Umeå University, Department of Public Health and Clinical Medicine, Section for Sustainable Health/The OLIN Unit, Sweden.
Umeå University, Department of Public Health and Clinical Medicine, The OLIN Unit, Sweden.
Respir Med. 2023 Nov-Dec;219:107418. doi: 10.1016/j.rmed.2023.107418. Epub 2023 Sep 27.
Adult-onset asthma is associated with a poor treatment response. The aim was to study associations between clinical characteristics, asthma control and treatment in adult-onset asthma.
Previous participants within the population-based Obstructive Lung Disease in Northern Sweden studies (OLIN) were in 2019-2020 invited to clinical examinations including structured interviews, spirometry, fractional exhaled nitric oxide (FeNO), skin prick test and blood sampling. In total, n = 251 individuals with adult-onset asthma (debut >15 years of age) were identified. Uncontrolled asthma was defined according to ERS/ATS and treatment step according to GINA (2019).
Among individuals with uncontrolled asthma (34%), severe obesity (16.3% vs 7.9%, p = 0.041) and elevated levels of blood neutrophils, both regarding mean level of blood neutrophils (4.2510/L vs 3.6710/L, p = 0.003), and proportions with ≥410/L (49.4% vs 33.3%, p = 0.017) and ≥510/L (32.1% vs 13.7%, p < 0.001) were more common than among those with controlled asthma. Adding the dimension of GINA treatment step 1-5, individuals with uncontrolled asthma on step 4-5 treatment had the highest proportions of blood neutrophils ≥5*10/L (45.5%), severe obesity (BMI≥35, 26.1%), dyspnea (mMRC≥2) (34.8%), and most impaired lung function in terms of FEV%<80% of predicted (42.9%), FEV<LLN (47.6%), FVC<80% of predicted (42.9%) and FVC < LLN (38.1%). No associations between level of asthma control and treatment were found regarding blood eosinophils, FeNO or allergic sensitization.
This study indicates that in adult-onset asthma, primarily non-type-2 characteristics such as obesity and blood neutrophils associate with poor asthma control and higher doses of inhaled corticosteroids.
成人起病哮喘与治疗反应不佳有关。本研究旨在探讨成人起病哮喘的临床特征、哮喘控制和治疗之间的关系。
在基于人群的瑞典北部阻塞性肺病研究（OLIN）中，先前的参与者于 2019-2020 年接受了临床检查，包括结构访谈、肺量测定、呼出气一氧化氮分数（FeNO）、皮肤点刺试验和血液采样。总共确定了 251 名成人起病哮喘（发病年龄>15 岁）患者。根据 ERS/ATS 标准定义未控制哮喘，根据 GINA（2019 年）标准定义治疗阶段。
在未控制哮喘患者（34%）中，严重肥胖（16.3% vs 7.9%，p=0.041）和血液中性粒细胞水平升高更为常见，包括血液中性粒细胞的平均水平（4.2510/L vs 3.6710/L，p=0.003）和比例（≥410/L，49.4% vs 33.3%，p=0.017；≥510/L，32.1% vs 13.7%，p<0.001）。与控制哮喘患者相比，在 GINA 治疗阶段 1-5 中，未控制哮喘患者处于 4-5 阶段治疗的患者血液中性粒细胞≥5*10/L（45.5%）、严重肥胖（BMI≥35，26.1%）、呼吸困难（mMRC≥2）（34.8%）和肺功能受损程度最高，FEV%<80%预计值（42.9%）、FEV<LLN（47.6%）、FVC<80%预计值（42.9%）和 FVC<LLN（38.1%）。血液嗜酸性粒细胞、FeNO 或过敏致敏与哮喘控制水平之间无关联。
本研究表明，在成人起病哮喘中，主要是非 2 型特征，如肥胖和血液中性粒细胞，与哮喘控制不佳和更高剂量的吸入性皮质类固醇相关。
