Ban Ga Young, Kim Su Chin, Lee Hyun Young, Ye Young Min, Shin Yoo Seob, Park Hae Sim
Department of Pulmonary, Allergy, and Critical Care Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Allergy and Clinical Immunology Research Center, Hallym University College of Medicine, Chuncheon, Korea.
Allergy Asthma Immunol Res. 2021 May;13(3):420-434. doi: 10.4168/aair.2021.13.3.420.
Minimizing the future risk of asthma exacerbation (AE) is one of the main goals of asthma management. We investigated prognostic factors for risk of severe AE (SAE) in a real-world clinical setting.
This is an observational study evaluating subjects who were diagnosed with asthma and treated with anti-asthmatic medications from January 1995 to June 2018. Risk factors for SAE were analyzed in 2 treatment periods (during the initial 2 years and the following 3-10 years of treatment) using the big data of electronic medical records.
In this study, 5,058 adult asthmatics were enrolled; 1,335 (28.64%) experienced ≥ 1 SAE during the initial 2 years of treatment. Female sex, higher peripheral eosinophil/basophil counts, and lower levels of forced expiratory volume in 1 second (FEV1; %) were factors predicting the risk of SAEs ( < 0.001 for all). Higher serum total immunoglobulin E levels increased the risk of SAEs among the patients having ≤ 2 SAEs ( = 0.025). Patients with more frequent SAEs during the initial 2 years of treatment had significantly higher risks of SAEs during the following years of treatment ( < 0.001, for all) (patients with ≥ 4 SAEs, odds ratio [OR], 29.147; those with 3 SAEs, OR, 14.819; those with 2 SAEs, OR, 9.867; those with 1 SAE, OR, 5.116), had higher maintenance doses of systemic steroids, and showed more gradual decline in FEV1 (%) and FEV1/forced vital capacity levels maintained during the following years of treatment ( < 0.001 for all).
Asthmatics having risk factors for SAEs (female sex, higher peripheral eosinophil/basophil counts, and lower FEV1) should be strictly monitored to prevent future risk and improve clinical outcomes.
将哮喘急性加重（AE）的未来风险降至最低是哮喘管理的主要目标之一。我们在真实世界的临床环境中研究了严重哮喘急性加重（SAE）风险的预后因素。
这是一项观察性研究，评估了1995年1月至2018年6月期间被诊断为哮喘并接受抗哮喘药物治疗的受试者。使用电子病历大数据在2个治疗阶段（初始治疗的2年期间以及随后治疗的3 - 10年）分析SAE的危险因素。
本研究纳入了5058名成年哮喘患者；1335名（28.64%）在治疗的初始2年期间经历了≥1次SAE。女性、外周嗜酸性粒细胞/嗜碱性粒细胞计数较高以及第1秒用力呼气量（FEV1；%）水平较低是预测SAE风险的因素（所有P均<0.001）。血清总免疫球蛋白E水平较高增加了SAE次数≤2次患者发生SAE的风险（P = 0.025）。在治疗初始2年期间SAE发作更频繁的患者在随后几年治疗中发生SAE的风险显著更高（所有P均<0.001）（SAE次数≥4次的患者，比值比[OR]为29.147；3次SAE的患者，OR为14.819；2次SAE的患者，OR为9.867；1次SAE的患者，OR为5.116），全身用糖皮质激素维持剂量更高，并且在随后几年治疗中FEV1（%）和FEV1/用力肺活量水平下降更缓慢（所有P均<0.001）。
具有SAE危险因素（女性、外周嗜酸性粒细胞/嗜碱性粒细胞计数较高以及FEV1较低）的哮喘患者应受到严格监测，以预防未来风险并改善临床结局。
