Sheng Haiyan, Wang Yuhong, Yao Xiujuan, Zhang Xichun, Wang Xiangdong, Liu Xiaofang, Zhang Luo
Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
J Thorac Dis. 2023 Jun 30;15(6):3025-3047. doi: 10.21037/jtd-22-1288. Epub 2023 May 10.
Asthmatic patients with comorbid bronchiectasis (ACB) show significantly severe condition with various inflammatory phenotypes; bronchiectasis is a heterogeneous disease caused by asthma and other multiple etiological factors. We aimed to investigate the inflammatory characteristics and their clinical significance in asthmatic patients according to the presence and onset time of bronchiectasis.
This prospective cohort study recruited outpatients with stable asthma. All the enrolled patients were divided into the non-bronchiectasis group and the ACB group, and the ACB group was separated into the bronchiectasis-prior group and the asthma-prior group. Demographic and clinical data were collected, and peripheral blood and induced sputum eosinophil counts, sputum pathogens, the fraction of exhaled nitric oxide (FeNO), lung function, and chest high-resolution computed tomography were examined.
A total of 602 patients (mean age: 55.36±14.58 years) were included, of which 255 (42.4%) were males. Bronchiectasis was present in 268 (44.5%) patients, with 171 (28.41%) in the asthma-prior group and 97 (16.11%) in the bronchiectasis-prior group. For the asthma-prior group, the presence of bronchiectasis was positively correlated with age, presence of nasal polyps, severe asthma, ≥1 pneumonia in the last 12 months, ≥1 severe exacerbation of asthma in the last 12 months (SEA), peripheral blood eosinophil counts, and sputum eosinophil ratio; the extent and severity of bronchiectasis were positively correlated with ≥1 SEA and FeNO levels; and the bronchiectasis severity index (BSI) scores were positively correlated with ≥1 SEA and immunoglobulin E levels. For the bronchiectasis-prior group, bronchiectasis was positively correlated with previous pulmonary tuberculosis or pneumonia in childhood and ≥1 pneumonia in the last 12 months and negatively correlated with forced expiratory volume in one second (FEV) % and the FeNO level. The extent and severity of bronchiectasis were positively correlated with ≥1 pneumonia in the last 12 months and negatively correlated with FEV%. The BSI scores were positively correlated with the duration of bronchiectasis.
The sequence of bronchiectasis onset may indicate distinct inflammatory characteristics and may be helpful in targeted therapy for patients with asthma.
合并支气管扩张的哮喘患者（ACB）病情显著严重，具有多种炎症表型；支气管扩张是一种由哮喘和其他多种病因引起的异质性疾病。我们旨在根据支气管扩张的存在情况和发病时间，研究哮喘患者的炎症特征及其临床意义。
这项前瞻性队列研究招募了病情稳定的哮喘门诊患者。所有纳入的患者被分为非支气管扩张组和ACB组，ACB组又分为支气管扩张先发病组和哮喘先发病组。收集人口统计学和临床数据，并检测外周血和诱导痰嗜酸性粒细胞计数、痰病原体、呼出一氧化氮分数（FeNO）、肺功能和胸部高分辨率计算机断层扫描。
共纳入602例患者（平均年龄：55.36±14.58岁），其中男性255例（42.4%）。268例（44.5%）患者存在支气管扩张，哮喘先发病组171例（28.41%），支气管扩张先发病组97例（16.11%）。对于哮喘先发病组，支气管扩张的存在与年龄、鼻息肉的存在、重度哮喘、过去12个月内≥1次肺炎、过去12个月内≥1次哮喘严重加重（SEA）、外周血嗜酸性粒细胞计数和痰嗜酸性粒细胞比例呈正相关；支气管扩张的范围和严重程度与≥1次SEA和FeNO水平呈正相关；支气管扩张严重指数（BSI）评分与≥1次SEA和免疫球蛋白E水平呈正相关。对于支气管扩张先发病组，支气管扩张与儿童期既往肺结核或肺炎以及过去12个月内≥1次肺炎呈正相关，与一秒用力呼气容积（FEV）%和FeNO水平呈负相关。支气管扩张的范围和严重程度与过去12个月内≥1次肺炎呈正相关，与FEV%呈负相关。BSI评分与支气管扩张的持续时间呈正相关。
支气管扩张发病顺序可能表明不同的炎症特征，可能有助于哮喘患者的靶向治疗。
