Clinical characteristics and burden of illness among adolescent and adult patients with severe asthma by asthma control: the IDEAL study
Clinical characteristics and burden of illness among adolescent and adult patients with severe asthma by asthma control: the IDEAL study
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DOI：
10.1080/02770903.2019.1708095
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发表时间：
2020-01-08
影响因子：
1.9
通讯作者：
Albers, Frank C.
中科院分区：
文献类型：
--
作者：
Mullerova, Hana;Cockle, Sarah M.;Albers, Frank C.
目的：尽管进行了指南指导的治疗，严重哮喘（SA）仍可能无法得到控制。我们描述了 SA 特征并确定了与不受控制的疾病和频繁恶化相关的因素。方法：观察性 IDEAL 研究 (201722/NCT02293265) 的事后分析包括年龄≥ 12 岁的 SA 患者，接受大剂量吸入皮质类固醇加额外控制器≥ 12 个月。不受控制的 SA 是通过哮喘控制问卷 (ACQ)-5 评分 >= 1.5 或 >= 1 次恶化（前一年）来定义的，并根据恶化频率进一步分层（无/不频繁 [0-1] 与频繁 [>= 2]；前一年）；使用多元逻辑回归确定相关因素。结果：在 670 名 SA 患者中，540 名 (81%) 未得到控制（ACQ-5 评分≥1.5：80%；≥1 次加重[前一年]：71%）。与对照患者相比，未受控制的患者肺功能较低，健康相关生活质量 (HRQoL) 更差； 197/540 (37%) 经历了频繁的病情恶化（前一年）。更糟糕的圣乔治呼吸问卷 (SGRQ) 总分、合并鼻窦炎或湿疹与不受控制的 SA 显着相关；年龄较小、从不吸烟、病情恶化需要住院（前一年）、SGRQ 症状评分较差、合并鼻息肉、慢性阻塞性肺病或骨质疏松症与不受控制的 SA 且频繁恶化显着相关。结论：在 IDEAL 中，根据症状，五分之一的 SA 患者得到了控制。不受控制的恶化 SA 与特定合并症、频繁恶化、肺功能较低和 HRQoL 受损相关，尽管该分析的推论受到队列选择性横截面性质的限制。尽管如此，这些数据凸显了该人群需要更有效的精准治疗。
Objectives: Severe asthma (SA) can be uncontrolled despite guideline-directed treatment. We described SA characteristics and identified factors associated with uncontrolled disease and frequent exacerbations. Methods: Post hoc analysis of the observational IDEAL study (201722/NCT02293265) included patients with SA aged >= 12 years receiving high-dose inhaled corticosteroids plus additional controller(s) for >= 12 months. Uncontrolled SA was defined by Asthma Control Questionnaire (ACQ)-5 scores >= 1.5 or >= 1 exacerbations (prior year), and further stratified by exacerbation frequency (no/infrequent [0-1] vs frequent [>= 2]; prior year); associated factors were determined using multivariate logistic regression. Results: Of 670 patients with SA, 540 (81%) were uncontrolled (ACQ-5 scores >= 1.5: 80%; >= 1 exacerbations [prior year]: 71%). Uncontrolled patients had lower lung function and worse health-related quality of life (HRQoL) than controlled patients; 197/540 (37%) experienced frequent exacerbations (prior year). Worse St George's Respiratory Questionnaire (SGRQ) total score, comorbid sinusitis, or eczema were significantly associated with uncontrolled SA; younger age, never smoker status, exacerbation requiring hospitalization (previous year), worse SGRQ symptom score, comorbid nasal polyps, COPD, or osteoporosis were significantly associated with uncontrolled SA with frequent exacerbations. Conclusions: In IDEAL, one-fifth of patients with SA were controlled, based on symptoms. Uncontrolled, exacerbating SA was associated with specific comorbidities, frequent exacerbations, a lower lung function, and compromised HRQoL, although inference from this analysis is limited by the selective cross-sectional nature of the cohort. Nonetheless, these data highlight the need for more effective precision treatments in this population.