Factors associated with bronchiectasis in patients with uncontrolled asthma; the NOPES score: a study in 398 patients
Factors associated with bronchiectasis in patients with uncontrolled asthma; the NOPES score: a study in 398 patients
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DOI：
10.1186/s12931-018-0746-7
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发表时间：
2018-03-16
影响因子：
5.8
通讯作者：
Martinez-Garcia, M. A.
中科院分区：
文献类型：
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作者：
Padilla-Galo, A.;Olveira, C.;Martinez-Garcia, M. A.
背景资料：一些研究报道了支气管扩张在未控制的哮喘患者中的高患病率，但与这种情况相关的因素尚不清楚。本研究的目的是确定支气管扩张症的患病率在不受控制的中度至重度哮喘，并确定危险因素及其与支气管扩张症在这些patients.Methods：这是一个前瞻性研究的数据，从连续的不受控制的中度至重度哮喘患者。支气管扩张的诊断是基于高分辨率计算机断层扫描。预后评分采用Logistic回归模型，这是用来确定与支气管扩张症的相关因素。结果：共398例（60%的严重哮喘）被列入。支气管扩张的患病率为28。百分之四支气管扩张的存在与慢性咳痰的频率较高有关（OR，2.95; 95% CI，1.49-5.84; p = 0.002），哮喘严重程度更高（OR，2.43; 95% CI，1.29-4.57; p = 0.006），既往至少有一次肺炎发作（OR，2.42; 95% CI，1.03-5.69; p = 0.044），以及较低水平的FeNO（OR，0.98; 95% CI，0.97-0.99; p = 0.016）。NOPES评分是基于这些变量（FeNO[临界点20.5 ppb]、肺炎、咳痰和哮喘严重程度）开发的，范围为0 - 4分，其中0表示“无风险”，4对应于“高风险”。NOPES评分诊断支气管扩张的AUC-ROC为70%，特异性为95%。结论：近1/3的中重度哮喘患者存在支气管扩张。支气管扩张与哮喘的严重程度、慢性咳痰、既往肺炎史和FeNO水平较低有关。NOPES评分是一种易于使用的评分系统，对不受控制的中重度哮喘患者的支气管扩张具有较高的预后价值。
Background: Some studies have reported a high prevalence of bronchiectasis in patients with uncontrolled asthma, but the factors associated with this condition are unknown. The objective of this study was to determine the prevalence of bronchiectasis in uncontrolled moderate-to-severe asthma and to identify risk factors and their correlation with bronchiectasis in these patients.Methods: This is a prospective study of data from consecutive patients with uncontrolled moderate-to-severe asthma. Diagnosis of bronchiectasis was based on high-resolution computed tomography. A prognostic score was developed using a logistic regression model, which was used to determine the factors associated with bronchiectasis.Results: A total of 398 patients (60% with severe asthma) were included. The prevalence of bronchiectasis was 28. 4%. The presence of bronchiectasis was associated with a higher frequency of chronic expectoration (OR, 2.95; 95% CI, 1.49-5.84; p = 0.002), greater severity of asthma (OR, 2.43; 95% CI, 1.29-4.57; p = 0.006), at least one previous episode of pneumonia (OR, 2.42; 95% CI, 1.03-5.69; p = 0.044), and lower levels of FeNO (OR, 0.98; 95% CI, 0.97-0.99; p = 0.016). The NOPES score was developed on the basis of these variables (FeNO[cut off point 20.5 ppb], Pneumonia, Expectoration and asthma Severity), and it ranges from 0 to 4 points, where 0 means "no risk" and 4 corresponds to "high risk". The NOPES score yielded an AUC-ROC of 70% for the diagnosis of bronchiectasis, with a specificity of 95%.Conclusions: Almost a third of the patients with uncontrolled moderate-to-severe asthma had bronchiectasis. Bronchiectasis was related to the severity of asthma, the presence of chronic expectoration, a previous history of pneumonia, and lower levels of FeNO. The NOPES score is an easy-to-use scoring system with a high prognostic value for bronchiectasis in patients with uncontrolled moderate-to-severe asthma.