Department of Allergy, La Paz University Hospital, Madrid, Spain.
Institute for Health Research IdiPAZ, Madrid, Spain.
J Investig Allergol Clin Immunol. 2023 Jul 27;33(4):281-288. doi: 10.18176/jiaci.0816. Epub 2002 May 3.
Comorbidities can influence asthma control and promote asthma exacerbations (AEs). However, the impact of multimorbidity in AEs, assessed based on long-term follow-up of patients with asthma of different degrees of severity, has received little attention in real-life conditions. To describe the epidemiological and clinical characteristics and predictors of AEs in patients who had presented at least 1 AE in the previous year in the MEchanism of Genesis and Evolution of Asthma (MEGA) cohort.
The work-up included a detailed clinical examination, pulmonary function testing, fractional exhaled nitric oxide (FeNO), blood counts, induced sputum, skin prick-tests, asthma questionnaires, and assessment of multimorbidity. The number of moderate-severe AEs in the preceding year was registered for each patient.
The study population comprised 486 patients with asthma (23.7% mild, 35% moderate, 41.3% severe). Disease remained uncontrolled in 41.9%, and 47.3% presented ≥1 moderate-severe AE, with a mean (SD) annual exacerbation rate of 0.47 (0.91) vs 2.11 (2.82) in mild and severe asthma, respectively. Comorbidity was detected in 56.4% (66.6% among those with severe asthma). Bronchiectasis, chronic rhinosinusitis with nasal polyps, atopy, psychiatric illnesses, hyperlipidemia, and hypertension were significantly associated with AEs. No associations were found for FeNO, blood eosinophils, or total serum IgE. Sputum eosinophilia and a high-T2 inflammatory pattern were significantly associated with AEs. Multivariable regression analysis showed a significant association with asthma severity, uncontrolled disease, and low prebronchodilator FEV1/FVC.
Our study revealed a high frequency of AE in the MEGA cohort. This was strongly associated with multimorbidity, asthma severity, poor asthma control, airflow obstruction, higher sputum eosinophils, and a very high-T2 inflammatory pattern.
合并症会影响哮喘控制并促进哮喘恶化（AE）。然而，在现实情况下，基于对不同严重程度哮喘患者的长期随访，对合并症对 AE 的影响关注甚少。本研究旨在描述 MEchanism of Genesis and Evolution of Asthma（MEGA）队列中至少有 1 次 AE 发作的患者的流行病学和临床特征以及 AE 的预测因素。
研究工作包括详细的临床检查、肺功能测试、呼出气一氧化氮分数（FeNO）、血细胞计数、诱导痰、皮肤点刺试验、哮喘问卷和合并症评估。为每位患者登记了前一年的中重度 AE 次数。
研究人群包括 486 名哮喘患者（23.7%为轻度、35%为中度、41.3%为重度）。41.9%的患者疾病仍未得到控制，47.3%的患者出现≥1 次中重度 AE，轻度和重度哮喘患者的平均（标准差）年恶化率分别为 0.47（0.91）和 2.11（2.82）。56.4%的患者（重度哮喘患者中为 66.6%）存在合并症。支气管扩张症、慢性鼻-鼻窦炎伴鼻息肉、特应性、精神疾病、高脂血症和高血压与 AE 显著相关。FeNO、血嗜酸性粒细胞或总血清 IgE 与 AE 无相关性。痰嗜酸性粒细胞增多和高 T2 炎症模式与 AE 显著相关。多变量回归分析显示，与哮喘严重程度、疾病未控制和支气管扩张前 FEV1/FVC 降低显著相关。
本研究揭示了 MEGA 队列中 AE 的高发生率。AE 与合并症、哮喘严重程度、疾病控制不佳、气流阻塞、痰中嗜酸性粒细胞增多和极高 T2 炎症模式密切相关。
