Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Eur Respir J. 2018 Feb 14;51(2). doi: 10.1183/13993003.01785-2017. Print 2018 Feb.
Little is known about the prognosis of adults with new-onset asthma. Cross-sectional studies suggest that these patients may exhibit accelerated decline in forced expiratory volume in 1 s (FEV). However, risk factors for accelerated decline in lung function have not yet been identified.We aimed to identify these risk factors in a prospective 5-year follow-up study in 200 adults with newly diagnosed asthma. In the current study, clinical, functional and inflammatory parameters were assessed annually for 5 years. Linear mixed-effects models were used to identify predictors.Evaluable lung function sets of 141 patients were available. Median (interquartile range) change in post-bronchodilator FEV was -17.5 (-54.2 to +22.4) mL per year. Accelerated decline in FEV was defined by the lower quartile of decline (>54.2 mL per year). Nasal polyps, number of blood and sputum eosinophils, body mass index, and level of exhaled nitric oxide were univariably associated with decline in lung function. Only the latter two were independently associated. Using cut-off values to identify patients at highest risk showed accelerated decline in FEV in all patients with combined exhaled nitric oxide fraction () ≥57 ppb and body mass index (BMI) ≤23 kg·mWe conclude that adults with new-onset asthma with both high levels of exhaled nitric oxide and low BMI are at risk of accelerated decline in lung function.
关于新诊断哮喘成人的预后知之甚少。横断面研究表明，这些患者的 1 秒用力呼气容积（FEV1）可能会加速下降。然而，肺功能下降的危险因素尚未确定。我们旨在对 200 名新诊断哮喘的成年人进行为期 5 年的前瞻性随访研究中确定这些危险因素。在目前的研究中，每年评估一次临床、功能和炎症参数，为期 5 年。使用线性混合效应模型来确定预测因素。可评估的肺功能集为 141 名患者。支气管扩张剂后 FEV1 的中位数（四分位距）变化为每年-17.5（-54.2 至+22.4）mL。FEV1 下降的加速定义为下降的较低四分位数（>54.2 mL/年）。鼻息肉、血和痰嗜酸性粒细胞数、体重指数和呼出气一氧化氮水平与肺功能下降呈单变量相关。只有后两者与下降独立相关。使用截断值来识别风险最高的患者，显示所有呼出气一氧化氮分数（）≥57 ppb 且体重指数（BMI）≤23 kg·m 的患者的 FEV1 加速下降。我们得出结论，新诊断哮喘成人中，呼出气一氧化氮水平高和 BMI 低的患者肺功能下降风险增加。
