Sugawara Internal Medicine and Respiratory Clinic, Tomakomai, 053-0821, Japan.
Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, S1W16 Chuoku, Sapporo, Hokkaido, 060-8543, Japan.
Respir Res. 2020 Aug 31;21(1):226. doi: 10.1186/s12931-020-01494-x.
Bronchial asthma (BA) has different phenotypes, and it requires a clinically effective subtype classification system. The impulse oscillometry system (IOS) is an emerging technique device used in respiratory functional tests. However, its efficacy has not been validated. Therefore, this study aimed to assess the relationship between BA and the IOS parameters, and the difference in the therapeutic effects of inhaled corticosteroids (ICSs) among the subtype classifications was evaluated using the IOS.
Of the 245 patients with bronchial asthma who were screened, 108 were enrolled in this study. These patients were divided based on three subtypes according to the IOS result as follows: central predominant type (n = 34), peripheral predominant type (n = 58), and resistless type (n = 16). Then, the following ICSs were randomly prescribed in daily medical care: coarse-particle ICS (fluticasone propionate [FP]), fine-particle ICS (mometasone furoate [MF]), and moderate-particle ICS (budesonide [BUD]). The treatment effects were assessed using the Asthma Health Questionnaire (AHQ) and the Asthma Control Test (ACT) and were compared among the three subtypes.
In the central predominant type, the AHQ score of the MF group was significantly higher than that of the FP group (15.4 vs. 3.6, p < 0.01) and the BUD group (15.4 vs. 8.8, p < 0.05); the ACT score of the FP group was significantly higher than that of the MF and BUD groups (24.3 vs. 21.7, 22.3, respectively, p < 0.05) at 4 weeks after treatment. In the peripheral predominant type, the AHQ score of the FP group was significantly higher than that of the MF group (14.1 vs. 3.4, p < 0.05); the ACT score of the FP group was lower than that of the MF and BUD groups (22.8 vs. 24.6, 24.4, respectively, p < 0.01) at 4 weeks after treatment.
An association was observed between IOS subtype classification and ICS particle size in terms of therapeutic efficacy in BA. This result indicates that the IOS could be an effective tool in the selection of ICS and the evaluation of the BA phenotype.
支气管哮喘（BA）存在不同的表型，需要一种临床有效的亚类分类系统。脉冲振荡系统（IOS）是一种新兴的呼吸功能测试技术设备。然而，其疗效尚未得到验证。因此，本研究旨在评估 BA 与 IOS 参数之间的关系，并使用 IOS 评估吸入皮质类固醇（ICS）在亚类分类中的治疗效果差异。
在筛选的 245 例支气管哮喘患者中，有 108 例患者入组本研究。根据 IOS 结果，这些患者分为以下三种亚型：中央占优势型（n=34）、外周占优势型（n=58）和阻力型（n=16）。然后，在日常医疗中随机开具以下 ICS：粗颗粒 ICS（丙酸氟替卡松[FP]）、细颗粒 ICS（糠酸莫米松[MF]）和中颗粒 ICS（布地奈德[BUD]）。使用哮喘健康问卷（AHQ）和哮喘控制测试（ACT）评估治疗效果，并比较三种亚型之间的差异。
在中央占优势型中，MF 组的 AHQ 评分明显高于 FP 组（15.4 比 3.6，p<0.01）和 BUD 组（15.4 比 8.8，p<0.05）；治疗 4 周后，FP 组的 ACT 评分明显高于 MF 和 BUD 组（24.3 比 21.7、22.3，分别为 p<0.05）。在外周占优势型中，FP 组的 AHQ 评分明显高于 MF 组（14.1 比 3.4，p<0.05）；治疗 4 周后，FP 组的 ACT 评分低于 MF 和 BUD 组（22.8 比 24.6、24.4，分别为 p<0.01）。
IOS 亚类分类与 ICS 颗粒大小与 BA 的治疗效果之间存在关联。结果表明，IOS 可能是选择 ICS 和评估 BA 表型的有效工具。
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