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重度哮喘的共病负担与临床管理挑战：泛欧洲SHARP研究的启示

Comorbidity Burden and Clinical Management Challenges in Severe Asthma: Insights from a Pan-European SHARP Study.

临床研究鼻科IF 3.7Q2

文献信息

PMID42936732
原文在 PubMed 查看原文 ↗
发表日期2026
作者Saša Rink
查看其他 69 位作者

Anna Freeman；Aruna T Bansal；Betty Frankemölle；Mehar Singh；Jacob K Sont；Apostolos Bossios；Ben Ainsworth；Michael Hyland；Rekha Chaudhuri；Dace Matisa；Florin Mihaltan；Antonio Spanevello；Enrico Heffler；Ian M Adcock；Martina Zappa；Giorgio Walter Canonica；Guy Brusselle；Arnaud Bourdin；Giulia Anna Maria Luigia Costanzo；Ildiko Horvath；Dóra Lúðvíksdóttir；Stefania Principe；Peter Kopač；Cláudia Chaves Loureiro；Caroline Giboin；Dounya Metdaoui；Eve Klising；Candice Estellat；Hadassa Cristhina Azevedo Soares Santos；Víctor Lozoya García；David Moreno-Martos；Kjell Erik Julius Håkansson；Susanne Hansen；Charlene Redmond；Salman Siddiqui；Arne Egesten；Virginija Kalinauskaite-Zukauske；Sanja Dimic-Janjic；Graham Roberts；Sanja Hromis；Branislava Milenkovic；Judit Varkonyi-Sepp；Ozlem Goksel；Ana Margarida Pereira；Ratko Djukanovic；Angela Rizzi；Marco Caminati；Ruihua Hou；Anamarija Štajduhar；Dóra Paróczai；Luisa Brussino；Liam G Heaney；Hans Michael Haitchi；Matteo Bonini；Kristina Bieksiene；Ebru Damadoglu；Valentyna Yasinska；Bilun Gemicioglu；Sanja Popović Grle；Anneke Ten Brinke；Zsuzsanna Csoma；Iveta Kroica；Piotr Kuna；Barbro Dahlen；Celeste Porsbjerg；Hilary Hodge；Florence Schleich；Sabina Škrgat；Ramesh J Kurukulaaratchy

作者单位Department of Pulmonary Diseases and Allergy, University Medical Centre Ljubljana, Ljubljana, Slovenia.
查看其他 63 条单位信息

Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.；School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.；National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.；Respiratory Medicine Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK.；Acclarogen Ltd, St John's Innovation Centre, Cambridge, UK.；European Lung Foundation, Sheffield, UK.；Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands.；Department of Respiratory Medicine and Allergy, Karolinska Severe Asthma Centre, Karolinska University Hospital, Stockholm, Sweden.；Division for Lung and Airway Research, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.；Lung Laboratory, Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden.；School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.；School of Psychology, University of Plymouth, Plymouth, UK.；School of Infection and Immunity, University of Glasgow, Glasgow, Scotland.；Department of Pneumology, Pauls Stradiņš Clinical University Hospital, Riga, Latvia.；National Institute of Pneumology, Bucharest, Romania.；Department of Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS Tradate, Italy.；Department of Biomedical Sciences, Humanitas University, Milan, Italy.；Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Milan, Italy.；National Heart & Lung Institute, Imperial College London, London, UK.；Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.；Department of Respiratory Diseases, Montpellier University Hospital, Arnaud de Villeneuve Hospital, Montpellier, France.；PhyMedExp (INSERM U 1046, CNRS UMR9214), Montpellier University, Montpellier, France.；Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy.；National Koranyi Institute of Pulmonology, Budapest, Hungary.；Department of Respiratory Medicine, Landspitali University Hospital and University of Iceland, Reykjavik, Iceland.；Department of Pulmonary Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands.；Department of Pneumology and Allergology, University Clinic of Respiratory Diseases Golnik, Golnik, Slovenia.；Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.；AP-HP.Sorbonne Université, Hôpital Pitié Salpêtrière, INSERM, Centre de Pharmacoépidémiologie, Paris, France.；Département de Santé Publique, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique - IPLESP, AP-HP, Hôpital Pitié Salpêtrière, Centre de Pharmacoépidémiologie (Cephepi), Paris, France.；MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.；Evidenze Clinical Research, Madrid, Spain.；Department of Respiratory and Infectious Diseases, Copenhagen University Hospital - Bispebjerg, Copenhagen, Denmark.；School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK.；Department of Clinical Sciences Lund, Respiratory Medicine, Allergology, & Palliative Medicine, Lund University and Skåne University Hospital, Lund, Sweden.；Department of Pulmonology, Lithuanian University of Health Sciences, Kaunas, Lithuania.；Faculty of Medicine, University of Belgrade, Belgrade, Serbia.；Clinic for Pulmonary Diseases, University Clinical Centre of Serbia, Belgrade, Serbia.；The David Hide Asthma & Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, Southampton, UK.；Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.；Faculty of Medicine, University in Novi Sad, Novi Sad, Serbia.；Clinical Health Psychology Department, Hampshire and Isle of Wight Healthcare NHS Foundation Trust/University Hospital Southampton NHS Foundation Trust, Southampton, UK.；Department of Pulmonary Medicine, Division of Immunology and Allergy, Laboratory of Occupational/Environmental Respiratory Diseases and Asthma, Ege University Faculty of Medicine, Izmir, Türkiye.；EgeSAM-Ege University Translational Pulmonary Research Center, Izmir, Türkiye.；PaCeIT - Patient Centred Innovation and Technologies, CINTESIS@RISE - Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal.；Allergy Unit, Instituto and Hospital CUF, Porto, Portugal.；UOSD Allergologia e Immunologia Clinica, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.；Department of Medicine, University of Verona, Verona, Italy.；Clinic for Pulmonary Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia.；School of Medicine, University of Zagreb, Zagreb, Croatia.；Department of Pulmonology, University of Szeged, Szeged, Hungary.；Allergy and Immunology Unit, Department of Medical Sciences, University of Turin, Turin, Italy.；Wellcome-Wolfson Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK.；Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.；Department of Pulmonology, Division of Allergy and Clinical Immunology, Hacettepe University, School of Medicine, Ankara, Türkiye.；Department of Medicine Huddinge, Clinical Lung and Allergy Research, Karolinska Institutet, Stockholm, Sweden.；Department of Pulmonary Diseases, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Türkiye.；Institute of Pulmonology and Tuberculosis, Istanbul University-Cerrahpaşa, Istanbul, Türkiye.；Department of Respiratory Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.；Department of Tuberculosis and Lung Diseases, Riga East University Hospital, Riga, Latvia.；Department of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Lodz, Poland.；Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.；Lab of Exercise Physiology, University of Liege, Liege, Belgium.

