Asthma control during the year after bronchial thermoplasty
Asthma control during the year after bronchial thermoplasty
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DOI：
10.1056/nejmoa064707
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发表时间：
2007-03-29
影响因子：
158.5
通讯作者：
Olsen, M.
中科院分区：
文献类型：
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作者：
Cox, Gerard;Thomson, Neil C.;Olsen, M.
背景支气管热成形术是一种支气管镜手术，用于减少气道平滑肌的质量并减弱支气管收缩。我们检查了支气管热成形术对控制中度或重度持续性哮喘的效果。 方法我们将 112 名接受过吸入皮质类固醇和长效 β(2)-肾上腺素能激动剂 (LABA) 治疗且在撤回 LABA 后哮喘控制受损的受试者随机分配到支气管热成形术组或对照组。主要结果是轻度加重的频率，在 3、6 和 12 个月的三个预定的 2 周戒断 LABA 期间进行计算。还评估了气流、气道反应性、哮喘症状、无症状天数、救援药物的使用以及哮喘生活质量问卷 (AQLQ) 和哮喘控制问卷 (ACQ) 的评分。 结果 与基线相比，支气管热成形术组的轻度恶化平均发生率有所降低，但对照组没有变化（变化 每个受试者每周的频率为 -0.16+/-0.37 与 0.04+/-0.29； P=0.005）。 12 个月时，支气管热成形术组在早晨峰值呼气流量（39.3+/-48.7 与 8.5+/-44.2 升/分钟）、AQLQ 分数（1.3+/-1.0 与 0.6+/-1.1）和 ACQ（降低，1.2+/-1.0 与 0.5+/-1.0）、百分比方面有显着更大的改善。 无症状天数（40.6+/-39.7 vs. 17.0+/-37.9）和症状评分（减少，1.9+/-2.1 vs. 0.7+/-2.5），同时需要更少的救援药物。两组之间气道反应性和 1 秒用力呼气量的值没有显着差异。支气管热成形术组治疗后立即发生的不良事件比对照组更常见，但治疗后 6 周至 12 个月期间的不良事件相似。 结论 中度或重度哮喘受试者的支气管热成形术可改善哮喘控制。
BACKGROUNDBronchial thermoplasty is a bronchoscopic procedure to reduce the mass of airway smooth muscle and attenuate bronchoconstriction. We examined the effect of bronchial thermoplasty on the control of moderate or severe persistent asthma.METHODSWe randomly assigned 112 subjects who had been treated with inhaled corticosteroids and long-acting beta(2)-adrenergic agonists (LABA) and in whom asthma control was impaired when the LABA were withdrawn to either bronchial thermoplasty or a control group. The primary outcome was the frequency of mild exacerbations, calculated during three scheduled 2-week periods of abstinence from LABA at 3, 6, and 12 months. Airflow, airway responsiveness, asthma symptoms, the number of symptom-free days, use of rescue medication, and scores on the Asthma Quality of Life Questionnaire (AQLQ) and the Asthma Control Questionnaire (ACQ) were also assessed.RESULTSThe mean rate of mild exacerbations, as compared with baseline, was reduced in the bronchial-thermoplasty group but was unchanged in the control group (change in frequency per subject per week, -0.16+/-0.37 vs. 0.04+/-0.29; P=0.005). At 12 months, there were significantly greater improvements in the bronchial-thermoplasty group than in the control group in the morning peak expiratory flow (39.3+/-48.7 vs. 8.5+/-44.2 liters per minute), scores on the AQLQ (1.3+/-1.0 vs. 0.6+/-1.1) and ACQ (reduction, 1.2+/-1.0 vs. 0.5+/-1.0), the percentage of symptom-free days (40.6+/-39.7 vs. 17.0+/-37.9), and symptom scores (reduction, 1.9+/-2.1 vs. 0.7+/-2.5) while fewer puffs of rescue medication were required. Values for airway responsiveness and forced expiratory volume in 1 second did not differ significantly between the two groups. Adverse events immediately after treatment were more common in the bronchial-thermoplasty group than in the control group but were similar during the period from 6 weeks to 12 months after treatment.CONCLUSIONSBronchial thermoplasty in subjects with moderate or severe asthma results in an improvement in asthma control.