Impact of Age and Sex on Response to Asthma Therapy
Impact of Age and Sex on Response to Asthma Therapy
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DOI：
10.1164/rccm.201503-0426oc
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发表时间：
2015-09-01
影响因子：
24.7
通讯作者：
Wechsler, Michael E.
中科院分区：
文献类型：
--
作者：
Dunn, Ryan M.;Lehman, Erik;Wechsler, Michael E.
理由：年龄和性别与哮喘患病率和发病率的差异有关。目的：确定年龄和性别是否与轻度至中度哮喘患者的不同表型和对治疗的可变反应相关。方法：我们使用哮喘临床研究网络的数据来确定年龄和性别对1993年至2003年参加10项试验的受试者的表型和治疗失败的影响。测量方法和主要结果：共确定1200名受试者（中位年龄30.4岁，男性520名[43.3%]，女性680名[56.7%]）并进行分析。大于或等于30岁的受试者中治疗失败的比例较高（17.3% vs. 10.3%；优势比[or]， 1.82；置信区间[CI]， 1.30-2.54; P < 0.001），并且在整个队列中，随着年龄大于30岁的增加，治疗失败的比例增加（or每年1.02 [CI, 1.01-1.04]； or每5年，1.13 [CI, 1.04-1.22]; P < 0.001）。较低的肺功能和较长的哮喘持续时间与较高的治疗失败风险相关。在接受控制者治疗的大于或等于30岁的受试者中，出现治疗失败的比例较高。当按特定治疗分层时，年龄大于30岁的吸入性皮质类固醇患者的治疗失败率逐年增加（OR每年，1.03；CI, 1.01-1.07）。女性的FEV1预测值略高（84.5% vs. 81.1%; P < 0.001），但哮喘控制措施相似。男女治疗失败率差异无统计学意义（15.2%比11.7%;P = 0.088）。结论：年龄较大与治疗失败的风险增加有关，尤其是吸入皮质类固醇的受试者。治疗失败在性别间无显著差异。
Rationale: Age and sex are associated with differences in asthma prevalence and morbidity.Objectives: To determine if age and sex associate with distinct phenotypes and a variable response to therapy in subjects with mild to moderate asthma.Methods: We used Asthma Clinical Research Network data to determine the impact of age and sex on phenotypes and treatment failures among subjects participating in 10 trials from 1993 to 2003.Measurements and Main Results: A total of 1,200 subjects were identified (median age, 30.4 yr; male, 520 [43.3%]; female, 680 [56.7%]) and analyzed. A higher proportion of subjects greater than or equal to 30 years old experienced treatment failures (17.3% vs. 10.3%; odds ratio [OR], 1.82; confidence interval [CI], 1.30-2.54; P < 0.001), and rates increased proportionally with increasing age older than 30 across the cohort (OR per yr. 1.02 [CI, 1.01-1.04]; OR per 5 yr, 1.13 [CI, 1.04-1.22]; P < 0.001). Lower lung function and longer duration of asthma were associated with a higher risk of treatment failures. A higher proportion of subjects greater than or equal to 30 years old receiving controller therapy experienced treatment failures. When stratified by specific therapy, treatment failures increased consistently for every year older than age 30 in subjects on inhaled corticosteroids (OR per year, 1.03; CI, 1.01-1.07). Females had a slightly higher FEV1 % predicted (84.5% vs. 81.1%; P < 0.001) but similar asthma control measures. There was not a statistically significant difference in treatment failures between females and males (15.2% vs. 11.7%; P = 0.088).Conclusions: Older age is associated with an increased risk of treatment failure, particularly in subjects taking inhaled corticosteroids. There was no significant difference in treatment failures between sexes.