Pfeffer Paul E, Brown Thomas, Chaudhuri Rekha, Faruqi Shoaib, Gore Robin, Heaney Liam G, Mansur Adel H, Pantin Thomas, Patel Mitesh, Rupani Hitasha, Siddiqui Salman, Vyas Aashish, Busby John
Barts Health NHS Trust, London, United Kingdom.
Queen Mary University of London, London, United Kingdom.
J Allergy Clin Immunol Glob. 2024 May 31;3(3):100286. doi: 10.1016/j.jacig.2024.100286. eCollection 2024 Aug.
Severe asthma pathology encompasses a wide range of pulmonary and extrapulmonary treatable traits with a high prevalence of comorbidities. Although asthma-specific health-related quality-of-life measures are most sensitive to changes in asthma control, generic measures, such as EQ-5D-5L (EuroQol 5-Dimension 5-Level questionnaire), are potentially better for capturing the impact of comorbidities.
We sought to examine the impact of pulmonary and extrapulmonary treatable traits on quality of life at initial severe asthma assessment, and to compare the characteristics of those patients whose quality of life does and does not improve during follow-up at severe asthma centers.
Patients' characteristics at baseline assessment within the UK Severe Asthma Registry were compared by EQ-5D-5L utility index quartile. Patients with follow-up review data were stratified by change in EQ-5D-5L utility index from baseline to follow-up, and characteristics similarly examined.
Patients in the quartiles with worst dysutility at baseline were observed to exhibit more treatable traits and in particular extrapulmonary traits associated with cumulative systemic corticosteroids, including obesity, anxiety/depression, and osteoporosis. In those patients whose quality of life improved over follow-up, a reduction in exacerbations, uncontrolled symptoms, and requirement for maintenance oral corticosteroids were observed.
Both pulmonary and extrapulmonary treatable traits are important determinants of quality of life in severe asthma. Comorbidities associated with cumulative systemic corticosteroid exposure are particularly associated with worse quality of life, emphasizing the importance of early identification and management of severe asthma before comorbidities develop.
重度哮喘病理涵盖广泛的肺部和肺外可治疗特征，且合并症患病率很高。尽管哮喘特异性健康相关生活质量测量对哮喘控制的变化最为敏感，但通用测量方法，如EQ-5D-5L（欧洲五维度五水平问卷），可能更有助于捕捉合并症的影响。
我们试图研究在初始重度哮喘评估时肺部和肺外可治疗特征对生活质量的影响，并比较在重度哮喘中心随访期间生活质量改善和未改善的患者的特征。
根据EQ-5D-5L效用指数四分位数比较英国重度哮喘登记处基线评估时患者的特征。有随访复查数据的患者根据EQ-5D-5L效用指数从基线到随访的变化进行分层，并对特征进行类似检查。
观察到基线时效用最差四分位数的患者表现出更多可治疗特征，特别是与累积全身皮质类固醇相关的肺外特征，包括肥胖、焦虑/抑郁和骨质疏松症。在随访期间生活质量改善的患者中，观察到病情加重、症状未得到控制以及维持口服皮质类固醇需求减少。
肺部和肺外可治疗特征都是重度哮喘生活质量的重要决定因素。与累积全身皮质类固醇暴露相关的合并症尤其与较差的生活质量相关，强调在合并症发生之前早期识别和管理重度哮喘的重要性。
