[Clinical characteristics of smoking asthma and efficacy of long-acting muscarinic antagonist in treating patients with smoking asthma].

Abstract / Summary

Objective: To analyze the clinical characteristics of smoking asthmatic patients and to evaluate the efficacy of long-acting muscarinic antagonist (LAMA) in treating smoking asthmatic patients. Methods: The characteristic analysis study of smoking asthma was a case-control study, including 128 patients with bronchial asthma. According to whether the patients smoked, they were divided into the smoking asthma group and the non-smoking asthma group. The clinical data, blood indicators, lung function indicators [forced expiratory volume in one second (FEV1), FEV1/forced vital capacity (FEV1/FVC), maximum mid-expiratory flow (MMEF 75/25)], and fractional exhaled nitric oxide (FeNO) were compared between the two groups. The efficacy of LAMA in treating smoking asthma patients was a randomized controlled trial. A total of 60 male patients with moderate to severe asthma, who were smokers and in a non-acute attack phase, were screened. According to computer-generated random numbers, they were divided into the intervention group [administered inhaled corticosteroid (ICS)+long-acting beta agonist (LABA)+LAMA for 1 month] and the control group (administered ICS+LABA for 1 month) in a 1∶1 ratio. Clinical characteristics, blood indicators, lung function indicators, asthma control test (ACT) scores, and Asthma Quality of Life Questionnaire (AQLQ) scores were collected before and after 1 month of treatment, and efficacy indicators were compared within and between groups before and after treatment. Results: A total of 98 patients were included in the non-smoking asthma group, aged (61.9±14.3) years, and 30 were male. A total of 30 patients were included in the smoking asthma group, aged (60.4±15.2) years, all of whom were male. The proportion of males in the smoking asthma group [30.0 (100.0)% vs 30.0 (30.6)%], blood neutrophil count [(4.5±1.9)×109/L vs (3.3±2.0)×109/L], and blood neutrophil ratio [(64.0±16.5)% vs (51.2±23.2)%] were higher than those in the non-smoking asthma group (all P<0.05). The blood eosinophil count of the non-smoking asthma group [(0.2±0.2)×109/L vs (0.1±0.1)×109/L], blood eosinophil ratio [(2.2±1.8)% vs (1.5±1.1)%], IgE [(374.5±496.5)u/ml vs (161.2±187.6) U/ml], FEV1 [(1.9±0.6)L vs (1.4±0.5) L], FEV1/FVC [(74.9±11.4)% vs (65.8±11.7)%], MMEF 75/25 [(1.8±1.0)L/s vs (1.3±0.8) L/s], and FeNO [M(Q1, Q3)][34.5 (17.3, 57.3) ppb vs 25.0 (17.0, 35.0) ppb (1 ppb=1×10-9)] were all higher than those in the smoking asthma group (all P<0.05). In the study on the efficacy of LAMA treatment for smoking asthma, the intervention group included 30 cases, with an age of (49.6±10.5) years. There were 30 cases in the control group, aged (50.5±11.0) years. There was no significant difference between the two groups from baseline (all P>0.05). The number of cigarettes smoked in both groups decreased before and after treatment [intervention group: (20.3±8.0) cigarettes/d vs (8.7±6.2) cigarettes/d; control