Leonie Biener, Hussein Morobeid, Carmen Pizarro, Georg Nickenig, Dirk Skowasch
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Follow-up evaluations were conducted after a minimum of 6 months of therapy.</p><p><strong>Results: </strong>After 34.0 ± 10.2 weeks, comparable therapeutic responses were observed between the three groups. There were no differences between the groups in terms of reduction in the annual acute exacerbation rate (AE median -3 [25th percentile -5; 75th percentile -1] vs. -6.1 [-11.3;-2.2] vs. -3 [-6;-2], p = 0.067), oral corticosteroid (OCS) doses (-5 [-10;0] vs. -1 [-7.5;0] vs. -7.5 [-10;-4] mg, p = 0.136), improvement in Asthma Control Test (ACT) scores (4 [0;9.3] vs. 3 [-1;6] vs. 4 [3;10], p = 0.276) or forced expiratory volume in 1 s (FEV1) improvement (5.5 [-2;21.5] vs. 0.5 [-2.8;9.3] vs. 5 [0;16] % predicted, p = 0.328). Linear regression analysis revealed no significant correlation between DLCO levels and changes in OCS dosage or AE rate, nor between DLCO and improvements in ACT scores or FEV1. Notably, a smaller proportion of patients exhibited a reduced transfer coefficient (DLCO/VA) (n = 13, 16.9%). This parameter did not significantly impact therapy response either.</p><p><strong>Conclusion: </strong>Our findings suggest that biologic therapy can effectively manage asthma irrespective of DLCO measurements. Thus, reduced DLCO values should not preclude thorough asthma diagnosis and treatment. Further investigation into the utility of DLCO/VA assessment in this context is warranted.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"733-740"},"PeriodicalIF":3.5000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Response to Biologic Therapy in Patients with Asthma and Reduced Pulmonary Diffusion Capacity.\",\"authors\":\"Leonie Biener, Hussein Morobeid, Carmen Pizarro, Georg Nickenig, Dirk Skowasch\",\"doi\":\"10.1159/000541159\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Asthma patients with a smoking history are usually excluded from asthma trials to exclude smoking-related comorbidities like chronic obstructive pulmonary disease (COPD). Therefore, little is known about the efficacy of biologic therapy in asthma patients with reduced diffusing capacity of the lungs for carbon monoxide (DLCO).</p><p><strong>Methods: </strong>This study aimed to assess the response to biologic therapy in asthma patients with reduced DLCO. A total of 77 consecutive patients undergoing biologic therapy in a routine clinical setting were included in the analysis and divided into three groups: DLCO ≥60%, DLCO <60% and <10 pack-years, and DLCO <60% and ≥10 pack-years = asthma and COPD comorbidity. Follow-up evaluations were conducted after a minimum of 6 months of therapy.</p><p><strong>Results: </strong>After 34.0 ± 10.2 weeks, comparable therapeutic responses were observed between the three groups. There were no differences between the groups in terms of reduction in the annual acute exacerbation rate (AE median -3 [25th percentile -5; 75th percentile -1] vs. -6.1 [-11.3;-2.2] vs. -3 [-6;-2], p = 0.067), oral corticosteroid (OCS) doses (-5 [-10;0] vs. -1 [-7.5;0] vs. -7.5 [-10;-4] mg, p = 0.136), improvement in Asthma Control Test (ACT) scores (4 [0;9.3] vs. 3 [-1;6] vs. 4 [3;10], p = 0.276) or forced expiratory volume in 1 s (FEV1) improvement (5.5 [-2;21.5] vs. 0.5 [-2.8;9.3] vs. 5 [0;16] % predicted, p = 0.328). Linear regression analysis revealed no significant correlation between DLCO levels and changes in OCS dosage or AE rate, nor between DLCO and improvements in ACT scores or FEV1. Notably, a smaller proportion of patients exhibited a reduced transfer coefficient (DLCO/VA) (n = 13, 16.9%). This parameter did not significantly impact therapy response either.</p><p><strong>Conclusion: </strong>Our findings suggest that biologic therapy can effectively manage asthma irrespective of DLCO measurements. Thus, reduced DLCO values should not preclude thorough asthma diagnosis and treatment. 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引用次数: 0
摘要
