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Frequent exacerbators - a distinct phenotype of severe asthma

机译：频繁发作的患者-严重哮喘的独特表型

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Background: Exacerbations represent a major source of morbidity and mortality in asthma and are a prominent feature of poorly controlled, difficult-to-treat disease. Objective: The goal of our study was to provide a detailed characterization of the frequent exacerbator phenotype and to identify risk factors associated with frequent and seasonal exacerbations. Methods: Ninety-three severe asthmatics (SA) and 76 mild-to-moderate patients (MA) were screened and prospectively followed up for 1 year (NCT00555607). Medical history, baseline clinical data and biomarkers were used to assess risk factors for frequent exacerbations. Results: During the study, 104 exacerbations were recorded in the SA group and 18 in the MA. Frequent exacerbators were characterized by use of higher doses of inhaled (1700 vs. 800 μg) and oral (6.7 vs. 1.7 mg) glucocorticosteroids, worse asthma control (ACQ score 2.3 vs. 1.4), lower quality of life (SGRQ score 48.5 vs. 33.3), higher sputum eosinophils (25.7% vs. 8.2%) and a more rapid decline in FEV1/FVC ratio (-0.07 vs. -0.01 ΔFEV1/FVC, frequent vs. non-frequent, respectively, P 0.05). Exhaled NO 45 p.p.b. and a history of smoking were associated with an increased risk of frequent exacerbations (odds ratios: 4.32 and 2.90 respectively). Conclusion and Clinical Relevance: We were able to distinguish and characterize a subphenotype of asthma subjects - frequent exacerbators - who are significantly more prone to exacerbations. Patients with FeNO 45 p.p.b. and a history of smoking are at increased risk of frequent exacerbations and require careful monitoring in clinical practice.
机译：背景：急性发作是哮喘发病率和死亡率的主要来源，并且是控制不佳，难以治疗的疾病的显着特征。目的：我们的研究目的是提供频繁发作者表型的详细特征，并确定与频繁发作和季节性发作相关的危险因素。方法：筛查了93例严重哮喘患者（SA）和76例轻度至中度患者（MA），并进行了为期1年的前瞻性随访（NCT00555607）。使用病史，基线临床数据和生物标志物评估频繁发作的危险因素。结果：在研究期间，SA组记录了104次加重，MA组记录了18次加重。频繁发作的患者的特征是使用较高剂量的吸入糖皮质激素（1700 vs. 800μg）和口服（6.7 vs. 1.7 mg），哮喘控制较差（ACQ评分为2.3 vs. 1.4），生活质量较低（SGRQ评分为48.5vs。 （33.3），痰中嗜酸性粒细胞增多（分别为25.7％和8.2％）和FEV1 / FVC比值的下降较快（-0.07对-0.01ΔFEV1/ FVC，分别为频繁和不频繁，P <0.05）。呼出NO> 45 p.p.b.吸烟史和频繁发作的风险增加（比值分别为4.32和2.90）。结论与临床意义：我们能够区分并表征哮喘患者的亚表型-频繁发作的患者-明显更容易发作。 FeNO> 45 p.p.b.的患者吸烟史和吸烟史容易加重，因此在临床实践中需要仔细监测。

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