The prevalence of severe refractory asthma
The prevalence of severe refractory asthma
复制标题
DOI：
10.1016/j.jaci.2014.08.042
复制
发表时间：
2015-04-01
影响因子：
14.2
通讯作者：
Bel, Elisabeth H.
中科院分区：
文献类型：
--
作者：
Hekking, Pieter-Paul W.;Wener, Reinier R.;Bel, Elisabeth H.
背景：重度哮喘的特点是尽管高强度治疗仍难以实现疾病控制。然而，缺乏严重哮喘的患病率数据，而长期估计在所有哮喘患者中占5%至10%之间。了解严重难治性哮喘的确切患病率，而不是难以控制的哮喘，对临床决策、药物开发和卫生当局的报销政策都很重要。目的：我们试图估计由创新医学倡议共识定义的严重难治性哮喘的患病率。方法：从65个荷兰药房数据库中提取具有高强度治疗处方（高剂量吸入皮质类固醇和长效β(2)-激动剂或中至高剂量吸入皮质类固醇联合口服皮质类固醇和长效β -激动剂）的成年患者，占人口的3%（500,500名居民）。向5002名患者发送了问卷，其中2312名患者进行了分析。通过问卷调查得出哮喘诊断和哮喘控制程度，以确定难以控制的哮喘患者。随机抽取60例患者（处方填充，>= 80%）进行吸入技术评估。难以控制的哮喘患者，坚持治疗，并有正确的吸入技术是合格的严重难治性哮喘。结果也反映在荷兰人身上。结果：在哮喘成人中，3.6% （95% CI， 3.0%至4.1%）符合严重难治性哮喘的诊断，每10,000名居民中有10.4名患者。结论：严重难治性哮喘的患病率可能低于专家的估计。这意味着目前公认的严重哮喘亚表型可能符合罕见病的标准。
Background: Severe asthma is characterized by difficulty to achieve disease control despite high-intensity treatment. However, prevalence figures of severe asthma are lacking, whereas longstanding estimates vary between 5% and 10% of all asthmatic patients. Knowing the exact prevalence of severe refractory asthma as opposed to difficult-to-control asthma is important for clinical decision making, drug development, and reimbursement policies by health authorities.Objective: We sought to estimate the prevalence of severe refractory asthma as defined by the Innovative Medicine Initiative consensus.Methods: Adult patients with a prescription for high-intensity treatment (high-dose inhaled corticosteroids and long-acting beta(2)-agonists or medium-to high-dose inhaled corticosteroids combined with oral corticosteroids and long-acting b2-agonists) were extracted from 65 Dutch pharmacy databases, representing 3% of the population (500,500 inhabitants). Questionnaires were sent to 5,002 patients, of which 2,312 were analyzed. The diagnosis of asthma and degree of asthma control were derived from questionnaires to identify patients with difficult-to-control asthma. Inhalation technique was assessed in a random sample of 60 adherent patients (prescription filling, >= 80%). Patients with difficult-to-control asthma, adherence to treatment, and a correct inhalation technique were qualified as having severe refractory asthma. Results were mirrored to the Dutch population.Results: Of asthmatic adults, 3.6% (95% CI, 3.0% to 4.1%) qualified for a diagnosis of severe refractory asthma, representing 10.4 patients per 10,000 inhabitants.Conclusion: The prevalence of severe refractory asthma might be lower than estimated by expert opinion. This implies that currently recognized severe asthma subphenotypes could meet the criteria of rare diseases.