韩国成年哮喘患者的早期临床缓解及其在肺功能下降和恶化中的作用
2025/04/06
摘要
引言：尽管哮喘管理取得了进展，但许多患者仍然经历着疾病控制不佳、肺功能下降和频繁恶化。临床缓解（CR）已被提出作为一种新的治疗靶点和长期结果的替代标志物。本研究评估了吸入糖皮质激素（ICS）开始后1年的早期CR是否会影响哮喘的肺功能下降和恶化风险。
方法：这项回顾性队列研究评估了两家教学医院492名接受ICS治疗的哮喘患者。患者分为早期CR组和非早期CR组。早期CR是根据一组综合标准定义的，包括持续无恶化、无全身性皮质类固醇使用、症状控制以及ICS启动后第一年肺功能稳定或改善。研究结果为一秒钟用力呼气量（FEV1）下降和中度至重度加重。
结果：早期完全缓解与FEV1年下降速度较慢显著相关（4组分完全缓解，调整后β=31.6 mL/年，p=0.001；3组分完全康复，调整后的β=15.7 mL/年（p=0.043）。早期4组分CR对减轻FEV1年下降的益处在特定表型中更为明显，包括2型高哮喘、持续性气流受限、严重哮喘和需要添加长效毒蕈碱拮抗剂的患者。早期4组分CR降低了中度至重度（调整后HR（aHR）=0.591，p=0.011）和严重恶化（aHR=0.508，p=0.025）的风险。
结论：ICS开始后1年内达到CR与改善肺功能保护和降低恶化风险有关。这些发现表明，实现早期CR作为哮喘管理的临床目标具有重要意义。
Early clinical remission and its role in lung function decline and exacerbation in adult Korean patients with asthma
Eunhye Bae, Hyun-Jun Park, Heemoon Park, Jung-Kyu Lee, Eun Young Heo, Chang Hoon Lee, Deog Kyeom Kim, Hyun Woo Lee
Abstract
Introduction: Despite advancements in asthma management, many patients continue to experience poor disease control, lung function decline, and frequent exacerbations. Clinical remission (CR) has been proposed as a novel treatment target and surrogate marker for long-term outcomes. This study evaluates whether early CR at 1 year after inhaled corticosteroid (ICS) initiation influences lung function decline and exacerbation risk in asthma.
Methods: This retrospective cohort study evaluated 492 asthma patients treated with ICS at two teaching hospitals. Patients were classified into early CR and non-early CR groups. Early CR was defined based on a composite set of criteria, including sustained absence of exacerbations, no systemic corticosteroid use, symptom control and stable or improved lung function in the first year following ICS initiation. Study outcomes were the annual forced expiratory volume in one second (FEV1) decline and the moderate-to-severe exacerbations.
Results: Early CR was significantly associated with slower annual FEV1 decline (4-component CR, adjusted β=31.6 mL/year, p=0.001; 3-component CR, adjusted β=15.7 mL/year, p=0.043). The benefits of early 4-component CR on attenuating annual FEV1 decline were more pronounced in specific phenotypes, including type-2 high asthma, persistent airflow limitation, severe asthma and patients requiring add-on long-acting muscarinic antagonists. Early 4-component CR had a reduced risk of moderate-to-severe (adjusted HR (aHR)=0.591, p=0.011) and severe exacerbations (aHR=0.508, p=0.025).
Conclusions: Achieving CR within 1 year of ICS initiation was associated with improved lung function preservation and reduced exacerbation risk. These findings suggest the importance of achieving early CR as a clinical target in asthma management.
引言：尽管哮喘管理取得了进展，但许多患者仍然经历着疾病控制不佳、肺功能下降和频繁恶化。临床缓解（CR）已被提出作为一种新的治疗靶点和长期结果的替代标志物。本研究评估了吸入糖皮质激素（ICS）开始后1年的早期CR是否会影响哮喘的肺功能下降和恶化风险。
方法：这项回顾性队列研究评估了两家教学医院492名接受ICS治疗的哮喘患者。患者分为早期CR组和非早期CR组。早期CR是根据一组综合标准定义的，包括持续无恶化、无全身性皮质类固醇使用、症状控制以及ICS启动后第一年肺功能稳定或改善。研究结果为一秒钟用力呼气量（FEV1）下降和中度至重度加重。
结果：早期完全缓解与FEV1年下降速度较慢显著相关（4组分完全缓解，调整后β=31.6 mL/年，p=0.001；3组分完全康复，调整后的β=15.7 mL/年（p=0.043）。早期4组分CR对减轻FEV1年下降的益处在特定表型中更为明显，包括2型高哮喘、持续性气流受限、严重哮喘和需要添加长效毒蕈碱拮抗剂的患者。早期4组分CR降低了中度至重度（调整后HR（aHR）=0.591，p=0.011）和严重恶化（aHR=0.508，p=0.025）的风险。
结论：ICS开始后1年内达到CR与改善肺功能保护和降低恶化风险有关。这些发现表明，实现早期CR作为哮喘管理的临床目标具有重要意义。
（中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校）
（Thorax. 2025 Mar 6:thorax-2024-222679. doi: 10.1136/thorax-2024-222679.）
Early clinical remission and its role in lung function decline and exacerbation in adult Korean patients with asthma
Eunhye Bae, Hyun-Jun Park, Heemoon Park, Jung-Kyu Lee, Eun Young Heo, Chang Hoon Lee, Deog Kyeom Kim, Hyun Woo Lee
Abstract
Introduction: Despite advancements in asthma management, many patients continue to experience poor disease control, lung function decline, and frequent exacerbations. Clinical remission (CR) has been proposed as a novel treatment target and surrogate marker for long-term outcomes. This study evaluates whether early CR at 1 year after inhaled corticosteroid (ICS) initiation influences lung function decline and exacerbation risk in asthma.
Methods: This retrospective cohort study evaluated 492 asthma patients treated with ICS at two teaching hospitals. Patients were classified into early CR and non-early CR groups. Early CR was defined based on a composite set of criteria, including sustained absence of exacerbations, no systemic corticosteroid use, symptom control and stable or improved lung function in the first year following ICS initiation. Study outcomes were the annual forced expiratory volume in one second (FEV1) decline and the moderate-to-severe exacerbations.
Results: Early CR was significantly associated with slower annual FEV1 decline (4-component CR, adjusted β=31.6 mL/year, p=0.001; 3-component CR, adjusted β=15.7 mL/year, p=0.043). The benefits of early 4-component CR on attenuating annual FEV1 decline were more pronounced in specific phenotypes, including type-2 high asthma, persistent airflow limitation, severe asthma and patients requiring add-on long-acting muscarinic antagonists. Early 4-component CR had a reduced risk of moderate-to-severe (adjusted HR (aHR)=0.591, p=0.011) and severe exacerbations (aHR=0.508, p=0.025).
Conclusions: Achieving CR within 1 year of ICS initiation was associated with improved lung function preservation and reduced exacerbation risk. These findings suggest the importance of achieving early CR as a clinical target in asthma management.
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