Difficult-to-control asthma: Clinical characteristics of steroid-insensitive asthma
Difficult-to-control asthma: Clinical characteristics of steroid-insensitive asthma
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DOI：
10.1016/s0091-6749(98)70165-4
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发表时间：
1998-05-01
影响因子：
14.2
通讯作者：
Spahn, JD
中科院分区：
文献类型：
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作者：
Chan, MTS;Leung, DYM;Spahn, JD
背景：虽然广泛使用，但对于严重哮喘受试者对口服糖皮质激素 (GC) 治疗的反应模式知之甚少。方法：我们回顾性审查了国家犹太医学研究中心收治的 164 名连续青少年难以控制的哮喘患者的图表，收集的数据包括病史、体积描记法测量的肺功能、乙酰甲胆碱激发结果、AM 皮质醇水平、血清 IgE、总嗜酸性粒细胞计数 (TEC)、血清嗜酸性粒细胞阳离子蛋白 (ECP)、可溶性 IL-2 受体 (sIL-2R) 和肺活量测定结果：87 名患者 (53%) 在住院期间因哮喘控制不佳而需要进行 GC 突发。那些需要GC爆发的人有明显更长的哮喘病史、更严重的支气管高反应性和更低的肺功能。 GC 爆发后，21 名患者 (24%) 未能做出反应，其 AM 前支气管扩张剂 FEV 改善超过 15%，被称为类固醇不敏感 (SI)。尽管 SI 哮喘患者的哮喘持续时间相似，但与类固醇敏感哮喘患者相比，他们在更年轻的时候需要口服 GC 治疗，入院时需要更大的维持口服 GC 剂量，并且更有可能是非裔美国人。此外，SI 哮喘受试者中有两种不同的肺活量测定模式：“混乱”和“非混乱”。具有混沌模式的患者的特征是每日肺功能的显着变异性（大于30%），而患有非混沌性SI哮喘的患者的特征是每日肺功能的变异性小于15%。那些患有非混乱性 SI 的人在较晚的年龄被诊断为哮喘并接受口服 GC 治疗。 结论：这项回顾性研究表明，在国家转诊中心评估的患有严重哮喘的青少年中，SI 哮喘相当常见 (25%)。此外，已经确定了两种不同的 SI 哮喘模式，它们构成了不同的病理生理过程。最后，SI 群体中非洲裔美国人的比例过高，支持进一步开展流行病学研究的必要性，以调查 SI 哮喘的患病率以及早期哮喘干预可能对这种严重哮喘的影响。
Background: Although widely used, little is known regarding the patterns of response that subjects with severe asthma exhibit to oral glucocorticoid (GC) therapy.Methods: We retrospectively reviewed the charts of 164 consecutive adolescents admitted to the National Jewish Medical and Research Center for difficult-to-control asthma, Data collected included medical history, pulmonary function measures by plethysmography, methacholine challenge results, AM cortisol levels, serum IgE, total eosinophil counts (TEC), serum eosinophil cationic protein (ECP), soluble IL-2 receptor (sIL-2R), and spirometry,Results: Eighty-seven patients (53%) required a GC burst during the hospitalization secondary to poor asthma control. Those requiring a GC burst had a significantly longer history of asthma, a greater degree of bronchial hyperresponsiveness, and lower pulmonary function. Twenty-one patients (24%) failed to respond with a greater than 15% improvement in their AM prebronchodilator FEV, after the GC burst and were termed steroid insensitive (SI). Although those with SI asthma had a similar duration of asthma, they required oral GC therapy at a younger age, required a larger maintenance oral GC dose on admission, and were more likely to be African-American, compared with those with steroid-sensitive asthma. Furthermore, two distinct spirometry patterns were noted among the SI asthmatic subjects: "chaotic" and "non-chaotic." Patients with the chaotic pattern were characterized by a significant degree of variability (greater than 30%) in daily pulmonary function, whereas those with nonchaotic, SI asthma were characterized by less than 15% variability in daily lung function. Those with nonchaotic SI were diagnosed with asthma and treated with oral GCs at a later age.Conclusions: This retrospective study suggests that SI asthma is quite common (25%) among adolescents with severe asthma evaluated at a national referral center, In addition, two distinct patterns of SI asthma have been identified that mag constitute different pathophysiologic processes. Finally, the overrepresentation of African-Americans in the SI group supports the need for further epidemiologic studies investigating the prevalence of SI asthma and the impact early asthma intervention may have on this severe form of asthma.