Susceptibility to exacerbations in Black adults with asthma
Susceptibility to exacerbations in Black adults with asthma
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DOI：
10.1080/02770903.2018.1486855
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发表时间：
2019-07-03
影响因子：
1.9
通讯作者：
Israel, Elliot
中科院分区：
文献类型：
--
作者：
Grossman, Nicole L.;Doros, Gheorghe D.;Israel, Elliot
目的：哮喘急性发作是哮喘发病的主要原因。在一项大型干预研究中，我们试图检验一种假设，即一种黑人成人哮喘加重倾向表型-一组在一年内重复加重的风险很高的黑人哮喘患者-独立于临床控制存在于哮喘中。研究方法：我们分析了536例符合或正在接受国家哮喘教育和预防计划（NAEPP）第3步治疗的美国黑人哮喘患者的急性加重风险因素，这些患者参加了一项为期6-18个月的噻托溴铵与长效β受体激动剂作为吸入性皮质类固醇添加治疗的随机试验。急性加重定义为口服或全身性皮质类固醇治疗的事件。通过经验证的哮喘控制问卷（ACQ 5）评估临床控制情况。结果：临床控制的丧失更可能加重。急性加重患者和非急性加重患者的平均基线ACQ分别为2.41和1.91（p < 0.001）。在所有ACQ水平中，与急性加重相关的最强独立因素是前一年的急性加重（校正OR 3.26; p < 0.001）。既往急性加重的严重程度与未来急性加重的可能性无关。基线FEV 1/FVC较低也与急性加重风险增加相关。结论：尽管急性发作随着临床控制的丧失而增加，但在患有哮喘的黑人成人中存在急性发作易感性表型，与临床控制无关。这种表型需要精确的治疗靶向。
Objective: Exacerbations account for much of the morbidity in asthma. In a large intervention study, we sought to test the hypothesis that a Black adult exacerbation-prone phenotype - a group of Black people with asthma who are at high risk of repeat exacerbation within one year - exists in asthma independent of clinical control. Methods: We analyzed exacerbation risk factors in 536 self-identified Black Americans with asthma eligible for, or on, Step 3 National Asthma Education and Prevention Program (NAEPP) therapy who participated in a randomized 6-18 month trial of tiotropium versus long acting beta agonist as add-on therapy to inhaled corticosteroids. Exacerbations were defined as events treated by oral or systemic corticosteroids. Clinical control was assessed by a validated asthma control questionnaire (ACQ5). Results: Exacerbations became more likely with loss of clinical control. The mean baseline ACQs for exacerbators and non-exacerbators were 2.41 and 1.91, respectively (p < 0.001). The strongest independent factor associated with exacerbations across all ACQ levels was an exacerbation in the preceding year (adjusted OR 3.26; p < 0.001). The severity of prior exacerbations did not correlate with the likelihood of a future exacerbation. Lower baseline FEV1/FVC was also associated with increased risk of exacerbations. Conclusions: Even though exacerbations increase with loss of clinical control, an exacerbation susceptibility phenotype exists in Black adults with asthma, independent of clinical control. This phenotype requires precision therapeutic targeting.