D'Amato Maria, Stanziola Anna A, de Laurentiis Guglielmo, Diana Radicella, Russo Cristian, Maniscalco Mauro, D'Amato Gennaro, Sofia Matteo
Department of Respiratory Diseases, University Federico II of Naples, Naples, Italy.
Clin Respir J. 2014 Oct;8(4):417-24. doi: 10.1111/crj.12088. Epub 2014 Jan 10.
It has been demonstrated that brief periods of nocturnal continuous positive airway pressure (nCPAP) reduce airway reactivity in animal models and in patients with asthma. The effects of nCPAP in severe uncontrolled non-apneic asthmatic patients are not well known.
In this open pilot study, we aimed to assess the effect nCPAP on peak flow (PEF) variability and asthma control in this type of patients.
CPAP was applied to 10 patients with severe long-standing asthma without obstructive sleep apnea for seven consecutive nights. CPAP was titrated in auto setting and applied to the patients. Daily PEF, was measured from 2 weeks before the intervention to 2 weeks after the end of nCPAP treatment. PEF amplitude and PEF morning dip (MD) over 24-h periods averaged over 1 week were calculated as indexes of PEF variability. Asthma control test (ACT) and European quality of life (EuroQol) questionnaire were measured at baseline and after 1 month, and at baseline and at the end of CPAP period, respectively.
The PEF amplitude significantly decreased both during CPAP period and in the first week after nCPAP discontinuation as compared with the baseline (19.8 ± 7.5%, 23.9 ± 9.1% and 28.9 ± 11.5%, respectively, always P < 0.05). PEF MD significantly decreased during nCPAP in comparison with the baseline (P < 0.001). The ACT and EuroQol significantly improved after nCPAP in comparison with the basal value.
In this preliminary report, brief period of nCPAP reduces PEF variability and improves control in severe non-apneic asthma at a short-term evaluation. Further studies with longer-term evaluation and larger number of patients are warranted.
已证实夜间短时间持续气道正压通气（nCPAP）可降低动物模型和哮喘患者的气道反应性。nCPAP对严重未控制的非呼吸暂停哮喘患者的影响尚不清楚。
在这项开放性试点研究中，我们旨在评估nCPAP对这类患者峰值呼气流速（PEF）变异性和哮喘控制的影响。
对10例患有严重长期哮喘且无阻塞性睡眠呼吸暂停的患者连续7晚应用CPAP。CPAP采用自动设置进行滴定并应用于患者。从干预前2周至nCPAP治疗结束后2周测量每日PEF。计算1周内24小时期间的PEF幅度和PEF晨降（MD）作为PEF变异性指标。分别在基线时、1个月后以及基线时和CPAP治疗期结束时测量哮喘控制测试（ACT）和欧洲生活质量（EuroQol）问卷。
与基线相比，CPAP期间以及nCPAP停用后的第一周PEF幅度均显著降低（分别为19.8±7.5%、23.9±9.1%和28.9±11.5%，P均<0.05）。与基线相比，nCPAP期间PEF MD显著降低（P<0.001）。与基础值相比，nCPAP后ACT和EuroQol显著改善。
在这份初步报告中，短期评估显示短时间的nCPAP可降低严重非呼吸暂停哮喘患者的PEF变异性并改善控制情况。有必要进行更长期评估和纳入更多患者的进一步研究。
