Background

Several studies have investigated the physiological effect of OCS in stable asthma, however these have included heterogeneous populations and outcomes. This paper is the first to combine their results.

Methods

We searched Medline, Embase and Web of Science databases for studies reporting the impact of OCS on FEV₁, FVC, blood eosinophils, fractional exhaled nitric oxide (FeNO), Asthma Control Questionnaire (ACQ) score or Asthma Quality Of Life Questionnaire (AQLQ) score in stable asthma. We extracted data on the correlates of OCS response.

Results

61 studies, comprising 1608 patients, were included. FEV₁ was improved by 9% (95% CI: 7, 11). There were stronger increases in FEV₁ among those with a mean baseline FEV₁<60% predicted (19%, 95% CI: 13, 24). Despite these improvements, substantial residual impairment remained after treatment. Blood eosinophils were reduced by 76% (95% CI: 63, 88) with larger decreases in studies of corticosteroid-naïve patients (93%, 95% CI: 73,100). Sputum eosinophils were reduced by 89% (95% CI: 79, 98) while FeNO was decreased by 35% (95% CI: 28, 41). ACQ scores were reduced by 20% (95% CI: 11, 29). Patients with higher baseline lung function impairment, sputum eosinophils, blood eosinophils and FeNO had improved OCS response.

Interpretation

OCS consistently improves lung function, reduces markers of type-2 inflammation, and alleviates asthma symptoms. However, substantial residual impairment remained following treatment and mean improvements were below the minimally important clinically difference. Patients with increased markers of type-2 inflammation are more responsive to treatment, suggesting these should be used to better target OCS use.

中文翻译：

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口服糖皮质激素对稳定型哮喘患者肺功能，2型生物标志物和患者报告结局的影响：系统评价和荟萃分析

背景

数项研究已经研究了OCS在稳定型哮喘中的生理作用，但是其中包括异质性人群和结局。本文是第一个结合他们的结果。

方法

我们搜索了Medline，Embase和Web of Science数据库，以研究报告OCS对FEV ₁，FVC，血液嗜酸性粒细胞，呼出气一氧化氮（FeNO），哮喘控制问卷（ACQ）得分或哮喘生活质量问卷（AQLQ）的影响哮喘稳定评分。我们提取了与OCS响应相关的数据。

结果

包括61项研究，包括1608例患者。FEV ₁提高了9％（95％CI：7、11）。在平均基线FEV ₁ <60％预测值的人群中，FEV _1的升高更大（19％，95％CI：13、24）。尽管有这些改进，但治疗后仍存在大量残余损伤。初次接受糖皮质激素治疗的患者的血液嗜酸性粒细胞减少了76％（95％CI：63、88），降幅更大（93％，95％CI：73,100）。痰中的嗜酸性粒细胞减少了89％（95％CI：79、98），而FeNO减少了35％（95％CI：28、41）。ACQ分数降低了20％（95％CI：11、29）。基线肺功能受损，痰中嗜酸性粒细胞，血液嗜酸性粒细胞和FeNO升高的患者OCS反应改善。

解释

OCS持续改善肺功能，减少2型炎症的标志，并缓解哮喘症状。但是，治疗后仍然存在大量残余损伤，平均改善低于最低限度的重要临床差异。2型炎症标记物增多的患者对治疗的反应更强，建议应使用这些标记物更好地靶向OCS使用。