背景:近年来,将LAMA纳入哮喘治疗有望增强症状控制.然而,相当数量的哮喘患者的症状管理仍然不佳.在使用IOS的哮喘治疗中,对LAMA诱导的气道改变的研究有限。在这项研究中,我们给哮喘控制不佳的患者服用了LAMA,评估临床反应和呼吸功能,并研究了使用IOS的LAMA治疗促进的气道变化。
方法:在总共1282名连续哮喘患者中,118表现出不受控制的症状。其中,42改用高剂量糠酸氟替卡松/米可地铵/维兰特罗(FF/UMEC/VI)(ICS/LABA/LAMA)治疗。然后使用AHQ-33或LCQ和ACT评估患者。测量肺活量测定参数(如FEV1或MMEF)和IOS参数(如R20或AX),并在加重和添加LAMA之前和之后进行比较。
结果:在42例患者中,17例因呼吸困难而切换至FF/UMEC/VI的患者在第1期和基线之间表现出肺功能下降,随后在基线和第2期之间肺功能增加。在IOS参数如R20、R5-R20、Fres、或AX在周期1和基线之间以及基线和周期2之间。在因咳嗽而改用吸入器的患者中,根据治疗结果,将25人分为应答者(n=17)和非应答者(n=8)。在无应答者中,肺活量测定参数如FEV1或PEF和IOS参数如R20或AX在第1期和基线之间没有显著差异.然而,在响应者中,在所有IOS参数中观察到显著差异,虽然不是在大多数肺活量测定参数中,在周期1和基线之间。此外,基线和第2期之间在FEV1、%MMEF、%PEF,和所有IOS参数。
结论:ICS/LABA/LAMA在改善症状和肺功能方面优于ICS/LABA,这主要归因于LAMA的加入。此外,IOS揭示了LAMA在所有气道段的有效性,特别是在外围。因此,LAMA可以有效对抗以气道炎症为特征的各种哮喘表型,即使在现实世界的情况下。
BACKGROUND: In recent years, the incorporation of LAMAs into asthma therapy has been expected to enhance symptom control. However, a significant number of patients with asthma continue to experience poorly managed symptoms. There have been limited investigations on LAMA-induced airway alterations in asthma treatment employing IOS. In this study, we administered a LAMA to patients with poorly controlled asthma, evaluated clinical responses and respiratory function, and investigated airway changes facilitated by LAMA treatments using the IOS.
METHODS: Of a total of 1282 consecutive patients with asthma, 118 exhibited uncontrolled symptoms. Among them, 42 switched their treatment to high-dose fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) (ICS/LABA/LAMA). The patients were then assessed using AHQ-33 or LCQ and ACT. Spirometry parameters (such as FEV1 or MMEF) and IOS parameters (such as R20 or AX) were measured and compared before and after exacerbations and the addition of LAMA.
RESULTS: Of the 42 patients, 17 who switched to FF/UMEC/VI caused by dyspnea exhibited decreased pulmonary function between period 1 and baseline, followed by an increase in pulmonary function between baseline and period 2. Significant differences were observed in IOS parameters such as R20, R5-R20, Fres, or AX between period 1 and baseline as well as between baseline and period 2. Among the patients who switched to inhaler due to cough, 25 were classified as responders (n = 17) and nonresponders (n = 8) based on treatment outcomes. Among nonresponders, there were no significant differences in spirometry parameters such as FEV1 or PEF and IOS parameters such as R20 or AX between period 1 and baseline. However, among responders, significant differences were observed in all IOS parameters, though not in most spirometry parameters, between period 1 and baseline. Furthermore, significant differences were noted between baseline and period 2 in terms of FEV1, %MMEF, %PEF, and all IOS parameters.
CONCLUSIONS: ICS/LABA/LAMA demonstrates superiority over ICS/LABA in improving symptoms and lung function, which is primarily attributed to the addition of LAMA. Additionally, IOS revealed the effectiveness of LAMA across all airway segments, particularly in the periphery. Hence, LAMA can be effective against various asthma phenotypes characterized by airway inflammation, even in real-world cases.