Clinical and biological factors associated with irreversible airway obstruction in adult asthma
Clinical and biological factors associated with irreversible airway obstruction in adult asthma
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DOI：
10.1016/j.rmed.2020.106202
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发表时间：
2020-12-01
影响因子：
4.3
通讯作者：
Schleich, Florence
中科院分区：
文献类型：
--
作者：
Graff, Sophie;Bricmont, Noemie;Schleich, Florence
背景和目的：哮喘患者的气道重塑与其他因素一样，可导致肺功能下降和不可逆性气流阻塞（IRAQ）。进行这项研究，以突出预测不完全可逆的气流阻塞在成人哮喘患者，以确定预后较差的患者，改善他们的护理，并降低发病率。方法：回顾性研究进行了973例哮喘患者招募从大学哮喘诊所的列日。IRAQ患者（BD后FEV 1/FVC 80%预测值）。对85名患者的痰上清液中的TGF-β进行了检测。结果：17%的哮喘患者出现IRAQ。这些患者年龄较大，吸烟者较多，女性比例较低，病程较长，病情控制较差，生活质量较低。哮喘患者的这一亚群也显示出更常见的血液和痰嗜酸性粒细胞和中性粒细胞升高，以及前一年更高的急性发作和住院率。多变量分析显示，男性、病程较长、吸烟、ACQ评分、痰嗜酸性粒细胞和中性粒细胞、ICS剂量和OCS维持、BMI和哮喘发作是与IRAQ独立相关的变量。结论：男性、吸烟、病程长、哮喘未控制、嗜酸性或嗜酸性气道炎症、低体重指数、迟发性哮喘是IRAQ的危险因素。此外，伊拉克的TGF-β水平较高。
Background and objective: Airway remodeling, as many other factors, may lead to lung function decline and irreversible airflow obstruction (IRAQ) in asthma. This study was undertaken in order to highlight predictors of incomplete reversibility of airflow obstruction in adult asthmatics to identify patients with poorer prognosis and improve their care, and decrease morbidity.Methods: A retrospective study was conducted in 973 asthmatics recruited from the University Asthma Clinic of Liege. Patients with IRAQ (post-BD FEV1/FVC80% predicted). TGF-beta was measured in sputum supernatant of 85 patients.Results: Seventeen percent of asthmatics presented with IRAQ. These patients were significantly older, more smokers, with a lower proportion of female, a longer disease duration, were more poorly controlled with a lower quality of life. This sub-population of asthmatics also showed more often elevated blood and sputum eosinophils and neutrophils, and higher exacerbation and hospitalisation rates in the previous year. The multivariable analysis revealed male gender, longer disease duration, cigarette smoking, ACQ score, sputum eosinophils and neutrophils, ICS dose and OCS maintenance, BMI, and asthma onset as variables independently linked to IRAQ. Total TGF-beta levels appeared higher in patients with IRAQ (n = 38) compared to patients with RAO (n = 47).Conclusion: These data show that risk factors for IRAQ are male gender, smoking, a longer disease duration, uncontrolled asthma, eosinophilic or neutrophilic airway inflammation, lower BMI, and later asthma onset. Moreover, TGF-beta levels are higher in IRAQ.