Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
J Allergy Clin Immunol. 2010 Mar;125(3):600-8, 608.e1-608.e6. doi: 10.1016/j.jaci.2009.11.033. Epub 2010 Feb 11.
Asthma guidelines emphasize both maintaining current control and reducing future risk, but the relationship between these 2 targets is not well understood.
This retrospective analysis of 5 budesonide/formoterol maintenance and reliever therapy (Symbicort SMART Turbuhaler(*)) studies assessed the relationship between asthma control questionnaire (ACQ-5) and Global Initiative for Asthma-defined clinical asthma control and future risk of instability and exacerbations.
The percentage of patients with Global Initiative for Asthma-defined controlled asthma over time was assessed for budesonide/formoterol maintenance and reliever therapy versus the 3 maintenance therapies; higher dose inhaled corticosteroid (ICS), same dose ICS/long-acting beta(2)-agonist (LABA), and higher dose ICS/LABA plus short-acting beta(2)-agonist. The relationship between baseline ACQ-5 and exacerbations was investigated. A Markov analysis examined the transitional probability of change in control status throughout the studies.
The percentage of patients achieving asthma control increased with time, irrespective of treatment; the percentage Controlled/Partly Controlled at study end was at least similar to budesonide/formoterol maintenance and reliever therapy versus the 3 maintenance therapies: higher dose ICS (56% vs 45%), same dose ICS/LABA (56% vs 53%), and higher dose ICS/LABA (54% vs 54%). Baseline ACQ-5 score correlated positively with exacerbation rates. A Controlled or Partly Controlled week predicted at least Partly Controlled asthma the following week (>or=80% probability). The better the control, the lower the risk of an Uncontrolled week. The probability of an exacerbation was related to current state and was lower with budesonide/formoterol maintenance and reliever therapy.
Current control predicts future risk of instability and exacerbations. Budesonide/formoterol maintenance and reliever therapy reduces exacerbations versus comparators and achieves at least similar control.
哮喘指南强调既要维持当前控制，又要降低未来风险，但这两个目标之间的关系尚不清楚。
本研究对 5 项布地奈德/福莫特罗维持和缓解治疗（Symbicort SMART Turbuhaler（*））研究进行了回顾性分析，评估了哮喘控制问卷（ACQ-5）与全球哮喘倡议定义的临床哮喘控制和未来不稳定和加重风险之间的关系。
评估布地奈德/福莫特罗维持和缓解治疗与 3 种维持治疗（高剂量吸入皮质激素（ICS）、相同剂量 ICS/长效β2-激动剂（LABA）和高剂量 ICS/LABA 加短效β2-激动剂）之间，随着时间的推移，全球哮喘倡议定义的控制哮喘患者的百分比。研究基线时 ACQ-5 与加重的关系进行了调查。马尔可夫分析考察了整个研究中控制状态变化的过渡概率。
无论治疗如何，随着时间的推移，患者达到哮喘控制的百分比均增加；研究结束时控制/部分控制的百分比与布地奈德/福莫特罗维持和缓解治疗至少相似：高剂量 ICS（56% vs 45%）、相同剂量 ICS/LABA（56% vs 53%）和高剂量 ICS/LABA（54% vs 54%）。基线时 ACQ-5 评分与加重率呈正相关。控制或部分控制周预示着下一周至少部分控制哮喘（>80%的概率）。控制越好，无控制周的风险越低。加重的可能性与当前状态有关，布地奈德/福莫特罗维持和缓解治疗的风险较低。
当前控制可预测未来不稳定和加重的风险。布地奈德/福莫特罗维持和缓解治疗与对照药物相比可减少加重，并至少达到相似的控制水平。
