Department of Pneumology, Hospital Universitario Central de Asturias, Oviedo, Spain.
Department of Radiology, Hospital Universitario Central de Asturias, Oviedo, Spain.
J Asthma. 2020 May;57(5):505-509. doi: 10.1080/02770903.2019.1579832. Epub 2019 Feb 20.
The aim of our study was to determine the tomographic findings and prevalence of bronchiectasis in our population of patients with severe asthma, and to identify factors associated with the presence of bronchiectasis in these patients. We retrospectively collected data from the medical histories of patients referred to the asthma unit of our hospital, with a diagnosis of severe asthma between 2015 and 2017. Patients with ABPA, cystic fibrosis, immunodeficiency or systemic disease were excluded. High-resolution thorax-computed tomodensitography (HRCT) was performed in all patients. A standardized protocol was applied in data collection. A total of 108 patients comprising 50 men (46%) and 58 women (54%) were included in the study. Of the 108 patients, 59 (55%) had at least one abnormality detected by HRCT, the most commonly reported abnormalities being bronchiectasis (35%), bronchial wall thickening (33%), emphysema (7%), atelectasis area (6%), mosaic attenuation due to air trapping (4%), and "tree in bud" image (2%). Subjects with bronchiectasis were older ( = 0.001), had a longer asthma history ( = 0.048), had poorer pulmonary function tests with lower FVC ( = 0.031), had more severe bronchial obstruction with lower FEV1 ( = 0.008) and had lower FEV1/FVC ( = 0.003). They also experienced more frequent hospitalizations in the previous year ( = 0.019) and received treatment with omalizumab more frequently ( = 0.049). Plasma eosinophil count and IgE levels were comparable in both groups. In the multivariate analysis, the presence of bronchiectasis was associated with ages older than 40 (OR: 8.3; 95% CI: 1.7-41.2) and chronic airflow obstruction (OR: 5.4; 95% CI: 1.9-15.3). We found that in patients with severe asthma, the prevalence of bronchiectasis is high and that bronchiectasis is associated with a longer asthma history, greater severity and, more importantly, chronic airflow obstruction. These findings are still insufficient evidence to considere features of asthma-bronchiectasis overlap syndrome, a distinct phenotype of severe asthma, but bronchiectasis is a frequent phenomenon leading to a more severe disease with frequent exacerbations. The performance of thorax HRCT on patients with severe asthma can help to evaluate management strategies for the disease in order to improve treatment and prognosis.
我们的研究目的是确定我们的严重哮喘患者群体中支气管扩张的断层摄影结果和流行率，并确定与这些患者支气管扩张存在相关的因素。我们回顾性地收集了 2015 年至 2017 年间我院哮喘科就诊的严重哮喘患者的病历数据。排除 ABPA、囊性纤维化、免疫缺陷或全身性疾病患者。所有患者均行高分辨率胸部计算机断层扫描（HRCT）。数据收集采用标准化方案。共纳入 108 例患者，其中 50 例为男性（46%），58 例为女性（54%）。在 108 例患者中，59 例（55%）至少有一项 HRCT 异常，最常见的异常为支气管扩张（35%）、支气管壁增厚（33%）、肺气肿（7%）、肺不张区（6%）、空气潴留导致的马赛克衰减（4%）和“树芽征”（2%）。支气管扩张患者年龄较大（=0.001），哮喘病史较长（=0.048），肺功能检查结果较差，FVC 较低（=0.031），支气管阻塞更严重，FEV1 较低（=0.008），FEV1/FVC 较低（=0.003）。他们在前一年也更频繁地住院（=0.019），更频繁地接受奥马珠单抗治疗（=0.049）。两组患者的血浆嗜酸性粒细胞计数和 IgE 水平无差异。多变量分析显示，支气管扩张的存在与年龄大于 40 岁（比值比：8.3；95%置信区间：1.7-41.2）和慢性气流阻塞（比值比：5.4；95%置信区间：1.9-15.3）有关。我们发现，在严重哮喘患者中，支气管扩张的患病率较高，支气管扩张与较长的哮喘病史、更严重的疾病相关，更重要的是与慢性气流阻塞有关。这些发现还不足以认为哮喘-支气管扩张重叠综合征是严重哮喘的一种特殊表型，但支气管扩张是一种常见的现象，可导致疾病更严重，更频繁的恶化。对严重哮喘患者进行胸部 HRCT 检查有助于评估疾病的管理策略，以改善治疗和预后。
