Characteristics of Perimenstrual Asthma and Its Relation to Asthma Severity and Control Data From the Severe Asthma Research Program
Characteristics of Perimenstrual Asthma and Its Relation to Asthma Severity and Control Data From the Severe Asthma Research Program
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DOI：
10.1378/chest.12-0973
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发表时间：
2013-04-01
期刊：
影响因子：
9.6
通讯作者：
Wenzel, Sally E.
中科院分区：
文献类型：
--
作者：
Rao, Chitra K.;Moore, Charity G.;Wenzel, Sally E.
背景：尽管经周哮喘（PMA）与严重和难以控制的哮喘有关，但其特征和理解仍然很差。本研究的目的是确定与PMA相关的临床、人口统计学和炎症因素，并评估PMA与哮喘严重程度和控制的关系。方法：在美国国家心肺血液研究所重度哮喘研究项目中招募的女性哮喘患者，在筛查问卷中报告PMA症状，并分析其基本人口统计学、临床问卷数据、免疫炎症标志物和生理参数。对PMA组和非PMA组进行单因素比较。建立了经严重程度调整后的PMA预测模型。另外的模型讨论了PMA在哮喘控制中的作用。结果：17%的受试者（n = 92）报告了自我认定的PMA，并与较高的BMI、较低的FVC%预测和较高的胃食管反流疾病发生率相关。52%的PMA组符合严重哮喘的标准，而非PMA组为30%。在控制严重程度的多变量分析中，预测阿司匹林敏感性和较低的FVC%与PMA的存在相关。此外，在控制了严重程度和混杂因素后，PMA仍然与更多的哮喘症状和紧急医疗保健利用相关。结论：PMA常见于严重哮喘患者，并与疾病控制不良相关。在调整多种因素后，预测阿司匹林敏感性和较低的FVC%与PMA相关，这表明前列腺素的改变可能有助于这种表型。胸部2013;143 (4): 984 - 992
Background: Although perimenstrual asthma (PMA) has been associated with severe and difficult-to-control asthma, it remains poorly characterized and understood. The objectives of this study were to identify clinical, demographic, and inflammatory factors associated with PMA and to assess the association of PMA with asthma severity and control.Methods: Women with asthma recruited to the National Heart, Lung, and Blood Institute Severe Asthma Research Program who reported PMA symptoms on a screening questionnaire were analyzed in relation to basic demographics, clinical questionnaire data, immunoinflammatory markers, and physiologic parameters. Univariate comparisons between PMA and non-PMA groups were performed. A severity-adjusted model predicting PMA was created. Additional models addressed the role of PMA in asthma control.Results: Self-identified PMA was reported in 17% of the subjects (n = 92) and associated with higher BMI, lower FVC% predicted, and higher gastroesophageal reflux disease rates. Fifty-two percent of the PMA group met criteria for severe asthma compared with 30% of the non-PMA group. In multivariable analyses controlling for severity, aspirin sensitivity and lower FVC% predicted were associated with the presence of PMA. Furthermore, after controlling for severity and confounders, PMA remained associated with more asthma symptoms and urgent health-care utilization.Conclusions: PMA is common in women with severe asthma and associated with poorly controlled disease. Aspirin sensitivity and lower FVC% predicted are associated with PMA after adjusting for multiple factors, suggesting that alterations in prostaglandins may contribute to this phenotype. CHEST 2013; 143(4):984-992