医学
哮喘
呼出气一氧化氮
逻辑回归
优势比
内科学
人口
哮喘恶化
儿科
肺活量测定
环境卫生
作者
Freda Yang,John Busby,Liam G. Heaney,Andrew Menzies‐Gow,Paul Pfeffer,David J. Jackson,Adel Mansur,Salman Siddiqui,Christopher E. Brightling,Robert Niven,Neil C. Thomson,Rekha Chaudhuri,Mitesh Patel,Robin Gore,Thomas Brown,Aashish Vyas,Deepak Subramanian
标识
DOI:10.1016/j.jaip.2020.12.062
摘要
Background
Frequent exacerbations are an important cause of morbidity in patients with severe asthma. Objective
Our aim was to identify factors associated with frequent exacerbations in a large well-characterized severe asthma population and determine whether factors differed in patients treated with and without maintenance oral corticosteroids (OCS). Methods
Adults with severe asthma from specialized asthma centers across the United Kingdom were recruited to the UK Severe Asthma Registry. Demography, comorbidities and physiological measurements were collected. We conducted univariable and multivariable logistic regression analyses to identify factors associated with frequent exacerbations, defined as 3 or more exacerbations treated with high-dose systemic corticosteroids in the past year. Results
Of 1,592 patients with severe asthma from the UK Severe Asthma Registry, 1,137 (71%) were frequent exacerbators and 833 (52%) were on maintenance OCS. The frequent exacerbators were more likely to be ex-smokers, have gastroesophageal reflux disease, higher Asthma Control Questionnaire-6 (ACQ-6) score, and higher blood eosinophilia. Multivariable regression analyses showed ACQ-6 score greater than 1.5 (odds ratio [OR] 4.25; P < .001), past smoking history (OR 1.55; P = .024), and fractional exhaled nitric oxide greater than 50ppb (OR 1.54; P = .044) were independently associated with frequent exacerbations. Past smoking history correlated with frequent exacerbations only in patients on maintenance OCS (OR 2.25; P = .004), whereas ACQ-6 score greater than 1.5 was independently associated with frequent exacerbations in those treated with and without maintenance OCS (OR 2.74; P = .017 and OR 6.42; P < .001, respectively). Conclusions
Several factors were associated with frequent exacerbations in a large UK severe asthma registry population. High ACQ-6 score had the strongest association with frequent exacerbations irrespective of maintenance OCS status.
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