Distinguishing characteristics of difficult-to-control asthma in inner-city children and adolescents.
Distinguishing characteristics of difficult-to-control asthma in inner-city children and adolescents.
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DOI：
10.1016/j.jaci.2016.06.059
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发表时间：
2016-10
期刊：
影响因子：
--
通讯作者：
Liu AH
中科院分区：
文献类型：
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作者：
Pongracic JA;Krouse RZ;Babineau DC;Zoratti EM;Cohen RT;Wood RA;Khurana Hershey GK;Kercsmar CM;Gruchalla RS;Kattan M;Teach SJ;Johnson CC;Bacharier LB;Gern JE;Sigelman SM;Gergen PJ;Togias A;Visness CM;Busse WW;Liu AH
控制哮喘所需的治疗水平在哮喘人群中差异很大。导致内城区儿童治疗需求差异的因素尚未完全阐明。确定区分难以控制的哮喘的临床特征。 6-17 岁的哮喘儿童在一年内接受基线评估和每两个月一次基于指南的管理访视。难控制哮喘与易控制哮喘的定义是每日使用氟替卡松≥500mcg +/-LABA 与至少 4 次就诊时分配的氟替卡松≤100mcg 进行治疗。使用单变量分析使用 44 个基线变量来比较 2 组，并使用变量选择算法确定难以控制哮喘的最相关特征。使用广义加性混合效应模型检查纵向测量（症状、肺部生理学和恶化）的非线性季节性变化。在 619 名招募的参与者中，40.9% 患有难以控制的哮喘，37.5% 患有易于控制的哮喘，21.6% 则不属于任何一组。在基线时，FEV1 支气管扩张剂反应性是区分难控制哮喘和易控制哮喘的最重要特征。鼻炎严重程度和过敏性的标志是其他主要的鉴别特征之一。随着时间的推移，难以控制的哮喘的特点是急性发作率高，特别是在春季和秋季，白天和夜间症状更严重，特别是在秋季和冬季，以及尽管持续进行高剂量控制治疗，但肺部生理机能受损。尽管依从性良好，但难以控制的哮喘在一年中的症状、病情加重或肺部生理学方面几乎没有改善。除了肺部生理学指标外，鼻炎的严重程度和特应性与高剂量哮喘控制治疗的需求相关。与肺生理学、鼻炎严重程度和特应性相关的临床基线特征前瞻性地区分难以控制和易于控制的哮喘。
Treatment levels required to control asthma vary greatly across a population with asthma. The factors that contribute to variability in treatment requirements of inner-city children have not been fully elucidated. To identify the clinical characteristics which distinguish difficult-to-control asthma. Children with asthma aged 6-17 underwent baseline assessment and bimonthly guidelines-based management visits over one year. Difficult- versus easy-to-control asthma were defined as daily therapy with fluticasone ≥500mcg +/-LABA versus ≤100mcg assigned on at least 4 visits. Forty-four baseline variables were used to compare the 2 groups using univariate analyses and identify the most relevant features of difficult-to-control asthma using a variable selection algorithm. Nonlinear seasonal variation in longitudinal measures (symptoms, pulmonary physiology and exacerbations) was examined using generalized additive mixed-effects models. Among 619 recruited participants, 40.9% had difficult-to-control asthma, 37.5% had easy-to-control asthma and 21.6% fell into neither group. At baseline, FEV1 bronchodilator responsiveness was the most important characteristic distinguishing difficult- from easy-to-control asthma. Markers of rhinitis severity and atopy were among the other major discriminating features. Over time, difficult-to-control asthma was characterized by high exacerbation rates, particularly in spring and fall, greater day and night symptoms, especially in fall and winter, and compromised pulmonary physiology despite ongoing high dose controller therapy. Despite good adherence, difficult-to-control asthma showed little improvement in symptoms, exacerbations or pulmonary physiology over the year. Besides pulmonary physiology measures, rhinitis severity and atopy were associated with high dose asthma controller therapy requirement. Clinical baseline characteristics related to pulmonary physiology, rhinitis severity, and atopy prospectively distinguish difficult- from easy-to-control asthma.