FitzGerald J Mark, Barnes Peter J, Chipps Bradley E, Jenkins Christine R, O'Byrne Paul M, Pavord Ian D, Reddel Helen K
Institute for Heart and Lung Health, University of British Columbia, Vancouver, BC, Canada.
Airway Disease Section, National Heart and Lung Institute, Imperial College, London, UK.
ERJ Open Res. 2020 Aug 11;6(3). doi: 10.1183/23120541.00359-2019. eCollection 2020 Jul.
Although most patients with asthma have mild disease, data on how mild asthma is defined, and how frequently exacerbations occur in this patient population are scarce, so we aimed to redress this.
We searched Medline and Medline In-Process (PubMed), and Embase in OVID for English-language publications containing "mild asthma" plus at least one relevant therapy and outcome/keyword, limited to randomised controlled trials (RCTs) and observational studies published between January 1990 and February 2019. Publications were filtered to ensure appropriate data extraction. The main outcomes were the definitions of mild asthma and exacerbations, baseline exacerbation rates and exacerbation data for placebo recipients in prospective studies. Meta-analysis of exacerbation rates was planned.
Of 4064 articles identified, 64 were included in our review (49 743 subjects); 54 RCTs and 10 observational/other studies. Six main types of definitions of mild asthma were identified. While care was taken to ensure inclusion only of patients with mild asthma, marked heterogeneity was revealed in the definitions of mild asthma and hence the study populations. Reporting of exacerbations also varied widely between studies, precluding meta-analysis. Between 0-22% of patients were hospitalised for asthma or had a severe exacerbation in the previous year, according to baseline data from prospective studies. In RCTs, severe exacerbation rates in placebo recipients taking only short-acting β-agonist therapy ranged from 0.20-2.88 per year.
These data provide new evidence of the burden of exacerbations in mild asthma and highlight the need for standardised definitions of mild asthma and of exacerbations to progress further research.
尽管大多数哮喘患者病情较轻，但关于轻度哮喘如何定义以及该患者群体中病情加重的频率的数据却很匮乏，因此我们旨在纠正这一情况。
我们在OVID平台上检索了Medline、Medline In-Process（PubMed）以及Embase数据库，查找包含“轻度哮喘”以及至少一种相关治疗方法和结局/关键词的英文出版物，仅限于1990年1月至2019年2月期间发表的随机对照试验（RCT）和观察性研究。对出版物进行筛选以确保能够进行适当的数据提取。主要结局包括轻度哮喘和病情加重的定义、基线病情加重率以及前瞻性研究中接受安慰剂治疗者的病情加重数据。计划对病情加重率进行荟萃分析。
在识别出的4064篇文章中，64篇被纳入我们的综述（共49743名受试者）；其中54项RCT和10项观察性/其他研究。确定了轻度哮喘的六种主要定义类型。尽管我们谨慎确保仅纳入轻度哮喘患者，但轻度哮喘的定义以及因此研究人群中仍显示出明显的异质性。不同研究之间病情加重情况的报告也存在很大差异，这使得无法进行荟萃分析。根据前瞻性研究的基线数据，在前一年中，0-22%的患者因哮喘住院或病情严重加重。在RCT中，仅接受短效β受体激动剂治疗的安慰剂接受者的严重病情加重率为每年0.20-2.88次。
这些数据为轻度哮喘病情加重的负担提供了新的证据，并强调需要对轻度哮喘和病情加重进行标准化定义，以便进一步开展研究。
