研究認為運動可改善氣喘控制


  【24drs.com】根據「有氧運動對氣喘發病率之影響(Ex-Asthma)」隨機研究的初步結果,在體適能相對較差的成年人中,12週有氧運動顯著改善氣喘控制。
  
  加拿大魁北克蒙特婁Concordia大學du Sacre-Coeur醫院的Simon Bacon博士等人表示,這篇研究結果認為,運動可作為這類患者藥物治療的輔助方法。
  
  他解釋,從歷史上看,人們有不鼓勵氣喘患者運動的迷思,但有趣的是,當患者做運動時,他們往往能夠有比較好的感覺。
  
  這篇研究發表為「CHEST 2015: 美國胸腔科醫師學院會議 」的最新發佈摘要。
  
  Bacon博士最近參與的一篇研究顯示,較常運動的氣喘患者疾病控制比較好(BMJ Open Respir Res. 2015;2:e000083)。
  
  目前這篇研究中,由醫師診斷有氣喘的33名患者被隨機分組,接受12週受監督的有氧運動,另外33人則是接受常規治療,所有研究對象的平均年齡為49歲;主要結果是運動後的氣喘控制,採用氣喘控制問卷(ACQ)評分加以測量。
  
  所有病患都是病況穩定,在開始時,7分ACQ量表的分數是2.0分,都有使用吸入型皮質類固醇治療,每日劑量相當於至少250 μg的fluticasone。
  
  如果是有共病症、無法運動、肥胖的患者則不被納入研究,Bacon博士解釋,因為體重和氣喘之間的關聯相當有趣,我們不希望研究結果受到干擾。
  
  一般來說,研究對象被分類為久坐不動-每週進行運動的時間少於60分鐘;這不是一個特別有體適能的族群。
  
  運動介入方法包括每週3次受監督的1小時課程,包括10分鐘暖身、40分鐘有氧運動(在前4週,心律儲量為50%-75%,在第5-12週則是70%-85%),以及10分鐘緩和;每次課程前15分鐘使用支氣管擴張劑,每次課程時檢查3次心律。
  
  至於常規治療組,病患在這12週研究期間維持久坐不動的生活形態,每4週聯繫一次以檢視症狀、藥物與運動程度,在研究結束時,讓他們有機會參與運動介入課程。
  
  運動組的氣喘控制顯著優於常規治療組(ACQ分數為1.34 vs 1.82;P = .008)。
  
  另外,每週使用短效支氣管擴張劑的次數方面,運動組比常規治療組少將近3次(P = .003),不過,兩組在最大耗氧量、乙酰甲膽鹼激發試驗、肺功能量計、痰液發炎生物標記等方面沒有差異。
  
  運動組和常規治療組在身體質量指數沒有差異,但是腰圍的變化有顯著差異(P = .04)。Bacon博士表示,與我們在對照組看到的增加幅度相比,(運動組)是真正有減少。
  
  運動也有一個心理上的效益,運動組的貝克憂鬱量表分數減少4分。Bacon博士表示,這一組是沒有憂鬱的,所以,即便是非憂鬱組,我們確實看到在心情方面有真正有趣的改善。
  
  ETH Zurich的Christina Spengler博士表示,這篇研究相當不錯地證明了我們的系統回顧和統合分析所總結的結果。她的研究團隊指出,分析的有關氣喘藥物使用的七篇研究中,大部份報告指出運動可以減少藥物的使用,只有兩篇研究認為沒有影響(Sports Med. 2013;43:1157-1170)。
  
  Spengler博士解釋,Bacon博士等人報告的運動的影響不被認為是有臨床意義的,因為ACQ量表0.5分是最小的臨床相關性差異。
  
  不幸的是,發表的ACQ量表改善與短效β-致效劑使用方面,在評估的任何氣喘特異性損傷上的改善都無法適當解釋。舉例來說,支氣管高反應性、肺功能、或發炎等方面並無改變,而其他研究有顯示出這些改善;因此,從機轉化的論點來看,觀察到的有改善的生理基礎仍不清楚。
  
  她指出,其他兩方面的研究結果也難以解釋。
  
  Spengler博士問道,為什麼運動訓練組(參與研究前久坐不動者)在3個月的耐力訓練之後,最大耗氧量並無顯著改善?這是相當意外的,是否是運動負荷量不足以改善他們的體適能程度? 還有,為什麼對照組的腰圍增加?這也是頗為意外。
  
  巴西Sao Paulo大學醫學院Celso Carvalho博士表示,很開心看到其他研究團體開始發現運動真正可以改善氣喘治療。
  
  Carvalho博士在氣喘與運動方面曾經發表相當多論述,他的研究團隊之前提出許多和Bacon博士的團隊一樣的發現。
  
  他表示,肺功能量計的結果沒有改變是令人驚訝的,因為有兩篇統合分析顯示會有差異。(Br J Sports Med. 2000;34:162-167以及Cochrane Database Syst Rev. 2013;30:CD001116)。
  
  不過,Carvalho博士指出,以他們的樣本規模,我本來預期他們會發現,在乙酰甲膽鹼激發試驗降低、痰液發炎生物標記增加。
  
  資料來源:http://www.24drs.com/
  
  Native link:Exercise Improves Asthma Control, Study Suggests

Exercise Improves Asthma Control, Study Suggests

By Kate Johnson
Medscape Medical News

MONTREAL — In relatively unfit adults, 12 weeks of aerobic exercise significantly improved asthma control, according to preliminary results from the randomized Impact of Aerobic Exercise on Asthma Morbidity (Ex-Asthma) study.

