Ricketts Helen Clare, Sharma Varun, Steffensen Femke, Mackay Elaine, MacDonald Gordon Wallace, Buchan Duncan S, Lean Michael, Chaudhuri Rekha, Cowan Douglas C
College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
Glasgow Clinical Research Facility, Glasgow Royal Infirmary, Glasgow, UK.
J Asthma Allergy. 2024 Sep 25;17:911-928. doi: 10.2147/JAA.S466894. eCollection 2024.
Management of difficult-to-treat asthma is particularly challenging in people with elevated body mass index (BMI). Our randomised controlled trial of pulmonary rehabilitation (PR) showed improved outcomes at 8 weeks. Here we assess immediate and one-year effects of asthma-tailored PR in participants with difficult-to-treat asthma and BMI ≥25 kg/m, and identify response predictors.
A prospective observational study of PR, tailored to asthma, comparing outcomes at baseline (V1), immediately after 8 weeks of PR (V2), and at 1 year (V3). Baseline characteristics were compared in responders/non-responders defined by achievement of minimum clinically important difference (MCID) for asthma control questionnaire (ACQ6) (0.5) at 8 weeks and 1 year.
Of 92 participants, 56 attended V2 and 45 attended V3. Mean age was 60 (SD 13) years, 60% were female, and median (IQR) BMI was 33.8 (29.5-38.7) kg/m. At V1, V2, and V3, respectively, there were significant differences in ACQ6 (mean (95% CI): 2.5 (2.1-2.9), 2.2 (1.8-2.5), and 2.3 (1.9-2.7), <0.003), Borg breathlessness score post-6-minute walk test (median (IQR): 2 (0.5-3), 1 (0-2), and 1 (0.5-2), <0.035), and annualised exacerbations requiring prednisolone (median (IQR): 3 (2-5), 0 (0-4.7), and 1.5 (0-4.2), <0.003). A total of 27/56 (48%) had improvements >MCID for ACQ6 at V2 and 16 (33%) at V3. Participants with higher ACQ6 scores at baseline (suggesting poorer asthma control) were more likely to achieve MCID. Baseline BMI, within the range studied, was not predictive.
Pulmonary rehabilitation induced improvements in asthma-related outcomes including perception of breathlessness, asthma control, and exacerbation frequency at 1 year. Those with poorer baseline asthma control were more likely to benefit.
对于体重指数（BMI）升高的人群，难治性哮喘的管理尤其具有挑战性。我们的肺康复（PR）随机对照试验显示8周时结果有所改善。在此，我们评估针对哮喘定制的PR对难治性哮喘且BMI≥25kg/m参与者的即刻和一年期效果，并确定反应预测因素。
一项针对哮喘定制的PR前瞻性观察性研究，比较基线（V1）、PR 8周后即刻（V2）和1年时（V3）的结果。根据哮喘控制问卷（ACQ6）在8周和1年时达到最小临床重要差异（MCID）（0.5）来定义反应者/无反应者，比较其基线特征。
92名参与者中，56人参加了V2评估，45人参加了V3评估。平均年龄为60（标准差13）岁，60%为女性，BMI中位数（四分位间距）为33.8（29.5 - 38.7）kg/m。在V1、V2和V3时，ACQ6评分分别有显著差异（均值（95%置信区间）：2.5（2.1 - 2.9）、2.2（1.8 - 2.5）和2.3（1.9 - 2.7），P<0.003），6分钟步行试验后的Borg呼吸困难评分分别为（中位数（四分位间距）：2（0.5 - 3）、1（0 - 2）和1（0.5 - 2），P<0.035），以及需要泼尼松龙治疗的年化加重次数分别为（中位数（四分位间距）：3（2 - 5）、0（0 - 4.7）和1.5（0 - 4.2），P<0.003）。共有27/56（48%）在V2时ACQ6改善超过MCID，16人（33%）在V3时达到。基线时ACQ6评分较高（提示哮喘控制较差）的参与者更有可能达到MCID。在所研究的BMI范围内，基线BMI无预测作用。
肺康复在1年时可改善哮喘相关结果，包括呼吸困难感知、哮喘控制和加重频率。基线哮喘控制较差的患者更可能从中获益。
