Petsky H L, Kynaston J A, Turner C, Li A M, Cates C J, Lasserson T J, Chang A B
Royal Children's Hospital, Department of Respiratory Medicine, Herston Road, Brisbane, Queensland, Australia, 4029.
Cochrane Database Syst Rev. 2007 Apr 18(2):CD005603. doi: 10.1002/14651858.CD005603.pub2.
Asthma severity and control can be measured both subjectively and objectively. Sputum analysis for evaluation of percentage of sputum eosinophilia directly measures airway inflammation, and is one method of objectively monitoring asthma. Interventions for asthma therapies have been traditionally based on symptoms and spirometry.
To evaluate the efficacy of tailoring asthma interventions based on sputum analysis in comparison to clinical symptoms (with or without spirometry/peak flow) for asthma related outcomes in children and adults.
We searched the Cochrane Airways Group Specialised Register of Trials, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and reference lists of articles. The last search was on 31 October 2006.
All randomised controlled comparisons of adjustment of asthma therapy based on sputum eosinophils compared to traditional methods (primarily clinical symptoms and spirometry/peak flow).
Results of searches were reviewed against pre-determined criteria for inclusion. Three sets of reviewers selected relevant studies. Two review authors independently assessed trial quality extracted data. Authors were contacted for further information but none were received. Data was analysed as "treatment received" and sensitivity analyses performed.
Three adult studies were included; these studies were clinically and methodologically heterogenous (use of medications, cut off for percentage of sputum eosinophils and definition of asthma exacerbation). There were no eligible paediatric studies. Of 246 participants randomised, 221 completed the trials. In the meta-analysis, a significant reduction in number of participants who had one or more asthma exacerbations occurred when treatment was based on sputum eosinophils in comparison to clinical symptoms; pooled odds ratio (OR) was 0.49 (95% CI 0.28 to 0.87); number needed to treat to benefit (NNTB) was 6 (95% CI 4 to 32). There were also differences between groups in the rate of exacerbation (any exacerbation per year) and severity of exacerbations defined by requirement for use of oral corticosteroids but the reduction in hospitalisations was not statistically significant. Data for clinical symptoms, quality of life and spirometry were not significantly different between groups. The mean dose of inhaled corticosteroids per day was similar in both groups and no adverse events were reported. However sputum induction was not always possible.
AUTHORS' CONCLUSIONS: Tailored asthma interventions based on sputum eosinophils is beneficial in reducing the frequency of asthma exacerbations in adults with asthma. This review supports the use of sputum eosinophils to tailor asthma therapy for adults with frequent exacerbations and severe asthma. Further studies need to be undertaken to strengthen these results and no conclusion can be drawn for children with asthma.
哮喘的严重程度和控制情况可通过主观和客观方法进行衡量。痰液分析用于评估痰液嗜酸性粒细胞百分比，可直接测量气道炎症，是客观监测哮喘的一种方法。传统上，哮喘治疗的干预措施基于症状和肺功能测定。
评估与基于临床症状（有或无肺功能测定/呼气峰值流速）的哮喘干预措施相比，基于痰液分析调整哮喘干预措施对儿童和成人哮喘相关结局的疗效。
我们检索了Cochrane气道组专业试验注册库、Cochrane对照试验中央注册库（CENTRAL）、MEDLINE、EMBASE以及文章的参考文献列表。最后一次检索时间为2006年10月31日。
所有基于痰液嗜酸性粒细胞调整哮喘治疗与传统方法（主要是临床症状和肺功能测定/呼气峰值流速）的随机对照比较。
根据预先确定的纳入标准对检索结果进行审查。三组评审人员选择相关研究。两位综述作者独立评估试验质量并提取数据。已联系作者获取更多信息，但未收到回复。数据按“接受的治疗”进行分析，并进行敏感性分析。
纳入了三项成人研究；这些研究在临床和方法上存在异质性（药物使用、痰液嗜酸性粒细胞百分比的临界值以及哮喘加重的定义）。没有符合条件的儿科研究。在随机分组的246名参与者中，221名完成了试验。在荟萃分析中，与基于临床症状的治疗相比，基于痰液嗜酸性粒细胞的治疗使发生一次或多次哮喘加重的参与者数量显著减少；合并比值比（OR）为0.49（95%CI 0.28至0.87）；需治疗获益人数（NNTB）为6（95%CI 4至32）。两组在加重率（每年任何加重情况）和因需要使用口服糖皮质激素定义的加重严重程度方面也存在差异，但住院人数的减少无统计学意义。两组在临床症状、生活质量和肺功能测定数据方面无显著差异。两组每天吸入糖皮质激素的平均剂量相似，且未报告不良事件。然而，并非总能进行痰液诱导。
基于痰液嗜酸性粒细胞的哮喘干预措施有助于减少成年哮喘患者的哮喘加重频率。本综述支持使用痰液嗜酸性粒细胞为频繁加重和重度哮喘的成年患者调整哮喘治疗方案。需要进一步开展研究以强化这些结果，对于儿童哮喘患者无法得出结论。
