Tay Tunn Ren, Radhakrishna Naghmeh, Hore-Lacy Fiona, Smith Catherine, Hoy Ryan, Dabscheck Eli, Hew Mark
Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Respirology. 2016 Nov;21(8):1384-1390. doi: 10.1111/resp.12838. Epub 2016 Jul 1.
Little is known about how comorbidities affect difficult asthma patients across different domains of asthma outcomes. We hypothesized that comorbidities in difficult asthma significantly influence asthma outcomes.
We analysed 90 consecutive patients who underwent systematic assessment at our hospital's difficult asthma clinic. Eight comorbidities were assessed in all patients. They were allergic rhinitis, chronic rhinosinusitis (CRS), gastroesophageal reflux disease, obesity, obstructive sleep apnoea, anxiety or depression, dysfunctional breathing (DB) and vocal cord dysfunction (VCD). Asthma outcomes examined were exacerbation frequency (≥3/year vs <3/year), asthma control using the Asthma Control Test (ACT) and quality of life using the Asthma Quality of Life Questionnaire (AQLQ). Multivariate logistic regression was performed for dichotomous outcomes and linear regression for continuous outcomes. Analyses were adjusted for lung function and absolute blood eosinophils.
Increasing BMI was an independent risk factor for exacerbations (OR: 1.1, 95% CI: 1-1.1, P = 0.042), lower ACT score (β coefficient: -0.25, 95% CI: -0.37 to -0.12, P < 0.001) and poorer AQLQ (β coefficient: -0.05, 95% CI: -0.09 to -0.02, P = 0.006). DB predicted lower ACT (β coefficient: -2.85, 95% CI: -5 to -0.7, P = 0.01) and AQLQ scores (β coefficient: -0.73, 95% CI: -1.34 to -0.12, P = 0.02). Patients with CRS had more exacerbations (OR: 4, 95% CI: 1.5-10.9, P = 0.006). Patients with VCD had lower AQLQ scores (β coefficient: -0.78, 95% CI: -1.38 to -0.18, P = 0.012).
Comorbidities independently impact a broad spectrum of outcomes in difficult asthma. Systematic evaluation of these conditions is essential in difficult asthma.
关于合并症如何在哮喘不同结局领域影响难治性哮喘患者，目前所知甚少。我们假设难治性哮喘中的合并症会显著影响哮喘结局。
我们分析了在我院难治性哮喘门诊接受系统评估的90例连续患者。对所有患者评估了8种合并症。它们分别是变应性鼻炎、慢性鼻-鼻窦炎（CRS）、胃食管反流病、肥胖症、阻塞性睡眠呼吸暂停、焦虑或抑郁、功能性呼吸障碍（DB）和声带功能障碍（VCD）。所检查的哮喘结局包括发作频率（≥3次/年与<3次/年）、使用哮喘控制测试（ACT）评估的哮喘控制情况以及使用哮喘生活质量问卷（AQLQ）评估的生活质量。对二分结局进行多因素逻辑回归分析，对连续结局进行线性回归分析。分析对肺功能和绝对血嗜酸性粒细胞进行了校正。
体重指数（BMI）增加是发作的独立危险因素（比值比：1.1，95%置信区间：1 - 1.1，P = 0.042）、ACT得分较低（β系数：-0.25，95%置信区间：-0.37至-0.12，P < 0.001）以及AQLQ较差（β系数：-0.05，95%置信区间：-0.09至-0.02，P = 0.006）。DB预示着较低的ACT（β系数：-2.85，95%置信区间：-5至-0.7，P = 0.01）和AQLQ得分（β系数：-0.73，95%置信区间：-1.34至-0.12，P = 0.02）。CRS患者发作更多（比值比：4，95%置信区间：1.5 - 10.9，P = 0.006）。VCD患者的AQLQ得分较低（β系数：-0.78，95%置信区间：-1.38至-0.18，P = 0.012）。
合并症独立影响难治性哮喘的广泛结局。对这些情况进行系统评估对于难治性哮喘至关重要。
