Intensive care unit admission for asthma: a marker for severe disease.
Intensive care unit admission for asthma: a marker for severe disease.
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因哮喘入住重症监护室：严重疾病的标志。
DOI：
10.1081/jas-62959
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发表时间：
2005
期刊：
影响因子：
--
通讯作者：
Iribarren,Carlos
中科院分区：
文献类型：
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作者：
Eisner,MarkD;Boland,Maureen;Tolstykh,Irina;Mendoza,Guillermo;Iribarren,Carlos
在美国和其他发达国家，哮喘似乎是一种流行病，患病率和严重程度都在增加。尽管有这些趋势，对严重哮喘的了解仍然有限。由于缺乏明确的方法来确定一组患有严重哮喘的成年人，研究受到了阻碍。我们系统地评估了一种基于最近重症监护病房哮喘入院的成人严重哮喘队列定义方法。方法：我们采用调查访谈和计算机化利用数据，这些数据来自北加州17家Kaiser Permanente医院的400名重症哮喘患者。为了评估哮喘的严重程度，我们采用了多方面的方法，将结构化的电话访谈数据与计算机化的使用数据相结合。采用参照组（n = 282）未入住重症监护病房（ICU）的成年人，我们检验了入住重症监护病房是否是严重疾病的有效标志（n = 118）。结果在控制了社会人口因素、吸烟和特应性史的情况下，近期入住ICU的成人哮喘患者哮喘严重程度评分更高（平均评分增加2.3点；95% CI 1.3 ~ 3.2）。ICU受试者的哮喘特异性生活质量也较差（平均评分增加6.6分；95% CI 3.5至9.8），并且更有可能表示严重的自我感知哮喘（49%对22%，p< 0.0001）。最近入住ICU的成年人在过去一年中更有可能看到哮喘专家（27%对16%）。在过去一年中，他们也更有可能出现与哮喘相关的急诊科就诊（37%对26%）、住院（17%对6%）和ICU住院（5%对0.7%）（所有病例p< 0.05）。在311名在过去12个月持续享受Kaiser Permanente药房福利的成人哮喘患者中，ICU组在住院前12个月吸入皮质类固醇的比例更高（78%对65%，p= 0.024）。结论：因哮喘入住ICU可识别重症亚组，为确定成人重症哮喘队列提供了有效的方法。
BackgroundThere appears to be an asthma epidemic in the United States and other developed countries, with increasing prevalence and severity of asthma. Despite these trends, the understanding of severe asthma remains limited. Research has been hampered by the lack of clear methodology for identifying a cohort of adults with severe asthma. We systematically evaluated a method for defining a cohort of adults with severe asthma based on recent intensive care unit admissions for asthma.MethodsWe used survey interview and computerized utilization data from a cohort of 400 adults with severe asthma who were enrolled after hospitalization at 17 Northern California Kaiser Permanente hospitals. To assess asthma severity, we used a multifaceted approach that combined structured telephone interview data with computerized utilization data. Using a referent group of adults who were hospitalized without intensive care unit (ICU) admission (n = 282), we examined whether ICU admission is a valid marker for severe disease (n = 118).ResultsAdults with asthma who had recent ICU admission had greater severity-of-asthma scores, controlling for sociodemographic factors, smoking, and atopic history (mean score increment 2.3 points; 95% CI 1.3 to 3.2). The ICU subjects also had poorer asthma-specific quality of life (mean score increment 6.6 points; 95% CI 3.5 to 9.8) and were more likely to indicate severe self-perceived asthma (49% vs. 22%,p< 0.0001). Adults with recent ICU admission were more likely to have seen an asthma specialist during the past year (27% vs. 16%). They were also more likely to have had an asthma-related emergency department visit (37% vs. 26%), hospitalization (17% vs. 6%), and ICU admission during the previous year (5% vs. 0.7%) (p< 0.05 in all cases). Among the 311 adults with asthma who had continuous Kaiser Permanente pharmacy benefits for the previous 12 months, a greater proportion of the ICU group received inhaled corticosteroids during the 12 months prior to hospitalization (78% vs. 65%,p= 0.024).ConclusionsAdmission to the ICU for asthma identifies a subgroup with severe disease, providing a valid methodology for defining a cohort of adults with severe asthma.