真实世界中哮喘伴慢性鼻-鼻窦炎的评估。

A real-world assessment of asthma with chronic rhinosinusitis.

机构信息

Department of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga University Hospital, Turin, Italy.

出版信息

Ann Allergy Asthma Immunol. 2020 Jul;125(1):65-71. doi: 10.1016/j.anai.2020.03.004. Epub 2020 Mar 30.

DOI:10.1016/j.anai.2020.03.004

PMID:32171930

Abstract

BACKGROUND: Chronic rhinosinusitis (CRS) includes 2 main phenotypes: CRS without nasal polyps (CRSsNP) and CRS with nasal polyps (CRSwNP). CRS has been reported to be a comorbidity of asthma. OBJECTIVE: This study aimed to investigate the role of CRS in outpatients with asthma visited in real-world setting. METHODS: This cross-sectional study enrolled 499 consecutive outpatients with asthma. Age, sex, body mass index, smoking status, lung function, Asthma Control Test, inflammatory type 2 biomarkers (including fractional exhaled nitric oxide, blood eosinophils, serum total immunoglobulin E, and allergy), treatment step according to the Global Initiative for Asthma, and comorbidities (obstructive sleep apnea syndrome, arterial hypertension, bronchiectasis, diabetes mellitus type 2, and osteoporosis) were evaluated. RESULTS: A total of 179 (35.87%) patients had CRS, in particular 93 (18.64%) had CRSsNP and 86 (17.23%) had CRSwNP. Type 2 inflammation (defined by at least 1 positive biomarker) was present in 81.44% of patients (fractional exhaled nitric oxide > 30 parts per billion in 46.9%, blood eosinophil count > 300 cell/μL in 39.67%, serum total immunoglobulin E >100 IU/mL in 51.54%, and allergy in 53.71%). By multivariate analysis, type 2 inflammation and blood eosinophils greater than 300 cell/μL were the main predictors (odds ratio [OR] 2.54 and 2.26, respectively) of CRS-asthma association. In particular, CRSwNP comorbidity was predicted by type 2 inflammation (OR 3.4) and blood eosinophils greater than 300 cell/μL (OR 3.0). Smoking had conflicting outcome. CONCLUSION: This study confirmed that CRS is a frequent asthma comorbidity because it affects more than one-third of outpatients with asthma. CRSwNP is associated with type 2 inflammation and blood eosinophilia. These outcomes underline that CRSwNP asthma phenotype deserves adequate attention for careful management and optimal identification of the best-tailored therapy.

摘要

背景：慢性鼻-鼻窦炎（CRS）包括 2 种主要表型：无鼻息肉的 CRS（CRSsNP）和有鼻息肉的 CRS（CRSwNP）。CRS 已被报道为哮喘的一种合并症。

目的：本研究旨在调查在真实环境中就诊的哮喘门诊患者中 CRS 的作用。

方法：这项横断面研究纳入了 499 例连续的哮喘门诊患者。评估了年龄、性别、体重指数、吸烟状况、肺功能、哮喘控制测试、炎症性 2 型生物标志物（包括呼出气一氧化氮分数、血嗜酸性粒细胞、血清总免疫球蛋白 E 和过敏）、根据全球哮喘倡议确定的治疗步骤以及合并症（阻塞性睡眠呼吸暂停综合征、动脉高血压、支气管扩张、2 型糖尿病和骨质疏松症）。

结果：共有 179 例（35.87%）患者患有 CRS，其中 93 例（18.64%）患有 CRSsNP，86 例（17.23%）患有 CRSwNP。81.44%的患者存在 2 型炎症（至少有 1 项阳性生物标志物定义）（呼出气一氧化氮分数>30 部分/十亿在 46.9%，血嗜酸性粒细胞计数>300 细胞/μL 在 39.67%，血清总免疫球蛋白 E>100 IU/mL 在 51.54%，过敏在 53.71%）。多变量分析显示，2 型炎症和血嗜酸性粒细胞计数大于 300 细胞/μL 是 CRS-哮喘关联的主要预测因素（比值比 [OR] 2.54 和 2.26）。特别是，CRSwNP 合并症与 2 型炎症（OR 3.4）和血嗜酸性粒细胞计数大于 300 细胞/μL（OR 3.0）相关。吸烟的结果存在冲突。

结论：本研究证实 CRS 是哮喘的一种常见合并症，因为它影响了三分之一以上的哮喘门诊患者。CRSwNP 与 2 型炎症和血嗜酸性粒细胞增多有关。这些结果表明，CRSwNP 哮喘表型需要引起足够的重视，以便进行仔细的管理和最佳的个体化治疗。