Marcon Alessandro, Marchetti Pierpaolo, Antó Josep M, Cazzoletti Lucia, Cerveri Isa, Corsico Angelo, Ferreira Diogenes Seraphim, Garcia-Aymerich Judith, Gislason David, Heinrich Joachim, Jõgi Rain, Johannessen Ane, Leynaert Bénédicte, Malinovschi Andrei, Pin Isabelle, Probst-Hensch Nicole, Weyler Joost, Janson Christer, Jarvis Deborah, Accordini Simone
Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
J Allergy Clin Immunol Pract. 2020 Mar;8(3):980-988.e10. doi: 10.1016/j.jaip.2019.10.023. Epub 2019 Nov 5.
Inhaled corticosteroids (ICSs) are the mainstay of asthma treatment, but response to medication is variable. Patients with allergic inflammation generally show a better short-term response to ICSs; however, studies on predictors of long-term response are few.
To assess whether allergic sensitization can modify the association between ICS use and lung function decline over 20 years in adult asthma.
We used data from the 3 clinical examinations of the European Community Respiratory Health Survey. We measured ICS use (no use, and use for <1.3, 1.3-8, and >8 years) and FEV decline among subjects with asthma over the 2 periods between consecutive examinations. We conducted a cohort study combining data of the 2 periods (906 observations from 745 subjects) to assess whether the association between ICS use and FEV decline was modified by allergic sensitization (IgE > 0.35 kU/L for any of house-dust mite, timothy grass, cat, or Cladosporium).
FEV decline was similar for non-ICS users, as well as ICS users for less than 1.3 years, with and without allergic sensitization. However, among subjects on ICSs for a longer period, sensitization was associated with an attenuated decline (P = .006): in the group treated for more than 8 years, FEV decline was on average 27 mL/y (95% CI, 11-42) lower for subjects with sensitization compared with nonsensitized subjects.
Our study suggests that biomarkers of atopy can predict a more favorable long-term response to ICSs. Randomized controlled studies are needed to confirm these findings.
吸入性糖皮质激素（ICSs）是哮喘治疗的主要药物，但药物反应存在个体差异。过敏性炎症患者通常对ICSs有较好的短期反应；然而，关于长期反应预测因素的研究较少。
评估过敏致敏是否会改变成人哮喘患者使用ICSs与20年肺功能下降之间的关联。
我们使用了欧洲共同体呼吸健康调查3次临床检查的数据。我们测量了哮喘患者在连续两次检查期间两个阶段的ICS使用情况（未使用、使用<1.3年、使用1.3 - 8年和使用>8年）以及第一秒用力呼气容积（FEV）下降情况。我们进行了一项队列研究，结合两个阶段的数据（来自745名受试者的906次观察结果），以评估过敏致敏（对屋尘螨、梯牧草、猫或枝孢菌中任何一种的IgE>0.35 kU/L）是否会改变ICS使用与FEV下降之间的关联。
未使用ICSs的患者以及使用ICSs少于1.3年的患者，无论有无过敏致敏，FEV下降情况相似。然而，在长期使用ICSs的受试者中，致敏与下降减缓相关（P = 0.006）：在治疗超过8年的组中，与未致敏受试者相比，致敏受试者的FEV平均每年下降27 mL（95% CI，11 - 42）更低。
我们的研究表明，特应性生物标志物可预测对ICSs更有利的长期反应。需要进行随机对照研究来证实这些发现。
