Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan.
Clin Exp Allergy. 2012 May;42(5):738-46. doi: 10.1111/j.1365-2222.2011.03880.x. Epub 2011 Oct 10.
Asthma is a clinical syndrome characterized by variabilities in disease expression and severity. The pathophysiological mechanism underlying anti-asthma treatment resistance is also assumed to be different between disease phenotypes.
To elucidate the effect of gender and atopic phenotype on the relationship between clinical factors and the risk of treatment resistance.
We compared outpatients with difficult-to-treat asthma (DTA; n = 486) in a tertiary hospital for allergic diseases in central Japan with those with controlled severe asthma (n = 621) with respect to clinical factors including body mass index (BMI) and aspirin intolerance using multivariate logistic regression analysis stratified by gender and atopic phenotype.
When analysis was performed on the entire study populations, obesity (BMI ≥ 30 kg/m(2); adjusted odds ratio (OR) 1.92; 95% confidence interval (95% CI: 1.07-3.43) and aspirin intolerance (OR: 2.56, 95% CI: 1.44-4.57) were found to be the significant risk factors for DTA. However, after the stratification by gender and atopic phenotype, the association between obesity and DTA was significant only in women (OR: 2.76, 95% CI: 1.31-5.78), but not in men (OR: 1.03, 95% CI: 0.38-2.81), and only in non-atopics (OR: 4.03, 95% CI: 1.15-14.08), but not in atopics (OR: 1.54, 95% CI: 0.79-3.02). The similar gender and phenotypic differences were also observed in the association between aspirin intolerance and DTA: namely, the association was significant only in women (OR: 3.96, 95% CI: 1.84-8.50), but not in men (OR: 1.19, 95% CI: 0.46-3.05); and only in non-atopics (OR: 5.49, 95% CI: 1.98-15.19), but not in atopics (OR: 1.39, 95% CI: 0.65-2.98).
Significant associations of obesity and aspirin intolerance with DTA were observed only in women and in non-atopics. These findings suggest that a phenotype-specific approach is needed to treat patients with DTA.
哮喘是一种以疾病表现和严重程度变化为特征的临床综合征。抗哮喘治疗抵抗的病理生理机制也假定在疾病表型之间有所不同。
阐明性别和特应性表型对临床因素与治疗抵抗风险之间关系的影响。
我们比较了日本中部一家过敏疾病三级医院的难治性哮喘（DTA；n=486）门诊患者和控制严重哮喘（n=621）患者的临床因素，包括体质指数（BMI）和阿司匹林不耐受情况，使用多变量逻辑回归分析按性别和特应性表型分层。
在整个研究人群中进行分析时，肥胖症（BMI≥30kg/m2；调整后的优势比（OR）为 1.92；95%置信区间（95%CI：1.07-3.43）和阿司匹林不耐受（OR：2.56，95%CI：1.44-4.57）被发现是 DTA 的显著危险因素。然而，在按性别和特应性表型分层后，肥胖症与 DTA 之间的关联仅在女性中具有显著性（OR：2.76，95%CI：1.31-5.78），而在男性中不具有显著性（OR：1.03，95%CI：0.38-2.81），并且仅在非特应性患者中具有显著性（OR：4.03，95%CI：1.15-14.08），而在特应性患者中不具有显著性（OR：1.54，95%CI：0.79-3.02）。在阿司匹林不耐受与 DTA 之间的关联中也观察到了类似的性别和表型差异：即，这种关联仅在女性中具有显著性（OR：3.96，95%CI：1.84-8.50），而在男性中不具有显著性（OR：1.19，95%CI：0.46-3.05）；并且仅在非特应性患者中具有显著性（OR：5.49，95%CI：1.98-15.19），而在特应性患者中不具有显著性（OR：1.39，95%CI：0.65-2.98）。
肥胖症和阿司匹林不耐受与 DTA 的显著关联仅在女性和非特应性患者中观察到。这些发现表明，需要针对 DTA 患者采用表型特异性治疗方法。
