Characterization of the severe asthma phenotype by the National Heart, Lung, and Blood Institute's Severe Asthma Research Program
Characterization of the severe asthma phenotype by the National Heart, Lung, and Blood Institute's Severe Asthma Research Program
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DOI：
10.1016/j.jaci.2006.11.639
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发表时间：
2007-02-01
影响因子：
14.2
通讯作者：
Wenzel, Sally E.
中科院分区：
文献类型：
--
作者：
Moore, Wendy C.;Bleecker, Eugene R.;Wenzel, Sally E.
背景：重度哮喘是哮喘发病的主要原因。目的：重症哮喘研究项目的目标是识别和表征重症哮喘患者，以了解重症哮喘的病理生理机制。方法：我们进行了全面的表型表征（问卷调查、特应性和肺功能测试、放血术、呼出的一氧化氮）。结果：共研究了438例哮喘受试者（204例重度，70例中度，164例轻度）。重度哮喘患者年龄较大，病程较长（P <0.0001），每日症状较多，紧急医疗服务利用率高，有鼻窦炎和肺炎（P <0.0001）。重度哮喘伴明显的支气管扩张剂可逆性时肺功能较低（P <0.001）。皮肤试验显示重度组的特应性较轻（P = 0.0007），但血嗜酸性粒细胞、IgE和呼出的一氧化氮水平并不能区分疾病的严重程度。FEV1降低、肺炎史和较少的阳性皮肤试验是严重疾病的危险因素。在重度哮喘患者中，早期发病（年龄< 12岁）与较长的病程（P <0.0001）和更紧急的医疗护理，尤其是重症监护（P = 0.002）相关。晚发病（年龄≥ 12岁）与肺功能低下和鼻窦感染有关（P
Background: Severe asthma causes the majority of asthma morbidity. Understanding mechanisms that contribute to the development of severe disease is important.Objective: The goal of the Severe Asthma Research Program is to identify and characterize subjects with severe asthma to understand pathophysiologic mechanisms in severe asthma.Methods: We performed a comprehensive phenotypic characterization (questionnaires, atopy and pulmonary function testing, phlebotomy, exhaled nitric oxide) in subjects with severe and not severe asthma.Results: A total of 438 subjects with asthma were studied (204 severe, 70 moderate, 164 mild). Severe subjects with asthma were older with longer disease duration (P < .0001), more daily symptoms, intense urgent health care utilization, sinusitis, and pneumonia (P < .0001). Lung function was lower in severe asthma with marked bronchodilator reversibility (P < .001). The severe group had less atopy by skin tests (P = .0007), but blood eosinophils, IgE, and exhaled nitric oxide levels did not differentiate disease severity. A reduced FEV1, history of pneumonia, and fewer positive skin tests were risk factors for severe disease. Early disease onset (age < 12 years) in severe asthma was associated with longer disease duration (P < .0001) and more urgent health care, especially intensive care (P = .002). Later disease onset (age >= 12 years) was associated with lower lung function and sinopulmonary infections (P