Department of Thoracic Medicine, Concord Hospital, Sydney, Australia; The Woolcock Institute of Medical Research, NSW, Australia; Faculty of Medicine and Health, Sydney University, Australia; Faculty of Medicine and Health Sciences, Macquarie University, NSW, Australia.
Department of Thoracic Medicine, Concord Hospital, Sydney, Australia; The Woolcock Institute of Medical Research, NSW, Australia.
Respir Med. 2019 Mar;148:49-53. doi: 10.1016/j.rmed.2019.01.016. Epub 2019 Feb 1.
Treatment with mepolizumab in severe eosinophilic asthma (SEA) significantly reduces exacerbations with modest improvements in symptom control and spirometry. The time course of any changes in small airway function is unknown.
To describe changes in ventilation inhomogeneity, a marker of small airway function, after commencing mepolizumab.
Prospective cohort of 20 adults (12 male) with SEA commencing monthly mepolizumab. Measurements at baseline, Week 4 and Week 26 included the Asthma Control Questionnaire (ACQ-5), spirometry, fraction of exhaled nitric oxide (FeNO) and multiple breath nitrogen washout to measure global (Lung Clearance Index, [LCI]) and regional ventilation inhomogeneity in acinar (Sacin) and conducting (Scond) airways. Other asthma therapy remained unchanged between baseline and Week 4. Treatment related changes were assessed using RM-ANOVA and paired t-tests. Relationships between changes in lung function and symptoms were assessed by Pearson's correlation.
At Week 4, ACQ-5, spirometry, LCI and Sacin improved significantly (p < 0.04) and all were sustained at Week 26. The change in ACQ-5 correlated with the change in Sacin (r = 0.48, p = 0.03) and FRC (r = 0.46, p = 0.04), but not spirometry.
Improved symptom control improved rapidly after commencing mepolizumab in patients with SEA. The early improvement in small airway function was associated with asthma control and may be a significant contributor to the therapeutic response.
在严重嗜酸性粒细胞性哮喘（SEA）患者中，美泊利珠单抗治疗可显著减少加重事件，适度改善症状控制和肺量计检查结果。小气道功能任何变化的时间过程尚不清楚。
描述开始使用美泊利珠单抗后通气不均一性（小气道功能的标志物）的变化。
前瞻性队列研究纳入 20 名 SEA 成年患者（12 名男性），开始每月接受美泊利珠单抗治疗。基线、第 4 周和第 26 周的测量包括哮喘控制问卷（ACQ-5）、肺量计检查、呼气一氧化氮分数（FeNO）和多次呼吸氮冲洗，以测量整体（肺清除指数 [LCI]）和腺泡（Sacin）和传导（Scond）气道的区域性通气不均一性。在基线和第 4 周之间，其他哮喘治疗保持不变。使用重复测量方差分析和配对 t 检验评估治疗相关变化。通过 Pearson 相关评估肺功能和症状变化之间的关系。
第 4 周时，ACQ-5、肺量计检查、LCI 和 Sacin 显著改善（p<0.04），并且所有指标在第 26 周时仍持续改善。ACQ-5 的变化与 Sacin（r=0.48，p=0.03）和功能残气（r=0.46，p=0.04）的变化相关，但与肺量计检查结果无关。
SEA 患者开始使用美泊利珠单抗后，症状控制迅速改善。小气道功能的早期改善与哮喘控制相关，可能是治疗反应的重要贡献因素。
