Alves Alexssandra Maia, Mello Luane Marques de, Matos Aline Silva Lima, Cruz Álvaro Augusto
Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal da Bahia, Salvador, BA, Brasil.
Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
J Bras Pneumol. 2020;46(3):e20180341. doi: 10.36416/1806-3756/e20180341. Epub 2020 Mar 13.
Objective To describe the clinical features and to identify factors associated with significant severe asthma in samples of patients followed in a reference center in Salvador. Methods A cross-sectional study of 473 adults, regularly followed in the "Asthma Control Program" in Bahia (Programa de Controle da Asma e da Rinite Alérgica na Bahia (ProAR)), reassessed systematically between 2013 and 2015. The patients were admitted for meeting previous criteria of severe asthma and were reclassified according to the most current definition proposed by a joint document of the "European Respiratory Society/American Thoracic Society" (ERS/ATS) (ERS/ATS 2014). Results Only 88/473 (18%) were reclassified as having severe asthma by ERS/ATS criteria (SA-ERS/ATS). Among these patients, 87% were women, 48% obese, with a median Body Mass Index (BMI) of 29 kg·m2 (IQ 26-34), furthermore, 99% had symptoms of chronic rhinitis and 83% had symptoms of Gastroesophageal Reflux Disease (GERD). None of the 88 patients claimed to be current smokers. The most frequently corticosteroids were beclomethasone dipropionate (BDP) (88%) and budesonide (BUD) (69%). The majority of the evaluations reported adequate adherence (77%), however, the minority (0,6%) detected serious errors in inhalation techniques. The median Forced Expiratory Volume (FEV1) associated with post-bronchodilator test (post-BD) was 67% predicted (IQ 55-80). The median number of eosinophils in the peripheral blood was lower in patients with SA-ERS/ATS (258 cells/mm3 (IQ 116-321) than in the other patients studied [258 cells/mm3 (IQ 154-403)]. Gastroesophageal reflux symptoms were associated with a higher severity [OR = 2.2 95% CI (1.2-4.2)]. Conclusion In this group of patients, symptoms of GERD were associated with SA-ERS/ATS and eosinophil count > 260 cells/mm3 were associated 42% with less chance SA-ERS/ATS.
目的 描述在萨尔瓦多一家参考中心随访的患者样本中严重哮喘的临床特征，并确定与之相关的因素。方法 对473名成年人进行横断面研究，这些患者在巴伊亚州的“哮喘控制项目”（巴伊亚州哮喘和过敏性鼻炎控制项目（ProAR））中接受定期随访，并在2013年至2015年期间进行系统重新评估。患者因符合先前严重哮喘标准而入院，并根据“欧洲呼吸学会/美国胸科学会”（ERS/ATS）联合文件提出的最新定义进行重新分类（ERS/ATS 2014）。结果 根据ERS/ATS标准，只有88/473（18%）被重新分类为患有严重哮喘（SA-ERS/ATS）。在这些患者中，87%为女性，48%肥胖，体重指数（BMI）中位数为29 kg·m²（四分位间距26-34），此外，99%有慢性鼻炎症状，83%有胃食管反流病（GERD）症状。88名患者中无一自称目前吸烟。最常用的皮质类固醇是二丙酸倍氯米松（BDP）（88%）和布地奈德（BUD）（69%）。大多数评估报告依从性良好（77%），然而，少数（0.6%）检测到吸入技术存在严重错误。支气管扩张剂后试验（post-BD）相关的用力呼气量（FEV1）中位数为预测值的67%（四分位间距55-80）。SA-ERS/ATS患者外周血嗜酸性粒细胞中位数（258个细胞/mm³（四分位间距116-321））低于其他研究患者[258个细胞/mm³（四分位间距154-403）]。胃食管反流症状与更高的严重程度相关[比值比=2.2，95%置信区间（1.2-4.2）]。结论 在这组患者中，GERD症状与SA-ERS/ATS相关，嗜酸性粒细胞计数>260个细胞/mm³与SA-ERS/ATS发生几率降低42%相关。
