The Regional Public Hospital, 38-600, Lesko, Kochanowskiego 2, Poland.
Department of Lung Diseases and Rheumatology, Medical University of Lublin, Poland.
Respir Med. 2019 Feb;147:7-12. doi: 10.1016/j.rmed.2018.12.009. Epub 2018 Dec 25.
Stability of asthma is a clinical phenotype of the disease based on long-term evaluation of control of asthma symptoms and its exacerbations. A relationship between airway inflammation and clinical classification of asthma based on stability criterion has not been well studied.
The purpose of our study was to analyze the inflammation profile of stable and unstable asthma in adolescents treated with moderate and high doses of inhaled corticosteroids.
139 young asthmatics of 16.8 (3.25) years were classified in the stable group (N = 72) and unstable group (N = 67) after a 3-month prospective observation. Inflammatory markers including cytogram of the induced sputum (IS), fractional exhaled nitric oxide (FeNO) and bronchial hyperresponsiveness (BHR) following provocation with hypertonic saline and exercises, as well as clinical and spirometric parameters in both groups were compared.
75% of patients with unstable asthma revealed elevated percentage of eosinophils in the induced sputum (>2.5%), and mean values were significantly higher in comparison with stable asthma: 2.0 (0,5-4,2) vs 5,5 (2,6-11,3), p < 0,001. Bronchial hyperresponsiveness was markedly higher in unstable asthma, especially in asthma with eosinophilic profile; statistically significant differences also related to functional pulmonary tests. In multivariate analysis, asthma instability was significantly associated with sEos (p = 0.005), BHR (p = 0.001) but not FeNO (p = 0.24).
CONCLUSION (AND CLINICAL RELEVANCE): Eosinophilic inflammation, relatively resistant to high doses of inhaled corticosteroids, is a dominant type of inflammation in unstable asthma in adolescents. Asthma instability is also associated with higher bronchial hyperresponsiveness and lower spirometric parameters. In the light of the new studies and progress in biological methods of therapy of eosinophilic inflammation, unstable asthma, especially in case of severe course, requires extended diagnostics with determination of inflammatory phenotype.
哮喘的稳定性是一种基于哮喘症状控制和加重的长期评估的疾病临床表型。气道炎症与基于稳定性标准的哮喘临床分类之间的关系尚未得到很好的研究。
我们的研究目的是分析接受中高剂量吸入皮质激素治疗的青少年中稳定和不稳定哮喘的炎症特征。
对 139 例 16.8（3.25）岁的青少年进行前瞻性观察 3 个月后，将其分为稳定组（N=72）和不稳定组（N=67）。比较两组炎症标志物，包括诱导痰细胞分类（IS）、呼出气一氧化氮分数（FeNO）和高渗盐水及运动激发后的支气管高反应性（BHR），以及临床和肺功能参数。
75%的不稳定哮喘患者诱导痰中嗜酸性粒细胞百分比升高（>2.5%），且与稳定哮喘相比，平均值显著升高：2.0（0，5-4.2）比 5.5（2.6-11.3），p<0.001。不稳定哮喘的支气管高反应性明显升高，尤其是在嗜酸性粒细胞表型的哮喘中；与功能肺测试相关的差异也具有统计学意义。多变量分析显示，哮喘不稳定与 sEos（p=0.005）、BHR（p=0.001）显著相关，但与 FeNO 无关（p=0.24）。
结论（和临床意义）：相对抵抗高剂量吸入皮质激素的嗜酸性粒细胞炎症是青少年不稳定哮喘的主要炎症类型。哮喘不稳定还与更高的支气管高反应性和更低的肺功能参数相关。鉴于新的研究和生物治疗嗜酸性粒细胞炎症的进展，不稳定哮喘，特别是在严重的情况下，需要进行扩展诊断，确定炎症表型。
