Dijk Lars, Gerritsma Yoran H, Van der Molen Thys, Pavord Ian, Meijer Ronald J, Kerstjens Huib, Kocks Janwillem
General Practitioners Research Institute, Groningen, The Netherlands.
University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands.
Int J Chron Obstruct Pulmon Dis. 2025 Apr 23;20:1189-1201. doi: 10.2147/COPD.S508281. eCollection 2025.
The primary objective of this study was to assess the prevalence of treatable traits (TTs) in patients with obstructive lung diseases in a primary care setting and how these TTs co-occur. The secondary objective was to assess the stability of TTs and the effect of management advice on changes in traits and health outcomes.
Data from the Dutch asthma/COPD service (2007-2023) were studied retrospectively. Patients ≥18 years with asthma, COPD, or Asthma-COPD overlap (ACO) were included. The prevalence of eight TTs were assessed: 1) insufficient inhaler technique, 2) poor medication adherence, 3) blood eosinophilia, 4) smoking, 5) obesity, 6) physical inactivity, 7) reversible airflow limitation, and 8) anxiety and/or depression. The effect of management advice on TTs was evaluated for patients with a follow-up visit scheduled within 1-2 years.
In total, 15246 patients (COPD n=4822; ACO n=1761, asthma n=8663) were included. The highest proportions of TTs were insufficient inhaler technique: 43.6% (95% CI: 42.9-44.4), followed by poor medication adherence: 40.3% (95% CI: 39.2-41.4) and blood eosinophilia: 36.9% (95% CI: 35.8-38.1). Overall, 83.3% of patients had ≥ 1 TTs, and 48.9% of patients ≥ 2 TTs. Among patients with blood eosinophilia, a significant reduction of the trait at follow-up (OR: 0.61, 95% CI: 0.39; 0.96) and improved health status were observed when the pulmonologist advised the general practitioner to initiate or increase the dose of ICS. No significant association was found between management advice and the exacerbation rate at follow-up.
The TTs assessed in this study are common in primary care patients, with nearly half of the patients showing a combination of at least two TTs. These TTs coexist in many different combinations. A personalized approach targeting these traits may be effective in achieving better control of these heterogeneous diseases.
本研究的主要目的是评估基层医疗环境中阻塞性肺疾病患者可治疗特征（TTs）的患病率以及这些TTs的共现情况。次要目的是评估TTs的稳定性以及管理建议对特征变化和健康结局的影响。
对荷兰哮喘/慢性阻塞性肺疾病服务机构（2007 - 2023年）的数据进行回顾性研究。纳入年龄≥18岁的哮喘、慢性阻塞性肺疾病或哮喘-慢性阻塞性肺疾病重叠综合征（ACO）患者。评估了八种TTs的患病率：1）吸入器技术不足，2）药物依从性差，3）血液嗜酸性粒细胞增多，4）吸烟，5）肥胖，6）身体活动不足，7）可逆性气流受限，8）焦虑和/或抑郁。对计划在1 - 2年内进行随访的患者评估管理建议对TTs的影响。
共纳入15246例患者（慢性阻塞性肺疾病患者4822例；ACO患者1761例，哮喘患者8663例）。TTs比例最高的是吸入器技术不足：43.6%（95%置信区间：42.9 - 44.4），其次是药物依从性差：40.3%（95%置信区间：39.2 - 41.4）和血液嗜酸性粒细胞增多：36.9%（95%置信区间：35.8 - 38.1）。总体而言，83.3%的患者有≥1种TTs，48.9%的患者有≥2种TTs。在血液嗜酸性粒细胞增多的患者中，当肺科医生建议全科医生启动或增加吸入糖皮质激素（ICS）剂量时，随访时该特征显著降低（比值比：0.61，95%置信区间：0.39；0.96）且健康状况改善。随访时未发现管理建议与加重率之间存在显著关联。
本研究评估的TTs在基层医疗患者中很常见，近一半患者表现出至少两种TTs的组合。这些TTs以多种不同组合共存。针对这些特征的个性化方法可能有效地更好控制这些异质性疾病。
