Yamasaki Akira, Tomita Katsuyuki, Kato Kazuhiro, Fukutani Kouji, Sano Hiroyuki, Tohda Yuji, Shimizu Eiji
Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori, Japan.
Department of Respiratory Medicine, Yonago Medical Centre, Tottori, Japan.
Patient Prefer Adherence. 2016 Mar 18;10:339-44. doi: 10.2147/PPA.S98637. eCollection 2016.
Asthma guidelines suggest stepping-down of inhaled corticosteroids (ICSs) when asthma is stable.
To determine outcomes of stepping-down and prediction of outcome after stepping-down of ICSs in controlled adult asthma.
We performed a retrospective study on 21-81 year-old hospital-based outpatients with asthma in Japan. Protocol for stepping-down of ICSs was performed according to the GINA guideline. Failure/success of stepping-down is judged as occurring exacerbation or not for stepping-down of ICSs. Multiple logistic regression analysis was used to develop a prediction model for failed stepping-down, and then was validated by the leave-one-out cross-validation method. Our model of prediction score was calculated using receiver-operating characteristic area under the curve (AUC) analysis. The Nelson-Aalen curve demonstrated time to failure of stepping-down of ICSs.
A total of 126 patients with asthma attempted the stepping-down of ICSs according to the guideline. Of patients with follow-up, 97 (77.0%) of stepping-down attempts were successful. Using multivariate logistic regression analysis, comorbidity with rhinitis/rhinosinusitis and phlegm grade were independent predictors of failed stepping-down of ICSs, with odds ratios of 3.8 (95% confidence interval, 1.04-13.3; P=0.04) and 1.3 (95% confidence interval, 1.01-11.5; P=0.04), respectively. These variables were then used to build a prediction score in terms of the prediction of failed stepping-down events. When the two variables were added to form the prediction score, the discriminative power of scores calculated by the prediction model using the AUC was 0.75 (range: 0.62-0.88) for naïve prediction and 0.72 (range: 0.60-0.86) after cross-validation. In the time-to-failure models, cumulative hazard ratio of failed stepping-down have fixed 1 year after stepping-down.
Our results suggest that comorbidity with rhinitis/rhinosinusitis and phlegm grade are imperative to predict failed stepping-down of ICSs in controlled patients with adult asthma.
哮喘指南建议在哮喘病情稳定时逐步减少吸入性糖皮质激素（ICS）的使用。
确定在病情得到控制的成年哮喘患者中减少ICS使用的结果以及减少使用后结果的预测因素。
我们对日本21至81岁的医院门诊哮喘患者进行了一项回顾性研究。根据全球哮喘防治创议（GINA）指南执行减少ICS使用的方案。减少ICS使用的失败/成功判断标准为在减少使用过程中是否发生病情加重。采用多因素logistic回归分析建立减少使用失败的预测模型，然后通过留一法交叉验证进行验证。我们的预测评分模型使用曲线下面积（AUC）分析来计算。Nelson-Aalen曲线显示了ICS减少使用失败的时间。
共有126例哮喘患者按照指南尝试减少ICS使用。在有随访的患者中，97例（77.0%）减少使用的尝试成功。通过多因素logistic回归分析，合并鼻炎/鼻窦炎和痰液分级是ICS减少使用失败的独立预测因素，比值比分别为3.8（95%置信区间，1.04 - 13.3；P = 0.04）和1.3（95%置信区间，1.01 - 11.5；P = 0.04）。然后使用这些变量建立关于减少使用失败事件预测的预测评分。当将这两个变量相加形成预测评分时，使用AUC的预测模型计算的评分在原始预测中的判别力为0.75（范围：0.62 - 0.88），交叉验证后为0.72（范围：0.60 - 0.86）。在失败时间模型中，减少使用失败的累积风险比在减少使用1年后固定。
我们的结果表明，合并鼻炎/鼻窦炎和痰液分级对于预测病情得到控制的成年哮喘患者减少ICS使用失败至关重要。
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