Moon Seong Mi, Choi Hayoung, Kang Hyung Koo, Lee Sei Won, Sim Yun Su, Park Hye Yun, Kwon Yong-Soo, Kim Sang-Heon, Oh Yeon-Mok, Lee Hyun
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Allergy Asthma Immunol Res. 2023 Jan;15(1):83-93. doi: 10.4168/aair.2023.15.1.83.
Although the coexistence of asthma and bronchiectasis is common, the impacts of asthma on bronchiectastic patients (BE) have not been well evaluated because this issue using bronchiectasis cohorts has been investigated in only a few studies.
In the present study, 598 patients who were prospectively enrolled in the Korean bronchiectasis registry were evaluated. The clinical characteristics between BE with asthma and those without asthma were compared.
Asthma was found in 22.4% of BE. BE with asthma had a higher body mass index (BMI) ( = 0.020), more dyspnea ( < 0.001), larger sputum volume ( = 0.015), and lower forced expiratory volume in 1 second (FEV1) ( < 0.001) than those without asthma. BE with asthma had a higher rate of previous pneumonia ( = 0.017) or measles ( = 0.037) than those without asthma. Regarding treatment, BE with asthma used inhaled corticosteroids, long-acting muscarinic antagonists, and leukotriene receptor antagonists more frequently than those without asthma. Although intergroup differences were not observed in disease severity of bronchiectasis ( = 0.230 for Bronchiectasis Severity Index and = 0.089 for FACED), the Bronchiectasis Health Questionnaire (BHQ) scores indicating the quality of life, were significantly lower in BE with asthma than in those without asthma (61.6 vs. 64.8, < 0.001). In a multivariable model adjusting for age, sex, body mass index, forced expiratory volume in 1 second %predicted, sputum volume, modified Medical Research Council dyspnea scale ≥ 2, and the number of involved lobes, asthma was associated with lower BHQ scores (β-coefficient = -2.579, = 0.014).
BE with asthma have more respiratory symptoms, worse lung function, and poorer quality of life than those without asthma. A better understanding of the impacts of asthma in BE will guide appropriate management in this population.
虽然哮喘与支气管扩张症并存很常见，但哮喘对支气管扩张症患者（BE）的影响尚未得到充分评估，因为仅有少数研究使用支气管扩张症队列对此问题进行了调查。
在本研究中，对前瞻性纳入韩国支气管扩张症登记处的598例患者进行了评估。比较了合并哮喘的BE患者与未合并哮喘的BE患者的临床特征。
在22.4%的BE患者中发现了哮喘。合并哮喘的BE患者比未合并哮喘的患者具有更高的体重指数（BMI）（P = 0.020）、更多的呼吸困难（P < 0.001）、更大的痰液量（P = 0.015）以及更低的一秒用力呼气容积（FEV1）（P < 0.001）。合并哮喘的BE患者比未合并哮喘的患者有更高的既往肺炎发生率（P = 0.017）或麻疹发生率（P = 0.037）。在治疗方面，合并哮喘的BE患者比未合并哮喘的患者更频繁地使用吸入性糖皮质激素、长效毒蕈碱拮抗剂和白三烯受体拮抗剂。虽然在支气管扩张症的疾病严重程度方面未观察到组间差异（支气管扩张症严重程度指数P = 0.230，FACED评分P = 0.089），但表明生活质量的支气管扩张症健康问卷（BHQ）评分在合并哮喘的BE患者中显著低于未合并哮喘的患者（61.6对64.8，P < 0.001）。在一个对年龄、性别、体重指数、一秒用力呼气容积预测值百分比、痰液量、改良医学研究理事会呼吸困难量表≥2以及受累肺叶数量进行校正的多变量模型中，哮喘与更低的BHQ评分相关（β系数 = -2.579，P = 0.014）。
合并哮喘的BE患者比未合并哮喘的患者有更多的呼吸道症状、更差的肺功能和更差的生活质量。更好地了解哮喘对BE的影响将指导对该人群的适当管理。
