范围 206,300 -589,400），比率为 10%，年流失率为 15%。 ABPA 的全球负担可能超过 480 万人，而 CPA 使 ABPA 复杂化 = 400,000，这比之前估计的更为常见。这两种情况都对抗真菌治疗有反应，证明改进病例检测是合理的。有必要进行前瞻性人群和临床队列研究，以更准确地确定不同地点和种族群体中 ABPA 和 CPA 的频率，并验证模型输入。
Allergic bronchopulmonary aspergillosis (ABPA) complicates asthma and may lead to chronic pulmonary aspergillosis (CPA) yet global burdens of each have never been estimated. Antifungal therapy has a place in the management of ABPA and is the cornerstone of treatment in CPA, reducing morbidity and probably mortality. We used the country-specific prevalence of asthma from the Global Initiative for Asthma (GINA) report applied to population estimates to calculate adult asthma cases. From five referral cohorts (China, Ireland, New Zealand, Saudi Arabia and South Africa), we estimated the prevalence of ABPA in adults with asthma at 2.5% (range 0.72-3.5%) (scoping review). From ABPA case series, pulmonary cavitation occurred in 10% (range 7 -20%), allowing an estimate of CPA prevalence worldwide using a deterministic scenario-based model. Of 193 million adults with active asthma worldwide, we estimate that 4,837,000 patients (range 1,354,000 -6,772,000) develop ABPA. By WHO region, the ABPA burden estimates are: Europe, 1,062,000; Americas, 1,461,000; Eastern Mediterranean, 351,000; Africa, 389,900; Western Pacific, 823,200; South East Asia, 720,400. We calculate a global case burden of CPA complicating ABPA of 411,100 (range 206,300 -589,400) at a 10% rate with a 15% annual attrition. The global burden of ABPA potentially exceeds 4.8 million people and of CPA complicating ABPA = 400,000, which is more common than previously appreciated. Both conditions respond to antifungal therapy justifying improved case detection. Prospective population and clinical cohort studies are warranted to more precisely ascertain the frequency of ABPA and CPA in different locations and ethnic groups and validate the model inputs.