Lee June H, Haselkorn Tmirah, Borish Larry, Rasouliyan Lawrence, Chipps Bradley E, Wenzel Sally E
Genentech, Inc., 1 DNA Way, MS 453B, South San Francisco, CA 94080, USA.
Chest. 2007 Dec;132(6):1882-9. doi: 10.1378/chest.07-0713.
The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens study is among the largest to assess persistent airflow limitation and the first to evaluate a wide range of potential risk factors in high-risk patients with severe or difficult-to-treat asthma. A better understanding is needed regarding factors associated with persistent airway obstruction; this study was performed to determine demographic and clinical characteristics associated with persistent airflow limitation.
Data from adult patients (>or= 18 years old) with severe or difficult-to-treat asthma were evaluated. Patients with COPD, obesity with a restrictive respiratory pattern, or a >or= 30 pack-year history of smoking were excluded. Patients with persistent airflow limitation (postbronchodilator FEV1/FVC ratio <or= 70% at two annual consecutive visits) and normal postbronchodilator FEV1/FVC ratio (75 to 85%) were compared. Multivariate analysis identified factors independently associated with persistent airflow limitation.
Of 1,017 patients, 612 patients (60%) showed evidence of persistent airflow limitation. Risk factors were as follows: older age (odds ratio [OR] per 10 years, 1.4; 95% confidence interval [CI], 1.3 to 1.6); male gender (OR, 4.5; 95% CI, 2.3 to 8.5); black ethnicity (OR, 2.2; 95% CI, 1.3 to 3.8); current or past smoking (OR, 3.9; 95% CI, 1.8 to 8.6; and OR, 1.6; 95% CI, 1.2 to 2.3, respectively); aspirin sensitivity (OR, 1.5; 95% CI, 1.0 to 2.4); and longer asthma duration (OR per 10 years, 1.6; 95% CI, 1.4 to 1.8). Protective factors were Hispanic ethnicity, higher education, family history of atopic dermatitis, pet(s) in the home, and dust sensitivity.
Persistent airflow limitation is prevalent in patients with severe or difficult-to-treat asthma and is associated with identifiable clinical and demographic characteristics.
哮喘的流行病学与自然史：结局与治疗方案研究是评估持续性气流受限的最大规模研究之一，也是首个评估重度或难治性哮喘高危患者多种潜在危险因素的研究。对于与持续性气道阻塞相关的因素，我们需要有更深入的了解；本研究旨在确定与持续性气流受限相关的人口统计学和临床特征。
对成年（≥18岁）重度或难治性哮喘患者的数据进行评估。排除慢性阻塞性肺疾病（COPD）患者、存在限制性呼吸模式的肥胖患者或吸烟史≥30包年的患者。比较持续性气流受限（连续两年就诊时支气管扩张剂后FEV1/FVC比值≤70%）患者和支气管扩张剂后FEV1/FVC比值正常（75%至85%）的患者。多因素分析确定与持续性气流受限独立相关的因素。
在1017例患者中，612例（60%）有持续性气流受限的证据。危险因素如下：年龄较大（每10岁的比值比[OR]为1.4；95%置信区间[CI]为1.3至1.6）；男性（OR为4.5；95%CI为从2.3至8.5）；黑人种族（OR为2.2；95%CI为1.3至3.8）；当前或既往吸烟（OR分别为3.9；95%CI为1.8至8.6和OR为1.6；95%CI为1.2至2.3）；阿司匹林敏感性（OR为1.5；95%CI为1.0至2.4）；哮喘病程较长（每10年的OR为1.6；95%CI为1.4至1.8）。保护因素为西班牙裔种族、高等教育、特应性皮炎家族史、家中有宠物和粉尘敏感性。
持续性气流受限在重度或难治性哮喘患者中普遍存在，且与可识别的临床和人口统计学特征相关。
