Annual changes in forced oscillation technique parameters correlate with FEV1 decline in patients with asthma, COPD, and asthma-COPD overlap
Annual changes in forced oscillation technique parameters correlate with FEV1 decline in patients with asthma, COPD, and asthma-COPD overlap
复制标题
强迫振荡技术参数的年度变化与哮喘、慢性阻塞性肺病和哮喘-慢性阻塞性肺病重叠患者的 FEV1 下降相关
DOI：
10.1016/j.alit.2020.03.013
复制
发表时间：
2020
影响因子：
6.8
通讯作者：
Shirai Toshihiro
中科院分区：
文献类型：
--
作者：
Tanaka Yuko;Hirai Keita;Nakayasu Hiromasa;Tamura Kanami;Masuda Toshihiro;Takahashi Shingo;Watanabe Hirofumi;Kishimoto Yutaro;Ohishi Kyouhei;Saigusa Mika;Akamatsu Taisuke;Yamamoto Akito;Morita Satoru;Asada Kazuhiro;Shirai Toshihiro
肺活量测定法评价气流受限对判断哮喘和慢性阻塞性肺疾病(COPD)的病情严重程度和疗效有重要意义。哮喘-慢性阻塞性肺疾病重叠(ACO)和迟发性哮喘患者容易出现第一秒用力呼气量(FEV1)的快速恶化，肺功能下降、入院治疗和生存期预后极差。1哮喘和慢性阻塞性肺疾病患者的气道狭窄分布和气流受限的生理机制可能不同。然而，肺活量测定可能并不总是区分每种疾病气流受限的病理和生理机制。此外，在COPD和ACO的晚期，需要用力呼气的肺活量测定给患者带来了负担。强迫振荡技术(FOT)是一种无创测量潮气呼吸时呼吸系统阻力(RRS)和电抗(XRS)的方法。它提供了使用肺活量测定法无法获得的信息。3研究还表明，FOT在治疗包括哮喘、COPD和ACO在内的阻塞性肺疾病患者方面是有用的。我们最近报道，FOT可能有助于鉴别ACO。4然而，只有少数研究集中在哮喘、5 COPD、6和ACO患者中FOT参数的年变化与肺活量测定之间的关系的差异。在此，我们旨在研究哮喘、COPD和ACO患者FOT参数和FEV1的年变化之间的关系。这项回顾性的观察性研究从先前发表的一项研究中招募了哮喘或慢性阻塞性肺病的成年患者。7相关伦理委员会批准了研究方案(SGH 15-01-55)。哮喘和COPD患者分别符合全球哮喘倡议8和慢性阻塞性肺疾病全球倡议指南9的定义。ACO是根据我们之前报道的招募标准诊断出来的。4所有患者在入选前同一天接受FOT和肺活量测定，至少4次，超过3年(即每年至少1次)。这项研究包括75名成人患者，分别为ACO(29例)、哮喘(23例)和慢性阻塞性肺疾病(23例)(补充图1)。在招募时，COPD患者的5赫兹(X5)的FEV1和XRS低于哮喘和ACO患者，而共振频率(Fres)和低频电抗面积(ALX)高于哮喘和ACO患者(补充表1)。FEV1和FOT的年度变化载于补充资料
Evaluation of airflow limitation using spirometry is important for determining the disease severity and therapeutic effect in asthma and chronic obstructive pulmonary disease (COPD). Patients with asthma-COPD overlap (ACO) and late-onset asthma are susceptible to rapid deterioration of forced expiratory volume in 1 s (FEV1), and have a very poor prognosis with respect to lung function decline, hospital admissions, and survival. 1 The distribution of airway stenosis and the physiological mechanism of airflow limitation may differ between patients with asthma and COPD. However, spirometry may not always distinguish the pathological and physiological mechanisms of airflow limitation in each disease. 2 Further, in advanced stages of COPD and ACO, spirometry, which requires forced expiration, places a burden on the patient. The forced oscillation technique (FOT) is a method for noninvasively measuring respiratory system resistance (Rrs) and reactance (Xrs) during tidal breathing. It provides information that cannot be obtained using spirometry. 3 Studies have also indicated the usefulness of the FOT for managing patients with obstructive lung diseases, including asthma, COPD, and ACO. We recently reported that the FOT may be useful for identifying ACO. 4 However, only a few studies have focused on the differences in the relationship between annual changes in FOT parameters and spirometry among patients with asthma, 5 COPD, 6 and ACO. Herein, we aimed to investigate the relationship between the annual changes in FOT parameters and those in FEV1 in patients with asthma, COPD, and ACO. This retrospective, observational study recruited adult patients with asthma or COPD from a previously published study. 7 The relevant ethics committee approved the study protocol (SGH 15-01-55). The patients with asthma and COPD fulfilled the definition of the Global Initiative for Asthma 8 and the Global Initiative for Chronic Obstructive Lung Disease guidelines, 9 respectively. ACO was diagnosed using our previously reported criteria at recruitment. 4 All patients underwent the FOT and spirometry on the same day, at least four times over 3 years (ie, at least one time per year) before recruitment. The details are provided in the Supplementary Methods.This study included 75 adult patients with ACO (n ¼ 29), asthma (n ¼ 23), and COPD (n ¼ 23)(Supplementary Fig. 1). At recruitment, patients with COPD had lower FEV1 and Xrs at 5 Hz (X5) and higher resonant frequency (Fres) and low-frequency reactance area (ALX) than did patients with asthma and ACO (Supplementary Table 1). The annual changes in FEV1 and FOT are shown in Supplementary