引言 有吸烟史的哮喘患者通常被排除在哮喘试验之外，以排除与吸烟相关的合并症，如慢性阻塞性肺病（COPD）。因此，人们对一氧化碳肺弥散能力（DLCO）降低的哮喘患者接受生物疗法的疗效知之甚少。方法 本研究旨在评估 DLCO 降低的哮喘患者对生物疗法的反应。共有 77 名在常规临床环境中接受生物治疗的患者被纳入分析，并分为三组（1.DLCO ≥60%；2.DLCO <60% and <10 pack-years；3.DLCO <60% and ≥10 pack-years=哮喘和慢性阻塞性肺疾病合并症）。治疗至少 6 个月后进行随访评估。结果 34.0 ± 10.2 周后，三组患者的治疗反应相当。组间在急性加重年率降低（AE 中位数 -3 [25%-percentile -5; 75%-percentile -1] vs. -6.1 [-11.3;-2.2] vs. -3 [-6;-2]，P=0.067）、口服皮质类固醇（OCS）剂量（-5 [-10;0] vs. -1 [-7.5;0] vs. -7.5 [-10;-4] mg，p=0.136）、哮喘控制测试（ACT）评分的改善（4 [0;9.3] vs. 3 [-1;6] vs. 4 [3;10]，p=0.276）或一秒钟用力呼气容积（FEV1）的改善（5.5 [-2;21.5] vs. 0.5 [-2.8;9.3] vs. 5 [0;16] %预测值，p=0.328）。线性回归分析表明，DLCO 水平与 OCS 剂量或 AE 率的变化无明显相关性，DLCO 与 ACT 评分或 FEV1 的改善也无明显相关性。值得注意的是，较小比例的患者表现出转移系数（DLCO/VA）降低（13 人，16.9%）。这一参数对治疗反应也没有明显影响。结论 我们的研究结果表明，无论 DLCO 测量结果如何，生物疗法都能有效控制哮喘。因此，DLCO 值降低不应妨碍哮喘的彻底诊断和治疗。在这种情况下，有必要进一步研究 DLCO/VA 评估的效用。
Response to Biologic Therapy in Patients with Asthma and Reduced Pulmonary Diffusion Capacity.
Introduction: Asthma patients with a smoking history are usually excluded from asthma trials to exclude smoking-related comorbidities like chronic obstructive pulmonary disease (COPD). Therefore, little is known about the efficacy of biologic therapy in asthma patients with reduced diffusing capacity of the lungs for carbon monoxide (DLCO).
Methods: This study aimed to assess the response to biologic therapy in asthma patients with reduced DLCO. A total of 77 consecutive patients undergoing biologic therapy in a routine clinical setting were included in the analysis and divided into three groups: DLCO ≥60%, DLCO <60% and <10 pack-years, and DLCO <60% and ≥10 pack-years = asthma and COPD comorbidity. Follow-up evaluations were conducted after a minimum of 6 months of therapy.
Results: After 34.0 ± 10.2 weeks, comparable therapeutic responses were observed between the three groups. There were no differences between the groups in terms of reduction in the annual acute exacerbation rate (AE median -3 [25th percentile -5; 75th percentile -1] vs. -6.1 [-11.3;-2.2] vs. -3 [-6;-2], p = 0.067), oral corticosteroid (OCS) doses (-5 [-10;0] vs. -1 [-7.5;0] vs. -7.5 [-10;-4] mg, p = 0.136), improvement in Asthma Control Test (ACT) scores (4 [0;9.3] vs. 3 [-1;6] vs. 4 [3;10], p = 0.276) or forced expiratory volume in 1 s (FEV1) improvement (5.5 [-2;21.5] vs. 0.5 [-2.8;9.3] vs. 5 [0;16] % predicted, p = 0.328). Linear regression analysis revealed no significant correlation between DLCO levels and changes in OCS dosage or AE rate, nor between DLCO and improvements in ACT scores or FEV1. Notably, a smaller proportion of patients exhibited a reduced transfer coefficient (DLCO/VA) (n = 13, 16.9%). This parameter did not significantly impact therapy response either.
Conclusion: Our findings suggest that biologic therapy can effectively manage asthma irrespective of DLCO measurements. Thus, reduced DLCO values should not preclude thorough asthma diagnosis and treatment. Further investigation into the utility of DLCO/VA assessment in this context is warranted.
期刊介绍：
''Respiration'' brings together the results of both clinical and experimental investigations on all aspects of the respiratory system in health and disease. Clinical improvements in the diagnosis and treatment of chest and lung diseases are covered, as are the latest findings in physiology, biochemistry, pathology, immunology and pharmacology. The journal includes classic features such as editorials that accompany original articles in clinical and basic science research, reviews and letters to the editor. Further sections are: Technical Notes, The Eye Catcher, What’s Your Diagnosis?, The Opinion Corner, New Drugs in Respiratory Medicine, New Insights from Clinical Practice and Guidelines. ''Respiration'' is the official journal of the Swiss Society for Pneumology (SGP) and also home to the European Association for Bronchology and Interventional Pulmonology (EABIP), which occupies a dedicated section on Interventional Pulmonology in the journal. This modern mix of different features and a stringent peer-review process by a dedicated editorial board make ''Respiration'' a complete guide to progress in thoracic medicine.
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