Perception of Pulmonary Function in Children with Asthma and Cystic Fibrosis.
Perception of Pulmonary Function in Children with Asthma and Cystic Fibrosis.
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哮喘和囊性纤维化儿童肺功能的认知。
DOI：
10.1089/ped.2018.0906
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Weiner,DanielJ
中科院分区：
文献类型：
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作者：
Forno,Erick;Abraham,Neethu;Winger,DanielG;Rosas-Salazar,Christian;Kurland,Geoffrey;Weiner,DanielJ
背景：对肺功能障碍的认识不足可能会延误适当的治疗，而过度认识可能会导致不必要的治疗。目的：评估哮喘或囊性纤维化患者及其专科护理人员根据主观临床印象评估肺功能变化的能力。方法：要求患者定性描述与之前就诊相比的感受（相同/更好/更差），并定量估计他们 1 秒内的用力呼气量(FEV1) 在上次就诊时被提醒其 FEV1 后。提供者根据病史、体格检查以及之前 FEV1 的知识做出类似的估计。调整相关临床协变量后，肺功能估计被分为准确（测量 FEV1 的 ±5%）、高估（高于测量值 > 5%）和低估（低于测量值 > 5%）。 结果：109 名患者在 179 次评估 FEV1。患者定性评估与基于 FEV1 的类别之间的一致性较低 (κ= 0.08)； 44% 的患者报告感觉比基于 FEV1 的类别显示的感觉更好。从数量上看，56% 的患者估计是准确的，18% 的估计被低估，26% 的患者估计高估；准确性随着年龄的增长而提高（优势比 = 1.16，P= 0.01）。提供者定性评估与基于 FEV1 的类别之间的一致性中等 (κ= 0.35)；大约 19% 的患者表示，他们的患者看起来比基于 FEV1 的类别显示的要好。从数量上看，65% 的供应商估计是准确的，16% 的估计被低估，19% 的供应商估计被高估；准确性随着多年的经验而提高。结论：患者和提供者对肺功能的看法从低到中等准确度。依赖主观印象可能会使患者面临不必要的治疗或发病率增加的风险。这些发现强调了客观肺功能评估的重要性。
Background:Under-perception of pulmonary dysfunction may delay appropriate treatment, while over-perception may result in unnecessary treatments.Objectives:To evaluate the ability of patients with asthma or cystic fibrosis and their subspecialty caregivers to assess changes in lung function based on their subjective clinical impressions.Methods:Patients were asked to qualitatively describe how they felt compared to their prior visit (same/better/worse) and to quantitatively estimate their forced expiratory volume in 1 s (FEV1) after being reminded of their FEV1at the prior visit. Providers made similar estimates based on history and physical examination and knowledge of prior FEV1. After adjusting for relevant clinical covariates, lung function estimates were categorized as accurate (±5% of measured FEV1), overestimated (>5% above measured), and underestimated (>5% below measured).Results:One hundred nine patients estimated FEV1on 179 occasions. Concordance between patient qualitative assessment and FEV1-based categories was low (κ= 0.08); 44% of patients reported feeling better than the FEV1-based category showed. Quantitatively, 56% of patient estimates were accurate, 18% were underestimated, and 26% overestimated; accuracy improved with age (odds ratio = 1.16,P= 0.01). Concordance between provider qualitative assessments and FEV1-based category was moderate (κ= 0.35); about 19% said their patient looked better than the FEV1-based category showed. Quantitatively, 65% of provider estimates were accurate, 16% were underestimated, and 19% were overestimated; accuracy improved with years of experience.Conclusions:Patients' and providers' perceptions of lung function were low to moderately accurate. Relying on subjective impression may place patients at risk for unnecessary treatments or increased morbidity. These findings highlight the importance of objective lung function assessment.