Hamzavi Abedi Yasmin, Perkins Amy M, Morales Maripaz B
Allergy Asthma Proc. 2017 Jan 1;38(1):63-69. doi: 10.2500/aap.2017.38.4016.
Identifying clinical features associated with difficult-to-control asthma will help address overall control and more-effective asthma management.
To evaluate our clinical observation that the proportion of patients who are overweight or obese is significantly higher in patients with difficult-to-control asthma than in patients with well-controlled asthma.
This was a retrospective chart review of 400 patients, ages 5 to 18 years. Cases (n = 200) were identified as 100 subjects with difficult-to-control asthma and an inhaled corticosteroid dose of ≥1000 μg/day and 100 subjects with well-controlled asthma and an inhaled corticosteroid dose of ≤500 μg/day. The control group included 200 subjects without asthma. Multivariable logistic regression models were used to assess the relationships between asthma status and weight status, age, race, and sex.
The mean body mass index percentile (± standard deviation at 95% confidence interval) was significantly higher in the difficult-to-control asthma group versus the well-controlled asthma group versus the control group (74.66 ± 28.19 versus 54.25 ± 29.92 versus 55.19 ± 32.54; p < 0.001). Thirty-six percent of the difficult-to-control patients with asthma were obese (versus 6% of the patients with well-controlled asthma [p < 0.001] versus 13% of patients without asthma [p = 0.002]), and 47% normal weight (versus 79% of the patients with well-controlled asthma versus 75% of patients without asthma; p < 0.001). The mean age and the proportion of African Americans in the difficult-to-control asthma group were significantly higher than in the well-controlled asthma group and in the control group (p < 0.001).
The results of this study demonstrated a significant association between severe persistent difficult-to-control asthma and obesity, age, and race. Patients who are obese and have difficult-to-control asthma need treatment approaches that address both asthma control and weight management.
识别与难治性哮喘相关的临床特征将有助于实现总体控制和更有效的哮喘管理。
评估我们的临床观察结果，即难治性哮喘患者中超重或肥胖患者的比例显著高于哮喘控制良好的患者。
这是一项对400名5至18岁患者的回顾性病历审查。病例组（n = 200）包括100名难治性哮喘患者，吸入糖皮质激素剂量≥1000μg/天，以及100名哮喘控制良好的患者，吸入糖皮质激素剂量≤500μg/天。对照组包括200名无哮喘的受试者。使用多变量逻辑回归模型评估哮喘状态与体重状态、年龄、种族和性别的关系。
难治性哮喘组的平均体重指数百分位数（±95%置信区间的标准差）显著高于哮喘控制良好组和对照组（74.66±28.19对54.25±29.92对55.19±32.54；p < 0.001）。36%的难治性哮喘患者肥胖（相比之下，哮喘控制良好的患者为6%[p < 0.001]，无哮喘的患者为13%[p = 0.002]），47%体重正常（相比之下，哮喘控制良好的患者为79%，无哮喘的患者为75%；p < 0.001）。难治性哮喘组的平均年龄和非裔美国人的比例显著高于哮喘控制良好组和对照组（p < 0.001）。
本研究结果表明，重度持续性难治性哮喘与肥胖、年龄和种族之间存在显著关联。肥胖且患有难治性哮喘的患者需要同时解决哮喘控制和体重管理问题的治疗方法。
