Bateman Eric D, Clark Tim J H, Frith Lucy, Bousquet Jean, Busse William W, Pedersen Soren E
University of Cape Town, Cape Town, South Africa.
J Asthma. 2007 Oct;44(8):667-73. doi: 10.1080/02770900701554821.
Using a composite measure based on clinical outcomes, the GOAL study showed that achievement of Total Control of asthma was time dependent with the proportion of controlled patients continuing to rise through the year-long study. Taking data from this study, we compared time taken to achieve Total Control with time taken to achieve total control of each individual clinical criterion on treatment with salmeterol/fluticasone propionate (SFC) or fluticasone propionate (FP) alone.
Time to achieving total control of individual outcomes (day-time symptoms, night-time awakenings, rescue medication use, PEF > or =80% predicted every day) were analyzed by Kaplan Meier plots and compared with achievement of composite Total Control.
Night-time awakenings responded most rapidly and daytime symptoms took longest to respond. After 12 weeks, the proportion of patients who achieved control of any individual clinical criterion was higher than the proportion who achieved control when using the composite outcome (no night-time awakenings achieved by 73% with SFC and 65% with FP; PEF > or =80% predicted every day, 55% and 45% respectively; no rescue usage 46% and 35% respectively; and no daytime symptoms, 35% and 24% respectively, compared with Total Control, 23% and 14% respectively). In every measure except night-time awakenings, more rapid responses were seen for SFC compared with FP alone.
Speed of response of individual asthma measures varies and evaluation of control using any single measure overestimates total asthma control. Treatment should be continued until composite control is reached, rather than control of individual outcomes.
GOAL研究使用基于临床结局的综合指标显示，哮喘完全控制的实现具有时间依赖性，在为期一年的研究中，病情得到控制的患者比例持续上升。利用该研究的数据，我们比较了使用沙美特罗/丙酸氟替卡松（SFC）或单用丙酸氟替卡松（FP）治疗时，实现完全控制所需的时间与实现各项临床标准完全控制所需的时间。
通过Kaplan Meier曲线分析实现各项结局（日间症状、夜间觉醒、急救药物使用、每日呼气峰流速（PEF）≥预计值的80%）完全控制的时间，并与综合完全控制的实现情况进行比较。
夜间觉醒的反应最快，日间症状的反应最慢。12周后，实现任何一项临床标准控制的患者比例高于使用综合结局（完全控制）时的比例（SFC组73%、FP组65%无夜间觉醒；每日PEF≥预计值的80%，分别为55%和45%；无急救药物使用，分别为46%和35%；无日间症状，分别为35%和24%，而完全控制分别为23%和14%）。除夜间觉醒外，在各项指标中，SFC组的反应均比单用FP组更快。
各项哮喘指标的反应速度不同，使用任何单一指标评估控制情况都会高估哮喘的整体控制情况。治疗应持续至达到综合控制，而非个别指标的控制。
