Department of Medicine, College of Medicine Tucson, and Asthma and Airway Diseases Research Center, University of Arizona Health Sciences, Tucson, AZ, USA.
Institute for Lung Health, Leicester NIHR Biomedical Research Centre (Respiratory Theme), College of Life Sciences, University of Leicester, Leicester, UK.
Lancet Respir Med. 2022 Jul;10(7):661-668. doi: 10.1016/S2213-2600(21)00536-1. Epub 2022 Mar 2.
Although small airway disease is a feature of asthma, its association with relevant asthma outcomes remains unclear. The ATLANTIS study was designed to identify the combination of physiological and imaging variables that best measure the presence and extent of small airway disease in asthma, both cross-sectionally and longitudinally. In this longitudinal analysis, we evaluated which small airway parameters studied were most strongly associated with asthma control, exacerbations, and quality of life.
In this observational cohort study, participants with mild, moderate, or severe stable asthma were recruited between June 30, 2014, and March 3, 2017, via medical databases and advertisements in nine countries worldwide. Eligible participants were aged 18-65 years with a clinical asthma diagnosis for at least 6 months. Participants were followed up for 1 year, with visits at baseline, 6 months, and 12 months. Physiological tests included spirometry, lung volumes, impulse oscillometry, multiple breath nitrogen washout (MBNW), and percentage decrease in forced vital capacity during methacholine challenge. CT densitometry was performed to evaluate small airway disease. We examined the associations between these measurements and asthma exacerbations, asthma control, and quality of life using univariate and multivariate analyses. A composite ordinal score comprising percent predicted R5-20 (resistance of small-to-mid-sized airways), AX (area of reactance), and X5 (reactance of more central, conducting small airways at 5 Hz) was constructed.
773 participants (median age 46 years [IQR 34-54]; 450 [58%] female) were included in this longitudinal study. Univariate analyses showed that components of impulse oscillometry, lung volumes, MBNW, and forced expiratory flow at 25-75% of FVC were significantly correlated with asthma control and exacerbations (Spearman correlations 0·20-0·25, p<0·0001 after Bonferroni correction). As a composite of impulse oscillometry, the ordinal score independently predicted asthma control and exacerbations in a multivariate analysis with known exacerbation predictors. CT parameters were not significantly correlated with asthma control, exacerbation, or quality of life.
Small airway disease, as measured by physiological tests, is longitudinally associated with clinically important asthma outcomes, such as asthma control and exacerbations.
Chiesi Farmaceutici.
虽然小气道疾病是哮喘的一个特征，但其与相关哮喘结局的关联仍不清楚。ATLANTIS 研究旨在确定最佳的生理和影像学变量组合，以在横断面和纵向研究中测量哮喘患者小气道疾病的存在和程度。在这项纵向分析中，我们评估了所研究的哪些小气道参数与哮喘控制、加重和生活质量最密切相关。
这是一项观察性队列研究，于 2014 年 6 月 30 日至 2017 年 3 月 3 日通过全球 9 个国家的医疗数据库和广告招募了轻、中或重度稳定哮喘患者。合格的参与者年龄在 18-65 岁之间，有至少 6 个月的临床哮喘诊断。参与者随访 1 年，在基线、6 个月和 12 个月时进行随访。生理测试包括肺活量测定、肺容积、脉冲振荡法、多次呼吸氮冲洗（MBNW）和乙酰甲胆碱激发期间用力肺活量下降百分比。进行 CT 密度测定以评估小气道疾病。我们使用单变量和多变量分析来检查这些测量值与哮喘加重、哮喘控制和生活质量之间的关系。构建了一个包含预测的 R5-20（中小气道阻力）、AX（电抗面积）和 X5（5Hz 时更中心传导小气道的电抗）的复合有序评分。
本纵向研究纳入了 773 名参与者（中位数年龄 46 岁[IQR 34-54]；450[58%]女性）。单变量分析显示，脉冲振荡法、肺容积、MBNW 和用力呼气流量在 25%-75%FVC 之间的成分与哮喘控制和加重显著相关（Spearman 相关系数 0·20-0·25，Bonferroni 校正后 p<0·0001）。作为脉冲振荡法的组合，有序评分在包含已知加重预测因子的多变量分析中独立预测哮喘控制和加重。CT 参数与哮喘控制、加重或生活质量无显著相关性。
通过生理测试测量的小气道疾病与临床重要的哮喘结局（如哮喘控制和加重）呈纵向相关。
Chiesi Farmaceutici。
