Asthma and Allergy Research Group, University of Dundee, Scotland, United Kingdom.
Ann Allergy Asthma Immunol. 2012 Sep;109(3):185-189.e2. doi: 10.1016/j.anai.2012.06.022. Epub 2012 Jul 18.
Whether small airways dysfunction persists in patients with asthma receiving standard community treatment is unknown. Impulse oscillometry (IOS) is a sensitive measure of small airways function.
To assess the degree of small airways dysfunction in a cross-section of patients with community-managed asthma.
We analyzed primary care referral data from patients with persistent asthma (n = 378) receiving standard community therapy, screened using spirometry and IOS. We compared patients by British Thoracic Society asthma treatment step (2-4).
Step 2 patients were not different from step 3 patients receiving long-acting beta-agonist (LABA). Step 4 patients differed from step 2 by: higher inhaled corticosteroid (ICS) dose (P < .0001); lower forced expiratory volume in 1 second (FEV(1)%; P = .02) and forced mid-expiratory flow (FEF(25-75%); P = .001); higher frequency of resonance (F(res); P = .02) and peripheral airway resistance (R5-R20; P = .006); whereas for steps 3 vs 4 there were differences in F(res) (P < .05) and R5-R20 (P = .006). There were high proportions of abnormality for R5-R20 (>0.03 kPa/L/s) at steps 2, 3, and 4, respectively: 64.6%, 63.5%, and 69.9%. Step 2 patients receiving extra-fine particle ICS demonstrated lower total airway resistance at 5Hz (R5) vs patients receiving standard ICS (124.1% vs 138.3%, P < .05), with no difference in FEV(1). At step 4, R5 remained elevated at 141.3% despite concomitant LABA, with only 2.4% using extra-fine ICS.
Persistent small airways dysfunction occurs despite treatment at steps 2 through 4 of current asthma guidelines. Extra-fine ICS may reduce airway resistance at step 2. Prospective studies with extra-fine ICS ± LABA at steps 2 through 4 are required to discern whether improving small airways function might result in long-term improved control.
在接受标准社区治疗的哮喘患者中，小气道功能障碍是否持续存在尚不清楚。脉冲震荡（IOS）是一种敏感的小气道功能测量方法。
评估经社区管理的哮喘患者小气道功能障碍的程度。
我们分析了通过常规治疗后仍持续存在哮喘的患者（n=378）的初级保健转诊数据，这些患者经过了常规的肺量计和 IOS 筛查。我们通过英国胸科学会（British Thoracic Society）哮喘治疗步骤（2-4 步）对患者进行了比较。
第 2 步患者与接受长效β激动剂（LABA）的第 3 步患者没有区别。第 4 步患者与第 2 步患者的区别在于：吸入皮质激素（ICS）剂量更高（P＜0.0001）；用力呼气 1 秒量（FEV1%；P=0.02）和用力呼出 25%-75%肺活量时的中段平均流量（FEF25-75%；P=0.001）较低；共振频率（Fres；P=0.02）和外周气道阻力（R5-R20；P=0.006）较高；而第 3 步与第 4 步患者的 Fres （P＜0.05）和 R5-R20 （P=0.006）存在差异。第 2、3 和 4 步患者的 R5-R20 异常率均较高（＞0.03 kPa/L/s），分别为 64.6%、63.5%和 69.9%。第 2 步接受超细颗粒 ICS 的患者在 5Hz 时的总气道阻力（R5）低于接受标准 ICS 的患者（124.1% vs 138.3%，P＜0.05），但 FEV1 无差异。在第 4 步，尽管同时使用 LABA，但 R5 仍升高至 141.3%，只有 2.4%的患者使用超细 ICS。
尽管当前哮喘指南的 2-4 步治疗，但仍存在持续的小气道功能障碍。超细 ICS 可能会降低第 2 步的气道阻力。需要进行有超细 ICS±LABA 的 2-4 步前瞻性研究，以确定改善小气道功能是否会导致长期控制的改善。
