Prognostic factors of asthma severity:: A 9-year international prospective cohort study
Prognostic factors of asthma severity:: A 9-year international prospective cohort study
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DOI：
10.1016/j.jaci.2006.03.019
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发表时间：
2006-06-01
影响因子：
14.2
通讯作者：
Janson, Christer
中科院分区：
文献类型：
--
作者：
de Marco, Roberto;Marcon, Alessandro;Janson, Christer
背景：哮喘严重程度的自然史知之甚少。目的：探讨哮喘严重程度的预后因素。方法：对 1991 年至 1993 年欧洲共同体呼吸健康调查中发现的所有现有哮喘患者进行随访，并于 2002 年使用全球哮喘分类倡议 (n = 856) 评估其严重程度。哮喘严重程度（间歇性、间歇性、轻度、中度、重度）与基线和随访期间通过多项 Logistic 模型评估的潜在决定因素相关，使用间歇性组作为相对风险比 (RRR) 的参考类别。 结果：基线时测量的哮喘严重程度是随访结束时患者严重程度的决定因素。在基线时，与间歇性哮喘患者相比，严重持续性哮喘患者的 FEV1% 预测较差、症状控制较差、IgE 水平较高（RRR，2.06；95% CI，1.38-3.06），并且慢性咳嗽/粘液分泌过多的患病率较高（RRR，4.90；95% CI，2.18-11.02）。中度持续性表现出与重度持续性相同的预后因素，即使相关性较弱。轻度持续性哮喘患者的预后因素分布与间歇性哮喘患者相似，尽管前者的症状控制效果比后者差。缓解主要发生在哮喘不太严重的患者中，并且与体重指数的变化呈负相关（RRR，0.86；95% CI，0.75-0.97）。儿童期过敏性鼻炎、吸烟和呼吸道感染与哮喘严重程度无关。结论：中度和重度持续性哮喘患者的特点是肺功能早期恶化。高 IgE 水平和持续咳嗽/粘液分泌过多是中度/重度哮喘的强烈标志，这似乎是与轻度持续性或间歇性哮喘不同的表型。临床意义：我们的结果表明哮喘严重程度的演变在很大程度上是可预测的。
Background: The natural history of asthma severity is poorly known.Objective: To investigate prognostic factors of asthma severity. Methods: All current patients with asthma identified in 1991 to 1993 in the European Community Respiratory Health Survey were followed up, and their severity was assessed in 2002 by using the Global Initiative for Asthma categorization (n = 856). Asthma severity (remittent, intermittent, mild, moderate, severe) was related to potential determinants evaluated at baseline and during the follow-up by a multinomial logistic model, using the intermittent group as the reference category for relative risk ratios (RRRs).Results: Asthma severity measured at baseline was a determinant of a patient's severity at the end of the follow-up. At baseline, severe persistent had a poorer FEV1% predicted, a poorer symptom control, higher IgE levels (RRR, 2.06; 95% CI, 1.38-3.06), and a higher prevalence of chronic cough/mucus hypersecretion (RRR, 4.90; 95% CI, 2.18-11.02) than patients with intermittent asthma. Moderate persistent showed the same prognostic factors as severe persistent, even if the associations were weaker. Mild persistent had a distribution of prognostic factors that was similar to patients with intermittent asthma, although the former showed a poorer symptom control than the latter. Remission mainly occurred in patients with less severe asthma and was negatively associated with a change in body mass index (RRR, 0.86; 95% CI, 0.75-0.97). Allergic rhinitis, smoking, and respiratory infections in childhood were not associated with asthma severity.Conclusion: Patients with moderate and severe persistent asthma are characterized by early deterioration of lung function. High IgE levels and persistent cough/mucus hypersecretion are strong markers of moderate/severe asthma, which seems to be a different phenotype from mild persistent or intermittent asthma.Clinical implications: Our results suggest that the evolution of asthma severity is to a large extent predictable.