Department of Respiratory Medicine, CHU Liege, GIGA I(3) Research Group, University of Liege, Belgium.
Department of Pediatrics, division of respirology, CHU Liege, GIGA I(3) Research Group, University of Liege, Belgium.
Respir Med. 2020 Dec;175:106202. doi: 10.1016/j.rmed.2020.106202. Epub 2020 Nov 10.
Airway remodeling, as many other factors, may lead to lung function decline and irreversible airflow obstruction (IRAO) in asthma. This study was undertaken in order to highlight predictors of incomplete reversibility of airflow obstruction in adult asthmatics to identify patients with poorer prognosis and improve their care, and decrease morbidity.
A retrospective study was conducted in 973 asthmatics recruited from the University Asthma Clinic of Liege. Patients with IRAO (post-BD FEV/FVC<0.7 & FEV<80% predicted) were compared to patients with reversible airway obstruction (RAO) (post-BD FEV/FVC≥0.7 & FEV≥80% predicted). TGF-β was measured in sputum supernatant of 85 patients.
Seventeen percent of asthmatics presented with IRAO. These patients were significantly older, more smokers, with a lower proportion of female, a longer disease duration, were more poorly controlled with a lower quality of life. This sub-population of asthmatics also showed more often elevated blood and sputum eosinophils and neutrophils, and higher exacerbation and hospitalisation rates in the previous year. The multivariable analysis revealed male gender, longer disease duration, cigarette smoking, ACQ score, sputum eosinophils and neutrophils, ICS dose and OCS maintenance, BMI, and asthma onset as variables independently linked to IRAO. Total TGF-β levels appeared higher in patients with IRAO (n = 38) compared to patients with RAO (n = 47).
These data show that risk factors for IRAO are male gender, smoking, a longer disease duration, uncontrolled asthma, eosinophilic or neutrophilic airway inflammation, lower BMI, and later asthma onset. Moreover, TGF-β levels are higher in IRAO.
气道重塑等多种因素可能导致哮喘患者肺功能下降和不可逆转的气流阻塞（IRAO）。本研究旨在强调成人哮喘患者气流阻塞不完全可逆的预测因素，以识别预后较差的患者，改善其治疗，降低发病率。
对列日大学哮喘诊所招募的 973 名哮喘患者进行回顾性研究。将 IRAO（BD 后 FEV/FVC<0.7 且 FEV<80%预计值）患者与可逆性气道阻塞（RAO）（BD 后 FEV/FVC≥0.7 且 FEV≥80%预计值）患者进行比较。对 85 名患者的痰上清液中 TGF-β进行了测量。
17%的哮喘患者出现 IRAO。这些患者年龄较大，吸烟较多，女性比例较低，疾病持续时间较长，控制较差，生活质量较低。哮喘患者亚组也显示出更高的血和痰中嗜酸性粒细胞和中性粒细胞计数，以及更高的前一年的恶化和住院率。多变量分析显示，男性、疾病持续时间较长、吸烟、ACQ 评分、痰中嗜酸性粒细胞和中性粒细胞计数、ICS 剂量和 OCS 维持、BMI 和哮喘发病时间是与 IRAO 独立相关的变量。IRAO 患者（n=38）的总 TGF-β水平明显高于 RAO 患者（n=47）。
这些数据表明，IRAO 的危险因素是男性、吸烟、疾病持续时间较长、哮喘控制不佳、嗜酸性粒细胞或中性粒细胞气道炎症、BMI 较低和哮喘发病较晚。此外，IRAO 患者的 TGF-β水平较高。
