残余呼吸困难可能预示哮喘患者存在小气道功能障碍以及对单吸入器三联疗法反应不佳。
Residual Dyspnea May Predict Small Airways Dysfunction and Poor Responsiveness to Single-Inhaler Triple Therapy in Asthmatic Patients.
作者信息
Ito Keima, Tajiri Tomoko, Nishiyama Hirono, Kurokawa Ryota, Yap Jenifer Maries Go, Takeda Norihisa, Fukumitsu Kensuke, Kanemitsu Yoshihiro, Fukuda Satoshi, Uemura Takehiro, Ohkubo Hirotsugu, Maeno Ken, Ito Yutaka, Oguri Tetsuya, Takemura Masaya, Niimi Akio
机构信息
Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Education and Research Center for Community Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
出版信息
J Asthma Allergy. 2022 Nov 2;15:1561-1568. doi: 10.2147/JAA.S381953. eCollection 2022.
PURPOSE
Recently, single-inhaler triple therapy (SITT) has demonstrated efficacy in patients with uncontrolled asthma who were symptomatic despite treatment with inhaled corticosteroids/long-acting β2 agonists. However, the characteristics of patients who benefit from SITT remain unclear in the real-world. The aim of this study was to examine the predictors of responsiveness to SITT in patients with asthma.
PATIENTS AND METHODS
A total of 45 patients with asthma who had regularly visited our respiratory clinic and were started on SITT from March 2019 to March 2021 were retrospectively analyzed. Patients' demographic characteristics, residual respiratory symptoms, type 2 biomarkers, and lung function before SITT were assessed from the patients' medical records. Predictors of responsiveness to four-week SITT were evaluated in these patients. The definition of responders was based on the physician-assessed global evaluation of treatment effectiveness.
RESULTS
Thirty-four (75%) of 45 patients were identified as responders to SITT. Non-responders showed significantly lower forced vital capacity (FVC) (%predicted) values, and complained of dyspnea more frequently than responders before SITT (p = 0.01 and p = 0.02, respectively). There were no significant differences in demographic characteristics and type 2 biomarkers between responders and non-responders. Clinical predictors of poor response to SITT were residual dyspnea (OR = 0.14, p = 0.02), low FVC (%predicted) values (OR = 1.05, p = 0.01), and FVC (%predicted) <80% (OR = 0.11, p = 0.02). Multivariate analysis showed that poor response to SITT was associated with residual dyspnea before SITT (OR = 0.14, p = 0.02). On the other hand, patients with residual dyspnea had significantly lower FEF (%predicted) values than patients without residual dyspnea before SITT (p = 0.04).
CONCLUSION
Residual dyspnea, reflecting small airways dysfunction, may predict poor responsiveness to short-term SITT in patients with asthma.
目的
最近，单吸入器三联疗法（SITT）已在尽管接受吸入性糖皮质激素/长效β2受体激动剂治疗但仍有症状的未控制哮喘患者中显示出疗效。然而，在现实世界中，从SITT中获益的患者特征仍不清楚。本研究的目的是探讨哮喘患者对SITT反应性的预测因素。
患者与方法
回顾性分析了2019年3月至2021年3月期间定期到我们呼吸科门诊就诊并开始接受SITT治疗的45例哮喘患者。从患者病历中评估患者的人口统计学特征、残余呼吸道症状、2型生物标志物以及SITT前的肺功能。在这些患者中评估四周SITT反应性的预测因素。反应者的定义基于医生评估的治疗效果整体评价。
结果
45例患者中有34例（75%）被确定为对SITT有反应。无反应者的用力肺活量（FVC）（预测值%）显著较低，并且在SITT前比有反应者更频繁地抱怨呼吸困难（分别为p = 0.01和p = 0.02）。有反应者和无反应者在人口统计学特征和2型生物标志物方面无显著差异。对SITT反应不佳的临床预测因素为残余呼吸困难（OR = 0.14，p = 0.02）、低FVC（预测值%）（OR = 1.05，p = 0.01）以及FVC（预测值%）<80%（OR = 0.11，p = 0.02）。多因素分析显示，对SITT反应不佳与SITT前的残余呼吸困难相关（OR = 0.14，p = 0.02）。另一方面，有残余呼吸困难的患者在SITT前的用力呼气流量（FEF）（预测值%）显著低于无残余呼吸困难的患者（p = 0.04）。
结论
反映小气道功能障碍的残余呼吸困难可能预测哮喘患者对短期SITT反应不佳。
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