Longitudinal outcomes of different asthma phenotypes in primary care, an observational study.
Longitudinal outcomes of different asthma phenotypes in primary care, an observational study.
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DOI：
10.1038/s41533-017-0057-3
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发表时间：
2017-10-03
影响因子：
3.1
通讯作者：
ACCURATE Study Group
中科院分区：
文献类型：
--
作者：
Khusial RJ;Sont JK;Loijmans RJB;Snoeck-Stroband JB;Assendelft PJJ;Schermer TRJ;Honkoop PJ;ACCURATE Study Group
虽然哮喘的表现是异质性的，但目前在初级保健中的哮喘管理指南是相当同质的。在这项研究中，我们的目标是将患者聚集到不同的表型中，这可能有助于全科医生进行个性化的哮喘管理。我们分析了来自ACCURATE试验的数据，该试验包括611名18 - 50岁的成人哮喘患者，在初级保健中接受治疗，随访1年。通过聚类分析评估基线时获得的变量（n = 14）。随后，在一年随访后，分别评估了已建立的表型的重要哮喘结局：哮喘控制（哮喘控制问卷（ACQ））、生活质量（哮喘生活质量问卷（AQLQ））、急性加重率和药物使用。鉴定了五种不同的表型。第一种表型主要由其早发特应性哮喘形式定义。第二种表型主要由女性迟发性哮喘患者组成。第三种表型是使用支气管扩张剂后可逆率高的患者。第四个表型是吸烟者，最后一个表型是频繁加重者。尽管使用了最多的药物，但急性发作者表型的哮喘控制和生活质量结局最差，急性发作率最高。早发性表型患者控制相对较好，药物剂量较低。哮喘患者应根据其个体哮喘类型进行特征描述，以确保更有针对性的治疗。尽管哮喘表现为各种各样的形式，严重程度不同，但疾病的治疗往往采取广泛的，一刀切的方法。为了确定哮喘是否真的可以分为不同的表型，莱顿大学医学中心的Rishi Khusial和荷兰各地的同事分析了611名在初级保健中接受治疗的成人哮喘患者的数据，并在一年后对他们进行了随访。研究小组在初级保健队列中确定了五种表型，包括一组早发性哮喘，另一组哮喘对支气管扩张剂反应良好，以及一组被归类为频繁加重者。对长期哮喘结果的进一步分析显示，表型之间存在明显差异，特别是在哮喘控制和生活质量方面。
While asthma presentation is heterogeneous, current asthma management guidelines in primary care are quite homogeneous. In this study we aim to cluster patients together into different phenotypes, that may aid the general practitioner in individualised asthma management. We analysed data from the ACCURATE trial, containing 611 adult asthmatics, 18–50 year-old, treated in primary care, with one year follow-up. Variables obtained at baseline (n = 14), were assessed by cluster analysis. Subsequently, established phenotypes were assessed separately on important asthma outcomes after one year follow-up: asthma control (Asthma Control Questionnaire (ACQ)), quality of life (Asthma Quality of Life Questionnaire (AQLQ)), exacerbation-rate and medication-usage. Five distinct phenotypes were identified. The first phenotype was predominantly defined by their early onset atopic form of asthma. The second phenotype mainly consisted of female patients with a late onset asthma. The third phenotype were patients with high reversibility rates after bronchodilator usage. The fourth phenotype were smokers and the final phenotype were frequent exacerbators. The exacerbators phenotype had the worst outcomes for asthma control and quality of life and experienced the highest exacerbation-rate, despite using the most medication. The early onset phenotype patients were relatively well controlled and their medication dosage was low. Asthma patients should be characterised according to their individual asthma type to ensure more targeted treatment. Even though asthma manifests itself in a wide variety of forms with differing degrees of severity, treatment of the disease often takes a broad, one-size-fits-all approach. To determine if asthma can indeed be split into distinct phenotypes, Rishi Khusial at the Leiden University Medical Center and co-workers across the Netherlands analysed data from 611 adult asthmatics treated in primary care, and followed them up after one year. The team identified five phenotypes in the primary care cohort, including one group with early onset asthma, another whose asthma responded well to bronchodilators, and a group classed as frequent exacerbators. Further analysis of long-term asthma outcomes showed clear differences between phenotypes, particularly in terms of asthma control and quality of life.
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影响因子：
4.3
作者：
Juniper, EF;Bousquet, J;Bateman, ED
通讯作者：
Bateman, ED
影响因子：
158.5
作者：
Green, LA;Fryer, GE;Dovey, SM
通讯作者：
Dovey, SM
影响因子：
3.7
作者：
Newby C;Heaney LG;Menzies-Gow A;Niven RM;Mansur A;Bucknall C;Chaudhuri R;Thompson J;Burton P;Brightling C;British Thoracic Society Severe Refractory Asthma Network
通讯作者：
British Thoracic Society Severe Refractory Asthma Network
影响因子：
24.3
作者：
Rabe, KF;Vermeire, PA;Maier, WC
通讯作者：
Maier, WC
影响因子：
5.9
作者：
Gold, Laura S.;Smith, Nancy;Sullivan, Sean D.
通讯作者：
Sullivan, Sean D.