Romagnoli M, Caramori G, Braccioni F, Ravenna F, Barreiro E, Siafakas N M, Vignola A M, Chanez P, Fabbri L M, Papi A
Research Centre on Asthma and COPD, University of Ferrara, Ferrara, Italy, and Department of Respiratory Diseases, University Hospital, INSERM U454, Montpellier, France.
Clin Exp Allergy. 2007 Apr;37(4):552-7. doi: 10.1111/j.1365-2222.2007.02683.x.
Near-fatal asthma (NFA) is characterized by severe asthma attacks usually requiring intensive care unit admission. This phenotype of asthma has been studied mainly in acute conditions.
The aim of our study was to compare the clinical, functional and inflammatory characteristics of NFA patients with mild to severe asthmatics in stable conditions. We recruited 155 asthmatic patients from five centres of the European Network for Understanding Mechanisms of Severe Asthma: 67 patients with mild-to-moderate asthma controlled by low/medium doses of inhaled corticosteroids; 64 with severe asthma that, despite treatment with high doses of inhaled corticosteroids, long-acting beta2-agonists and for 1/3 also with regular oral corticosteroids, had at least one asthma exacerbation in the previous year; 24 with an NFA episode in the previous 5 years in the absence of inclusion criteria for the previous groups. All the patients were examined in stable conditions.
NFA patients were taking less corticosteroids and were less compliant to prescribed asthma medications than the other two groups of patients. Lung function, blood gases, atopic status, sputum and blood inflammatory cell count of NFA patients were similar to mild-to-moderate, but not severe, asthmatic patients.
In stable conditions patients with an NFA attack in the previous 5 years cannot be distinguished from patients with mild-to-moderate asthma, while they are different from severe asthmatics both in terms of lung function and of airway inflammation. The risk factor that characterizes this group of patients is reduced usage of prophylactic corticosteroids.
近致死性哮喘（NFA）的特征是严重哮喘发作，通常需要入住重症监护病房。这种哮喘表型主要在急性情况下进行研究。
我们研究的目的是比较NFA患者与稳定状态下轻度至重度哮喘患者的临床、功能和炎症特征。我们从欧洲重症哮喘机制理解网络的五个中心招募了155名哮喘患者：67名轻度至中度哮喘患者，通过低/中剂量吸入性糖皮质激素控制病情；64名重度哮喘患者，尽管使用高剂量吸入性糖皮质激素、长效β2受体激动剂治疗，且三分之一的患者还规律使用口服糖皮质激素，但在前一年至少有一次哮喘发作；24名在过去5年中有NFA发作且不符合前两组纳入标准的患者。所有患者均在稳定状态下接受检查。
与其他两组患者相比，NFA患者服用的糖皮质激素较少，对规定的哮喘药物依从性较差。NFA患者的肺功能、血气、特应性状态、痰液和血液炎症细胞计数与轻度至中度哮喘患者相似，但与重度哮喘患者不同。
在稳定状态下，过去5年中有NFA发作的患者与轻度至中度哮喘患者无法区分，但在肺功能和气道炎症方面与重度哮喘患者不同。该组患者的特征性危险因素是预防性糖皮质激素使用减少。
