Green Ruth H, Brightling Christopher E, McKenna Susan, Hargadon Beverley, Parker Debbie, Bradding Peter, Wardlaw Andrew J, Pavord Ian D
Institute for Lung Health, Department of Respiratory Medicine and Thoracic Surgery, Glenfield Hospital, LE3 9PQ, Leicester, UK.
Lancet. 2002 Nov 30;360(9347):1715-21. doi: 10.1016/S0140-6736(02)11679-5.
Treatment decisions in asthma are based on assessments of symptoms and simple measures of lung function, which do not relate closely to underlying eosinophilic airway inflammation. We aimed to assess whether a management strategy that minimises eosinophilic inflammation reduces asthma exacerbations compared with a standard management strategy.
We recruited 74 patients with moderate to severe asthma from hospital clinics and randomly allocated them to management either by standard British Thoracic Society asthma guidelines (BTS management group) or by normalisation of the induced sputum eosinophil count and reduction of symptoms (sputum management group). We assessed patients nine times over 12 months. The results were used to manage those in the sputum management group, but were not disclosed in the BTS group. The primary outcomes were the number of severe exacerbations and control of eosinophilic inflammation, measured by induced sputum eosinophil count. Analyses were by intention to treat.
The sputum eosinophil count was 63% (95% CI 24-100) lower over 12 months in the sputum management group than in the BTS management group (p=0.002). Patients in the sputum management group had significantly fewer severe asthma exacerbations than did patients in the BTS management group (35 vs 109; p=0.01) and significantly fewer patients were admitted to hospital with asthma (one vs six, p=0.047). The average daily dose of inhaled or oral corticosteroids did not differ between the two groups.
A treatment strategy directed at normalisation of the induced sputum eosinophil count reduces asthma exacerbations and admissions without the need for additional anti-inflammatory treatment.
哮喘的治疗决策基于症状评估和简单的肺功能指标，而这些与潜在的嗜酸性粒细胞气道炎症并无紧密关联。我们旨在评估与标准管理策略相比，一种将嗜酸性粒细胞炎症降至最低的管理策略是否能减少哮喘急性发作。
我们从医院诊所招募了74例中度至重度哮喘患者，并将他们随机分配至按照英国胸科学会哮喘指南进行管理（BTS管理组）或诱导痰嗜酸性粒细胞计数正常化并减轻症状的管理方式（痰液管理组）。我们在12个月内对患者进行了9次评估。评估结果用于管理痰液管理组的患者，但在BTS组中不公开。主要结局指标为严重急性发作次数以及通过诱导痰嗜酸性粒细胞计数衡量的嗜酸性粒细胞炎症控制情况。分析采用意向性分析。
痰液管理组在12个月内的诱导痰嗜酸性粒细胞计数比BTS管理组低63%（95%CI 24 - 100）（p = 0.002）。痰液管理组的患者严重哮喘急性发作次数显著少于BTS管理组（35次对109次；p = 0.01），因哮喘住院的患者也显著更少（1例对6例，p = 0.047）。两组吸入或口服糖皮质激素的平均日剂量无差异。
旨在使诱导痰嗜酸性粒细胞计数正常化的治疗策略可减少哮喘急性发作和住院次数，且无需额外的抗炎治疗。
