What are key symptoms to be captured for preventing a physician's underestimation of asthma control?
What are key symptoms to be captured for preventing a physician's underestimation of asthma control?
复制标题
为了防止医生低估哮喘控制，需要捕捉哪些关键症状？
DOI：
10.1016/j.jaip.2020.07.053
复制
发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Hirano Tsunahiko
中科院分区：
文献类型：
--
作者：
Chikumoto Ayumi;Matsunaga Kazuto;Oishi Keiji;Hamada Kazuki;Yamaji Yoshikazu;Hirano Tsunahiko
哮喘控制的评估偶尔会在患者和医生之间存在差异，这种不一致性对当前症状控制和未来风险有负面影响。在一项多中心、横断面、观察性研究中，我们对1697例哮喘控制主观评价（SEACON）的成人哮喘患者进行了与医患对哮喘控制感知不一致相关的因素的研究。1在SEACON研究中，在常规哮喘回顾之前，患者完成5项哮喘控制问卷（ACQ-5）。ACQ评分为0.75或更高被定义为“控制不佳的哮喘”。医生记录了他们对患者哮喘控制的看法（控制良好或控制不好），而不查看ACQ结果。不一致定义为医生的感知与患者的评估（基于ACQ评分）之间的不一致。医患不一致率为35.4%。我们认为，定期使用经验证的客观参数，如ACQ和肺功能测试可能在减轻哮喘控制感知中的医患不一致方面发挥关键作用。[1]然而，众所周知，医生对使用综合指标评估哮喘病情缺乏足够的依从性。因此，我们在此研究了ACQ-5上的哪些症状及其强度将有助于在不牺牲可靠性的情况下尽可能有效地捕获医生对哮喘控制的低估。在1697名成人哮喘患者中，受试者为1350名被医生判断为哮喘控制良好的患者。此外，根据是否存在患者-医生不一致，将1350例患者分为2组。我们比较了ACQ-5中每个症状的平均得分，以确定常见症状。接下来，我们通过使用曲线下面积（AUC）确定了检测控制不佳的哮喘的症状的最佳截止值。最后，使用常见症状的截止值，我们比较了一致组和不一致组之间的患者比例，以确定与哮喘控制感知中的医患不一致的相关性。通过Mann-Whitney U检验进行2个不同组之间的比较。所有分析均使用JMP pro 13.0版进行。0（SAS Institute Inc.，卡里，北卡罗来纳州）。数据表示为平均值+标准差。P值<。05被认为是重要的。在1350例患者中，一致组有818例，不一致组有532例。在所有患者中，ACQ-5项目的平均评分如下：夜间觉醒（0.59 ± 0.03）、早晨症状（0.61 ± 0.03）、活动受限（0.59 ± 0.02）、呼吸短促（0.86 ± 0.02）和喘息（0.79 ± 0.03）（图1，A）。呼吸困难和喘息是最常见的症状，与其他症状比较，差异有统计学意义（P<. 0001）。如表中所示，检测这2种症状强度不一致性的AUC如下：1（0.792）、2（0.818）、3（0.623）和4（0.530）。最合适的临界值为2分强度症状。换句话说，偶尔出现呼吸短促和/或喘息被确定为识别哮喘控制不佳和医生低估控制的患者的临床重要特征。有2个或2个以上症状的患者的实际分布如下：整体上呼吸急促（24%）和喘息（21%）。在一致组中，短...
Assessments of asthma control occasionally differ between patients and physicians, and the discordance has a negative impact on current symptom control and future risk. We examined factors associated with physician-patient discordance in the perception of asthma control in 1697 adult asthmatic patients in the Subjective Evaluation of Asthma Control (SEACON) multicenter, cross-sectional, observational study. 1 In the SEACON study, before the routine asthma review, patients completed the 5-item Asthma Control Questionnaire (ACQ-5). An ACQ score of 0.75 or more was defined as “not wellcontrolled asthma.” Physicians recorded their perception of the patients’ asthma control (well-controlled or not well-controlled) without viewing the ACQ results. The discordance was defined as the discoincidence between the physicians’ perception and patients’ assessment (based on the ACQ score). The rate of patient-physician discordance was 35.4%. We suggested that the periodic use of validated objective parameters such as ACQ and lung function testing could have a pivotal role in attenuating the physician-patient discordance in the perception of asthma control. 1 However, it is well known that sufficient adherence by physicians to the use of composite measures that assess the asthma condition is lacking. Therefore, we herein investigated which symptoms and their intensity on the ACQ-5 would be useful to capture a physician’s underestimation of asthma control as efficiently as possible without sacrificing reliability. Among 1697 adult asthmatic patients, the subjects were 1350 patients who were judged to have well-controlled asthma by the physician. Furthermore, 1350 patients were dichotomized into 2 groups based on the presence or absence of the patient-physician discordance. We compared the average score for each symptom in the ACQ-5 to identify the frequent symptoms. Next, we determined the optimal cutoff value of symptoms for detecting not well-controlled asthma by using the area under the curve (AUC). Finally, using the cutoff values of frequent symptoms, we compared the proportion of patients between concordant and disconcordant groups to determine the association with the physician-patient discordance in the perception of asthma control. Comparisons between 2 different groups were performed by Mann-Whitney U tests. All analyses were performed with JMP pro version 13.0. 0 (SAS Institute Inc., Cary, NC). Data were expressed as mean values+ standard deviation. A P value of<. 05 was considered significant. In 1350 patients, there were 818 patients in the concordant group and 532 patients in the discordant group. In all patients, the average scores by ACQ-5 items were as follows: nocturnal awaking (0.59+ 0.03), morning symptoms (0.61+ 0.03), activity limitation (0.59+ 0.02), shortness of breath (0.86+ 0.02), and wheeze (0.79+ 0.03)(Figure 1, A). Dyspnea and wheeze were identified as significantly more frequent symptoms compared with other items (P<. 0001). As shown in the table, the AUC for detecting discordance per intensities of these 2 symptoms was as follows: 1 (0.792), 2 (0.818), 3 (0.623), and 4 (0.530). The most appropriate cutoff value was 2-point intensity symptom. In other words, the presence of occasional shortness of breath and/or wheeze was identified as a clinically important feature to identify patients whose asthma was not well controlled and whose control was underestimated by their physicians. The actual distribution of patients who had symptoms of 2 or more points was as follows: shortness of breath (24%) and wheeze (21%) in the whole. In the concordant group, the proportion of patients with shortness of …