group: (20.5±7.6) cigarettes/d vs (8.3±5.3) cigarettes/d], but there was no significant difference between the two groups before and after treatment (all P>0.05). Intra-group comparison, FEV1, FVC, FEV1/FVC, MMEF 75/25, ACT score, and AQLQ score of intervention group after treatment were higher than those before treatment, and FeNO of intervention group after treatment was lower than before treatment (all P<0.05). After treatment, the ACT score and AQLQ score of control group were higher than those before treatment (all P<0.05). Between-group comparison showed that after treatment, the intervention group had higher FEV1 [(2.5±0.7) L vs (1.9±0.7) L], FVC [(3.2±0.9) L vs (2.7±0.9) L], FEV1/FVC [(78.6±6.7)% vs (72.8±11.7)%], ACT score [23.0 (23.0, 24.0) points vs 21.5 (20.3, 24.0) points], and AQLQ score [101.0 (98.0, 104.0) points vs 97.5 (93.0, 101.3) points], and lower FeNO [14.5 (10.0, 28.3) ppb vs 25.0 (19.3, 51.5) ppb] than the control group (all P<0.05). Conclusions: This study indicates that smoking asthmatic patients have worse pulmonary function but lower FeNO and peripheral blood eosinophil counts than non-smoking asthmatic patients. Compared to ICS+LABA alone, the addition of LAMA to ICS+LABA significantly improves pulmonary function, reduces FeNO, and enhances symptom control and quality of life in smoking asthmatic patients. 目的： 分析吸烟哮喘患者的临床特征，并探讨长效抗胆碱药物（LAMA）治疗吸烟哮喘患者的有效性。 方法： 吸烟哮喘的特征分析研究为病例对照研究，共纳入128例支气管哮喘患者，根据患者是否吸烟分为吸烟哮喘组和非吸烟哮喘组，比较两组间临床资料、血液指标、肺功能指标［第1秒用力呼气量（FEV1）、用力肺活量（forced vital capacity，FVC）、FEV1与用力肺活量比值（FEV1/FVC）、最大呼气中期流量（MMEF 75/25）］及呼出气一氧化氮（FeNO）。LAMA治疗吸烟哮喘患者的疗效为随机对照试验，共筛选出60例处于非急性发作期且吸烟的男性中重度哮喘患者，按照计算机软件生成随机数，以1∶1的比例分成干预组［给予吸入性糖皮质激素（ICS）+长效β2受体激动剂（LABA）+LAMA治疗1个月］和对照组（给予ICS+LABA治疗1个月）。收集患者治疗1个月前后临床特征、血液指标、肺功能指标及哮喘症状（ACT）评分及哮喘生命质量（AQLQ）评分，比较治疗前后组内和组间疗效指标。 结果： 非吸烟哮喘组共纳入98例患者，年龄为（61.9±14.3）岁，男30例。吸烟哮喘组共纳入30例患者，年龄为（60.4±15.2）岁，全部为男性。吸烟哮喘组男性比例［30.0（100.0）%比30.0（30.6）%］、血中性粒细胞计数［（4.5±1.9）×109/L比（3.3±2.0）×109/L］、血中性粒细胞比例［（64.0±16.5）%比（51.2±23.2）%］均高于非吸烟哮喘组（均P<0.05）。非吸烟哮喘组患者的血嗜酸性粒细胞计数［（0.2±0.2）×109/L比（0.1±0.1）×109/L］、血嗜酸性粒细胞比例［（2.2±1.8）%比（1.5±1.1）%］、IgE［（374.5±496.5）U/ml比（161.2±187.6）U/ml］、FEV1［（1.9±0.6）L比（1.4±0.5）L］、FEV1/FVC［（74.9±11.4）%比（65.8±11.7）%］、MMEF 75/25［（1.8±1.0）L/s比（1.3±0.8）L/s］以及FeNO［M（Q1，Q3）］［34.5（17.3，57.3）ppb比25.0（17.0，35.0）ppb（1 ppb=1×10-9）］均高于吸烟哮喘组患者（均P<0.05）。LAMA治疗吸烟哮喘的疗效研究干预组30例，年龄为（49.6±10.5）岁；对照组30例，年龄为（50.5±11.0）岁。两组间基线指标差异无统计学意义（均P>0.05）。两组患者治疗前后吸烟支数均减少［干预组：（20.3±8.0）支/d比（8.7±6.2）支/d；对照组：（20.5±7.6）支/d比（8.3±5.3）支/d］，但两组间治疗前后差异均无统计学意义（均P>0.05）。组内比较，干预组治疗后，FEV1、FVC、FEV1/FVC、MMEF 75/25、ACT评分、AQLQ评分均高于治疗前，治疗后FeNO低于治疗前（均P<0.05）；对照组治疗后，ACT评分、AQLQ评分均高于治疗前（均P<0.05）。组间比较，治疗后干预组FEV1［（2.5±0.7）L比（1.9±0.7）L］、FVC［（3.2±0.9）L比（2.7±0.9）L］、FEV1/FVC［（78.6±6.7）%比（72.8±11.7）%］、ACT评分［23.0（23.0，24.0）分比21.5（20.3，24.0）分］、AQLQ评分［101.0（98.0，104.0）分比97.5（93.0，101.3）分］均高于对照组，FeNO［14.5（10.0，28.3）ppb比25.0（19.3，51.5）ppb］低于对照组（均P<0.05）。 结论： 与非吸烟哮喘患者相比，吸烟哮喘患者的肺功能更差，FeNO和外周血嗜酸性粒细胞计数更低。在吸烟哮喘患者中，与ICS+LABA相比，LAMA+ICS+LABA能降低吸烟哮喘患者的FeNO，改善吸烟哮喘患者的肺功能、临床症状以及生活质量。.

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