期刊Journal of asthma and allergy
SCI 分区Q2
IF3.7
研究类型临床研究 · 临床
所属专科鼻科

中文摘要

背景与目的： 重度哮喘（SA）常合并多种共病，这些共病显著恶化临床结局。然而，临床实践中对哮喘共病的识别仍不明确。我们旨在评估SA登记系统中共病记录方面的差距，评价欧洲各地共病患病率及其差异，并探讨医生对多病共存管理的观点，重点关注共病的真实世界识别与记录。
方法： 我们分析了来自22个欧洲登记系统的13,245例SA患者数据。将32种临床相关共病分为五类（2型（T2）相关、肺部、肺外、心理生理及类固醇相关），以评估登记系统的捕获情况和各国患病率。一项泛欧洲在线调查纳入239名SA专科医生，探讨多病共存管理的临床方法和资源。
结果： 在各登记系统中，T2相关和肺部共病的捕获一致性高于肺外、心理生理及类固醇相关疾病，且国家间差异显著。记录的最常见共病包括慢性鼻窦炎（40%）、鼻息肉（35%）、肥胖（30%）、过敏性鼻炎（30%）和胃食管反流病（29%），但其患病率在各国间差异很大。41%的受访医生缺乏多学科团队（MDT）可及性，时间不足（36%）和资金不足（26%）被报告为主要障碍。85%的受访者承认多病共存对哮喘结局的影响，并表示需要改进培训和患者教育以改善其管理。
结论： 共病在欧洲SA人群中高度流行，但在各登记系统中记录不一致，尤其是类固醇相关疾病。然而，这些发现应在登记系统结构、诊断路径和数据捕获实践存在国家间异质性的背景下解读。资源有限进一步制约了最佳的多病共存管理。这些发现强调需要标准化登记方案、改善MDT可及性以及开展有针对性的教育。本研究首次对SA登记系统中的共病捕获进行了泛欧洲评估，并同时呈现了医生对多病共存的观点。

英文摘要

BACKGROUND AND OBJECTIVE: Severe asthma (SA) is commonly complicated by multiple comorbidities, which significantly worsen clinical outcomes. However, the recognition of asthma comorbidities in clinical practice remains unclear. We aimed to assess gaps in comorbidity documentation in SA registries, evaluate comorbidity prevalence and variation across Europe, and explore physician perspectives on multimorbidity management, with a focus on real-world recognition and documentation of comorbidities.
METHODS: We analysed data from 13,245 SA patients across 22 European registries. Thirty-two clinically relevant comorbidities were grouped into five categories (type 2 (T2)-related, pulmonary, extrapulmonary, psychophysiological, and steroid-related) to assess registry capture and national prevalence. A pan-European online survey of 239 SA specialists explored clinical approaches and resources for multimorbidity management.
RESULTS: Across the registries, T2-related and pulmonary comorbidities were captured more consistently than extrapulmonary, psychophysiological, and steroid-related conditions, with substantial variation between countries. The most prevalent recorded comorbidities included chronic sinusitis (40%), nasal polyps (35%), obesity (30%), allergic rhinitis (30%), and gastroesophageal reflux disease (29%) but their prevalence varied widely across countries. Forty-one percent of surveyed physicians lacked multidisciplinary team (MDT) access, with lack of time (36%) and funding (26%) reported as the main barriers. Eighty-five percent of respondents acknowledged the impact of multimorbidity on asthma outcomes and expressed a need for improved training and patient education to improve its management.
CONCLUSION: Comorbidities are highly prevalent in European SA populations but remain inconsistently documented across registries, especially steroid-related conditions. However, these findings should be interpreted in the context of heterogeneity in registry structure, diagnostic pathways, and data capture practices across countries. Limited resources further constrain optimal multimorbidity management. These findings highlight the need for standardized registry protocols, improved MDT access, and targeted education. This study provides the first pan-European evaluation of comorbidity capture in SA registries alongside physician perspectives on multimorbidity.