Chamard Wongsa MD , Pakpoom Wongyikul MD , Piyaporn Chokevittaya MD , Anapat Nititammaluk MD , Kay Khine Soe MD, PhD , Phichayut Phinyo MD, PhD , Jonathan A. Bernstein MD , Torpong Thongngarm MD
{"title":"患有轻度至中度哮喘的青少年和成人的亚型流行率和治疗意义：系统回顾和荟萃分析","authors":"Chamard Wongsa MD , Pakpoom Wongyikul MD , Piyaporn Chokevittaya MD , Anapat Nititammaluk MD , Kay Khine Soe MD, PhD , Phichayut Phinyo MD, PhD , Jonathan A. Bernstein MD , Torpong Thongngarm MD","doi":"10.1016/j.jacig.2024.100366","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Inhaled corticosteroid (ICS)-containing regimens are the mainstay for treating asthma despite usually being ineffective in noneosinophilic asthma (NEA). Data on the prevalence of NEA versus eosinophilic asthma (EA) in mild-to-moderate asthma are limited.</div></div><div><h3>Objective</h3><div>We performed a systematic review of the prevalence of mild-to-moderate asthma in adolescents and adults using sputum inflammatory cell analysis and their responses to ICS.</div></div><div><h3>Methods</h3><div>We searched electronic databases (PubMed, Scopus, EMBASE, Cochrane) for studies in adolescents and adults with mild-to-moderate asthma. The primary outcome was the prevalence of asthma subtypes based on sputum inflammatory cell analysis, categorized into EA and NEA. The secondary outcome involved comparing asthma outcomes between different subtypes after ICS therapy. Certainty of evidence was reported for each pooled analysis.</div></div><div><h3>Results</h3><div>Eighteen studies involving 3,533 adolescents and adults with mild-to-moderate asthma were reviewed. The pooled prevalence (95% confidence interval) of NEA was estimated at 40.39% (27.54, 53.93) in patients with ICS naive with very low certainty of evidence. On reevaluating sputum cytology, the disease of approximately 20% to 30% of patients initially diagnosed as NEA transitioned to the EA subtype. EA patients showed significant improvements in asthma symptoms after ICS therapy: forced expiratory volume in 1 second (standardized mean difference, 0.79; 95% confidence interval, 0.30, 1.27), and airway hyperresponsiveness (standardized mean difference, 1.34; 95% confidence interval, 0.29, 2.40). NEA patients exhibited limited response.</div></div><div><h3>Conclusion</h3><div>A high proportion of adolescents and adults with mild-to-moderate asthma were identified with NEA subtype disease, which exhibited a poor response to ICS. A thorough diagnostic evaluation before initiating treatment should be integrated into clinical practice.</div><div>Registered in PROSPERO (CRD42023484334)</div></div>","PeriodicalId":75041,"journal":{"name":"The journal of allergy and clinical immunology. Global","volume":"4 1","pages":"Article 100366"},"PeriodicalIF":0.0000,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Subtype prevalence and treatment implication in adolescents and adults with mild-to-moderate asthma: Systematic review and meta-analysis\",\"authors\":\"Chamard Wongsa MD , Pakpoom Wongyikul MD , Piyaporn Chokevittaya MD , Anapat Nititammaluk MD , Kay Khine Soe MD, PhD , Phichayut Phinyo MD, PhD , Jonathan A. Bernstein MD , Torpong Thongngarm MD\",\"doi\":\"10.1016/j.jacig.2024.100366\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Inhaled corticosteroid (ICS)-containing regimens are the mainstay for treating asthma despite usually being ineffective in noneosinophilic asthma (NEA). Data on the prevalence of NEA versus eosinophilic asthma (EA) in mild-to-moderate asthma are limited.</div></div><div><h3>Objective</h3><div>We performed a systematic review of the prevalence of mild-to-moderate asthma in adolescents and adults using sputum inflammatory cell analysis and their responses to ICS.</div></div><div><h3>Methods</h3><div>We searched electronic databases (PubMed, Scopus, EMBASE, Cochrane) for studies in adolescents and adults with mild-to-moderate asthma. The primary outcome was the prevalence of asthma subtypes based on sputum inflammatory cell analysis, categorized into EA and NEA. The secondary outcome involved comparing asthma outcomes between different subtypes after ICS therapy. Certainty of evidence was reported for each pooled analysis.</div></div><div><h3>Results</h3><div>Eighteen studies involving 3,533 adolescents and adults with mild-to-moderate asthma were reviewed. The pooled prevalence (95% confidence interval) of NEA was estimated at 40.39% (27.54, 53.93) in patients with ICS naive with very low certainty of evidence. On reevaluating sputum cytology, the disease of approximately 20% to 30% of patients initially diagnosed as NEA transitioned to the EA subtype. EA patients showed significant improvements in asthma symptoms after ICS therapy: forced expiratory volume in 1 second (standardized mean difference, 0.79; 95% confidence interval, 0.30, 1.27), and airway hyperresponsiveness (standardized mean difference, 1.34; 95% confidence interval, 0.29, 2.40). NEA patients exhibited limited response.</div></div><div><h3>Conclusion</h3><div>A high proportion of adolescents and adults with mild-to-moderate asthma were identified with NEA subtype disease, which exhibited a poor response to ICS. A thorough diagnostic evaluation before initiating treatment should be integrated into clinical practice.</div><div>Registered in PROSPERO (CRD42023484334)</div></div>\",\"PeriodicalId\":75041,\"journal\":{\"name\":\"The journal of allergy and clinical immunology. Global\",\"volume\":\"4 1\",\"pages\":\"Article 100366\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-11-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"The journal of allergy and clinical immunology. 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Subtype prevalence and treatment implication in adolescents and adults with mild-to-moderate asthma: Systematic review and meta-analysis
Background
Inhaled corticosteroid (ICS)-containing regimens are the mainstay for treating asthma despite usually being ineffective in noneosinophilic asthma (NEA). Data on the prevalence of NEA versus eosinophilic asthma (EA) in mild-to-moderate asthma are limited.
Objective
We performed a systematic review of the prevalence of mild-to-moderate asthma in adolescents and adults using sputum inflammatory cell analysis and their responses to ICS.
Methods
We searched electronic databases (PubMed, Scopus, EMBASE, Cochrane) for studies in adolescents and adults with mild-to-moderate asthma. The primary outcome was the prevalence of asthma subtypes based on sputum inflammatory cell analysis, categorized into EA and NEA. The secondary outcome involved comparing asthma outcomes between different subtypes after ICS therapy. Certainty of evidence was reported for each pooled analysis.
Results
Eighteen studies involving 3,533 adolescents and adults with mild-to-moderate asthma were reviewed. The pooled prevalence (95% confidence interval) of NEA was estimated at 40.39% (27.54, 53.93) in patients with ICS naive with very low certainty of evidence. On reevaluating sputum cytology, the disease of approximately 20% to 30% of patients initially diagnosed as NEA transitioned to the EA subtype. EA patients showed significant improvements in asthma symptoms after ICS therapy: forced expiratory volume in 1 second (standardized mean difference, 0.79; 95% confidence interval, 0.30, 1.27), and airway hyperresponsiveness (standardized mean difference, 1.34; 95% confidence interval, 0.29, 2.40). NEA patients exhibited limited response.
Conclusion
A high proportion of adolescents and adults with mild-to-moderate asthma were identified with NEA subtype disease, which exhibited a poor response to ICS. A thorough diagnostic evaluation before initiating treatment should be integrated into clinical practice.
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