Exacerbation risk in severe asthma is stratified by inflammatory phenotype using longitudinal measures of sputum eosinophils
Exacerbation risk in severe asthma is stratified by inflammatory phenotype using longitudinal measures of sputum eosinophils
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DOI：
10.1111/cea.12762
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发表时间：
2016-10-01
影响因子：
6.1
通讯作者：
Martin, J. G.
中科院分区：
文献类型：
--
作者：
Walsh, C. J.;Zaihra, T.;Martin, J. G.
背景气道炎症表型越来越多地应用于哮喘患者。然而，其与难治性哮喘临床结局的关系尚未完全阐明。目的：我们研究的目标是确定急性发作率和表型之间的关系，难以哮喘的基础上的纵向措施痰嗜酸性粒细胞和中性粒细胞。方法主题在纵向观察研究，从两个三级保健中心，完成了1年的观察，并提供至少3个痰样本进行分类炎症表型使用先前建立的阈值。Kaplan-Meier曲线和单变量及多变量考克斯比例风险模型用于确定炎症表型与急性发作率之间的关系。基于单变量和多变量考克斯比例风险模型，持续性嗜酸性粒细胞表型受试者的首次急性加重时间显著短于非嗜酸性粒细胞表型受试者，1年内急性加重风险更大（风险比[HR]，3.24; 95%置信区间[CI]，1.35-7.72;校正HR，3.90; 95% CI，1.34-11.36）。第一次急性发作或急性发作的风险超过1年的时间没有显着差异之间的嗜酸性phenotypes.Conclusions持续嗜酸性表型与严重哮喘的非嗜酸性表型相比，急性发作的风险增加。在1年时间内，在嗜酸性表型之间未检测到首次急性加重时间或急性加重风险的差异。
Background Airway inflammatory phenotyping is increasingly applied to subjects with asthma. However, its relationship to clinical outcomes in difficult asthma is incompletely elucidated. Objective The goal of our study was to determine the relationship between exacerbation rates and phenotypes of difficult asthma based on the longitudinal measures of sputum eosinophils and neutrophils.Methods Subjects in the longitudinal observational study from two tertiary care centres that completed 1 year of observation and provided at least three sputum samples were classified by inflammatory phenotypes using previously established thresholds. Kaplan-Meier curves and univariable and multivariable Cox proportional hazard models were used to determine the association between inflammatory phenotypes and exacerbation rate.Results During the study, 115 exacerbations occurred in 73 severe asthmatic subjects. Subjects with the persistently eosinophilic phenotype had a significantly shorter time to first exacerbation and greater risk of exacerbation over a 1-year period than those with the non-eosinophilic phenotype based on the univariable and multivariable Cox proportional hazard model (hazard ratio [HR], 3.24; 95% confidence interval [CI], 1.35-7.72; adjusted HR, 3.90; 95% CI, 1.34-11.36). No significant differences in time to first exacerbation or exacerbation risk over a 1-year period were observed among the neutrophilic phenotypes.Conclusions The persistent eosinophilic phenotype is associated with increased exacerbation risk compared with the non-eosinophilic phenotype in severe asthma. No differences in time to first exacerbation or exacerbation risk over a 1-year period were detected among neutrophilic phenotypes.