Predictive value of blood eosinophils and exhaled nitric oxide in adults with mild asthma: a prespecified subgroup analysis of an open-label, parallel-group, randomised controlled trial

医学 呼出气一氧化氮 布地奈德 福莫特罗 哮喘 吸入器 沙丁胺醇 布地奈德/福莫特罗 子群分析 内科学 支气管扩张剂 随机对照试验 恶化 临床试验 嗜酸性粒细胞 肺活量测定 置信区间
作者
Ian Pavord,Mark Holliday,Helen K. Reddel,Irene Braithwaite,Stefan Ebmeier,Robert J. Hancox,Tim Harrison,Claire Houghton,Karen Oldfield,Alberto Papi,Mathew Williams,Mark Weatherall,Richard Beasley,Andrew Corin,Colin Helm,Bhuwan Poudel,Davitt Sheahan,Pamela Sheahan,Miriam Bennett,Caterina Chang
出处
期刊:The Lancet Respiratory Medicine [Elsevier BV]
卷期号:8 (7): 671-680 被引量:96
标识
DOI:10.1016/s2213-2600(20)30053-9
摘要

Whether blood eosinophil counts and exhaled nitric oxide (FeNO) are associated with important outcomes in mild asthma is unclear. In this prespecified subgroup analysis of a previously published open-label clinical trial, we aimed to assess associations between blood eosinophil counts and FeNO with outcomes and response to asthma treatment.In the previously reported 52-week, open-label, randomised controlled trial, people with mild asthma receiving only β agonist reliever inhalers were enrolled at one of 16 clinical trials units in New Zealand, the UK, Italy, or Australia. Eligible participants were randomly assigned (1:1:1, stratified by country), to receive inhalers to take as-needed salbutamol (two inhalations of 100 μg in a pressurised metered dose inhaler), maintenance budesonide (200 μg twice per day by inhaler) plus as-needed salbutamol (two inhalations of 100 μg), or as-needed budesonide-formoterol (one inhalation of 200 μg budesonide and 6μg formoterol by inhaler). The primary outcome was the annual rates of asthma exacerbations per patient, and in this prespecified subgroup analysis, we assessed whether annual exacerbation rates in each treatment group were significantly different depending on levels of blood eosinophil count, FeNO, or a composite score of both. Analyses were done for patients with available biomarker measurements The study was registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12615000999538.675 participants were enrolled between March 17, 2016, and Aug 29, 2017, of whom 656 had results for blood eosinophil analysis and 668 had results for FeNO. Of the patients who received as-needed salbutamol, the proportion of patients having a severe exacerbation increased progressively with increasing blood eosinophil count (two [4%] of 49 participants with <0·15 × 109/L, six [6%] of 93 with 0·15 to <0·3 × 109/L, and 15 [19%] of 77 with ≥0·3 × 109/L; p=0·014). There were no significant interactions between blood eosinophil count or FeNO level and the effect of as-needed budesonide-formoterol compared with as-needed salbutamol for either exacerbations or severe exacerbations. However, there were significant interactions between blood eosinophil count subgroups and the effect of maintenance budesonide plus as-needed salbutamol compared with as-needed salbutamol, both for exacerbations (p=0·0006) and severe exacerbations (p=0·0007). Maintenance budesonide plus as-needed salbutamol was more effective than as-needed salbutamol in patients with blood eosinophil counts of 0·3 × 109/L or more, both for exacerbations (rate ratio 0·13 [95% CI 0·05-0·33]) and severe exacerbations (risk odds ratio 0·11 [0·03-0·45]). This difference was not seen for blood eosinophil counts of less than 0·15 × 109/L (1·15 [0·51-1·28] for exacerbations and 5·72 [0·97-33·60] for severe exacerbations). There was no consistent interaction between treatment response and FeNO or the composite score.In patients with mild asthma, the effects of as-needed budesonide-formoterol on exacerbations are independent of biomarker profile, whereas the benefits of maintenance inhaled budesonide are greater in patients with high blood eosinophil counts than in patients with low counts.AstraZeneca, Health Research Council of New Zealand.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
朴树朋友完成签到,获得积分20
刚刚
wlnhyF完成签到,获得积分10
2秒前
pursuit完成签到,获得积分10
5秒前
Neltharion完成签到,获得积分10
6秒前
沈海完成签到,获得积分10
8秒前
悦耳傥完成签到 ,获得积分10
8秒前
一叶知秋应助大橙子采纳,获得10
8秒前
科研小能手完成签到,获得积分10
9秒前
guoxingliu发布了新的文献求助200
10秒前
Double_N完成签到,获得积分10
13秒前
路路完成签到 ,获得积分10
14秒前
碧蓝的盼夏完成签到,获得积分10
18秒前
AU完成签到 ,获得积分10
19秒前
研友_yLpYkn完成签到,获得积分10
20秒前
兴奋的定帮完成签到 ,获得积分0
21秒前
一叶知秋应助大橙子采纳,获得10
22秒前
23秒前
金蛋蛋完成签到 ,获得积分10
23秒前
马琛尧完成签到 ,获得积分10
25秒前
一行白鹭上青天完成签到 ,获得积分10
29秒前
帅气的宽完成签到 ,获得积分10
30秒前
lixoii完成签到 ,获得积分10
32秒前
萌萌许完成签到,获得积分10
32秒前
sunce1990完成签到 ,获得积分10
35秒前
Bin_Liu完成签到,获得积分20
36秒前
宇老师完成签到,获得积分10
36秒前
研友_VZG7GZ应助马琛尧采纳,获得10
37秒前
安安的小板栗完成签到,获得积分10
40秒前
123_完成签到,获得积分10
42秒前
NexusExplorer应助大橙子采纳,获得10
43秒前
上善若水完成签到 ,获得积分10
45秒前
qiqi发布了新的文献求助10
49秒前
49秒前
英俊的铭应助cm采纳,获得10
50秒前
51秒前
量子星尘发布了新的文献求助10
51秒前
affy210310完成签到,获得积分10
52秒前
名字不好起完成签到,获得积分10
52秒前
齐朕完成签到,获得积分10
53秒前
大橙子发布了新的文献求助10
55秒前
高分求助中
【提示信息,请勿应助】关于scihub 10000
Les Mantodea de Guyane: Insecta, Polyneoptera [The Mantids of French Guiana] 3000
徐淮辽南地区新元古代叠层石及生物地层 3000
The Mother of All Tableaux: Order, Equivalence, and Geometry in the Large-scale Structure of Optimality Theory 3000
Handbook of Industrial Diamonds.Vol2 1100
Global Eyelash Assessment scale (GEA) 1000
Picture Books with Same-sex Parented Families: Unintentional Censorship 550
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 4038157
求助须知:如何正确求助?哪些是违规求助? 3575869
关于积分的说明 11373842
捐赠科研通 3305650
什么是DOI,文献DOI怎么找? 1819255
邀请新用户注册赠送积分活动 892655
科研通“疑难数据库(出版商)”最低求助积分说明 815022