This finding suggests that exercise could be used as an adjunct to pharmacotherapy in this population, said lead investigator Simon Bacon, PhD, from Concordia University and Hopital du Sacre-Coeur in Montreal, Quebec, Canada.

"Historically, people have built this sort of myth that exercise for people with asthma should be discouraged, but anecdotally, when patients do exercise, they tend to report feeling better," he explained.

The study was presented as a late-breaking abstract here at CHEST 2015: the American College of Chest Physicians Meeting.

Dr Bacon was involved in a recent study showing that patients with asthma reporting higher levels of physical activity had better control of their disease (BMJ Open Respir Res. 2015;2:e000083).

In the current study, 33 patients with physician-diagnosed asthma were randomly assigned to receive 12 weeks of supervised aerobic activity and 33 were assigned to receive usual care. Mean age was 49 years. The primary outcome was postexercise asthma control, measured with the Asthma Control Questionnaire (ACQ) score.

All patients had stable but symptomatic disease, indicated by a baseline score of 2.0 on the 7-point ACQ scale, and were treated with inhaled corticosteroids, at a per day equivalent of at least 250μg of fluticasone.

Patients were excluded from the study if they had comorbidities, were unable to exercise, or were obese "because of the interesting relationship between weight and asthma, and we did not want to confound the findings," Dr Bacon explained.

In general, the cohort was classified as "sedentary," performing less then 60 minutes of planned physical activity per week. "This is not a particularly fit population," he pointed out.

The exercise intervention involved three supervised 1-hour sessions each week that consisted of a 10-minute warm-up, 40 minutes of aerobic exercise titrated at 50% to 75% of heart rate reserve for the first 4 weeks and 70% to 85% from weeks5 to 12, and a 10-minute cool-down. Bronchodilators were used 15 minutes before each session, and heart rate checks were performed three times during the session.

For usual care, patients were encouraged to maintain their sedentary lifestyle for the 12-week study period and were contacted every 4 weeks to check on symptoms, medication, and exercise levels. They were given the opportunity to participate in the exercise intervention at the conclusion of the study.

Asthma Control

Asthma control was significantly better in the exercise group than in the usual-care group (ACQ score, 1.34 vs 1.82; P= .008).

In addition, the weekly use of short-acting bronchodilators was nearly three times less in the exercise group than in the usual-care group (P = .003). However, maximal oxygen consumption, the methacholine challenge test, spirometry, and sputum inflammation biomarkers did not differ between groups.

There was also no difference in body mass index between the exercise and usual-care groups, but a significant difference was seen in change in waist circumference (P = .04). "This was really an attenuation of the increase we saw in the control group," said Dr Bacon.

Even in a nondepressed group, we're seeing some really interesting improvements in mood. Dr Simon Bacon

Exercise also had a psychological benefit. Beck Depression Inventory scores decreased 4 points in the exercise group. "And this is a group that was not depressed," said Dr Bacon. "So even in a nondepressed group, we're seeing some really interesting improvements in mood."

This study "nicely confirms previous results summarized in our systematic review and meta-analysis," said Christina Spengler, PhD, MD, from ETH Zurich. Her team showed that most of the seven studies analyzing the use of asthma medication reported a reduction in medication intake with exercise, whereas two studies reported none (Sports Med. 2013;43:1157-1170).

The effect of exercise reported by Dr Bacon and his colleagues would not be considered clinically meaningful because it is suggested that 0.5 is "the minimal clinically relevant difference in ACQ," Dr Spengler explained.

"Unfortunately, the presented improvements in ACQ and short-acting β-agonist use cannot be explained by improvements in any of the asthma-specific impairments assessed," she said. For instance, "there were no changes in bronchial hyper-reactivity, lung function, or inflammation," but such improvements have been shown in other studies.

"Therefore, from a mechanistic point of view, the physiological basis for the observed improvements remains unclear," she pointed out.

Two other aspects of the results are also difficult to explain, she added.

"Why did the exercise training subjects — a sedentary group before the study — have no significant improvement in maximal oxygen consumption after 3 months of endurance training?" Dr Spengler asked. "This is very unexpected. Was the load not high enough for their fitness level?"

"And why did waist circumference increase in the control group? This is also quite unexpected," she added.

"It is exciting to see that other groups are beginning to show that exercise really improves asthma treatment," said Celso Carvalho, PhD, from the University of Sao Paulo School of Medicine in Brazil.

Dr Carvalho, who has published extensively in the field of asthma and exercise, told Medscape Medical News that his group has previously shown many of the findings reported by Dr Bacon's team.

"Their finding of no change in spirometry is surprising, since there are two meta-analyses demonstrating this," he said (Br J Sports Med. 2000;34:162-167 and Cochrane Database Syst Rev. 2013;30:CD001116).

However, "I expect that they would find a reduction in the methacholine challenge test and sputum inflammation biomarkers with an increase in their sample size," Dr Carvalho added.

Dr Bacon reports financial relationships with GlaxoSmithKline, AbbVie, Schering-Plough, Merck, Kataka Medical Communication, and Novartis. Dr Spengler and Dr Carvalho have disclosed no relevant financial relationships.

CHEST 2015: American College of Chest Physicians Meeting. Presented October26, 2015.

    
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