ten Brinke A, Sterk P J, Masclee A A M, Spinhoven P, Schmidt J T, Zwinderman A H, Rabe K F, Bel E H
Dept of Pulmonary Diseases, C3-P, Leiden University Medical Center, P.O. Box 9600, NL-2300 RC Leiden, The Netherlands.
Eur Respir J. 2005 Nov;26(5):812-8. doi: 10.1183/09031936.05.00037905.
Recurrent exacerbations are a major cause of morbidity and medical expenditure in patients with asthma. Various exogenous and endogenous factors are thought to influence the level of asthma control, but systematical data on the involvement of these factors in the recurrence of asthma exacerbations are scarce. In this study, 13 clinical and environmental factors potentially associated with recurrent exacerbations were investigated in 136 patients with difficult-to-treat asthma. Patients with more than three severe exacerbations (n = 39) in the previous year were compared with those with only one exacerbation per year (n = 24). A systematic diagnostic protocol was used to assess 13 potential risk factors. Factors significantly associated with frequent exacerbations included: severe nasal sinus disease (adjusted odds ratio (OR) 3.7); gastro-oesophageal reflux (OR 4.9); recurrent respiratory infections (OR 6.9); psychological dysfunctioning (OR 10.8); and obstructive sleep apnoea (OR 3.4). Severe chronic sinus disease and psychological dysfunctioning were the only independently associated factors (adjusted OR 5.5 and 11.7, respectively). All patients with frequent exacerbations exhibited at least one of these five factors, whilst 52% showed three or more factors. In conclusion, the results show that recurrent exacerbations in asthma are associated with specific co-morbid factors that are easy to detect and that are treatable. Therapeutic interventions aimed at correcting these factors are likely to reduce morbidity and medical expenditure in these patients.
哮喘复发是哮喘患者发病和医疗支出的主要原因。各种外源性和内源性因素被认为会影响哮喘控制水平，但关于这些因素在哮喘复发中作用的系统性数据却很匮乏。在本研究中，对136例难治性哮喘患者调查了13种可能与复发相关的临床和环境因素。将上一年有三次以上严重发作的患者（n = 39）与每年仅有一次发作的患者（n = 24）进行比较。采用系统的诊断方案评估13种潜在风险因素。与频繁发作显著相关的因素包括：严重鼻窦疾病（校正比值比（OR）3.7）；胃食管反流（OR 4.9）；反复呼吸道感染（OR 6.9）；心理功能障碍（OR 10.8）；以及阻塞性睡眠呼吸暂停（OR 3.4）。严重慢性鼻窦疾病和心理功能障碍是仅有的独立相关因素（校正OR分别为5.5和11.7）。所有频繁发作的患者均表现出这五种因素中的至少一种，而52%的患者表现出三种或更多因素。总之，结果表明哮喘复发与易于检测且可治疗的特定合并症因素相关。针对这些因素的治疗干预可能会降低这些患者的发病率和医疗支出。
