PHYSIOLOGICAL MEASURES - PULMONARY-FUNCTION TESTS - ASTHMA OUTCOME
PHYSIOLOGICAL MEASURES - PULMONARY-FUNCTION TESTS - ASTHMA OUTCOME
复制标题
DOI：
10.1164/ajrccm/149.2_pt_2.s9
复制
发表时间：
1994-02-01
影响因子：
24.7
通讯作者：
COCKROFT, DW
中科院分区：
文献类型：
--
作者：
ENRIGHT, PL;LEBOWITZ, MD;COCKROFT, DW
当在研究环境中评估哮喘干预措施的有效性时，哮喘的生理表现（可变气道阻塞）总是通过以下一些肺功能测试来客观测量：（1）基线肺活量测定可以高度准确地“了解”哮喘严重程度和气道阻塞程度。 FEV(1) 源自肺活量测定法，是最具重复性的肺功能参数，与气道阻塞的严重程度线性相关。该测试没有禁忌症，肺活量计以合理的价格广泛使用，并且方法和结果解释全面标准化。 (2) 支气管扩张剂后 FEV(1) 测量就诊当天通过支气管扩张剂治疗可达到的最佳肺功能，因此对于哮喘患者来说，它比比较每次就诊基线 FEV(1) 更稳定。尽管对支气管扩张剂的阳性急性反应有助于确认哮喘的诊断，但每次就诊时支气管扩张剂的可逆性程度（可逆性的变化）并不是哮喘结果的有用指标。 (3) 气道反应性（支气管激发）测量个体承受引发哮喘发作的非特异性刺激的程度。乙酰甲胆碱激发测试是安全的，需要不到一个小时，但它比基线肺活量测定法需要更多的技术技能，并且在某些情况下是禁忌的。 (4) 使用峰值流量计或手持式肺活量计进行动态监测，可在患者自然环境下连续数天至数周对阻塞程度进行多次测量。 PEF 计非常便宜，几乎所有哮喘患者都可以使用它们，但 PEF 结果不如 FEV 可靠。哮喘患者通常无症状的阻塞既有短期（一天内和日常）变化，也有由自然发生的刺激引发的长期变化。这些变化是通过 PEF 不稳定性来测量的，而不是通过临床就诊期间的肺活量测定法来测量的。 (5)其他肺功能检查，如绝对肺容量和气道阻力，可提供证实性数据，但仪器体积大、价格昂贵、技术要求高。所有上述肺功能测试的结果彼此显着相关，并且与哮喘严重程度差异较大的大组患者的症状评分和药物使用显着相关。由于目前不存在衡量哮喘严重程度的“金标准”，因此在临床试验中衡量哮喘结果时，所有这些测试都提供了额外的独特信息。
When the effectiveness of asthma interventions are evaluated in the research setting, the physiologic manifestation of asthma-variable airways obstruction-is always objectively measured by some of the following pulmonary function tests: (1) Baseline spirometry gives a highly accurate ''snapshot'' of asthma severity and the degree of airways obstruction. The FEV(1), derived from spirometry, is the most reproducible pulmonary function parameter and is linearly related to the severity of airways obstruction. There are no contraindications for the test, spirometers are widely available at reasonable cost, and methods and result interpretation are comprehensively standardized. (2) The post-bronchodilator FEV(1) measures the best lung function that can be achieved by bronchodilator therapy on the day of the visit and therefore is a more stable measure in asthmatics than comparing visit-to-visit baseline FEV(1). Although a positive acute response to bronchodilator helps to confirm the diagnosis of asthma, the degree of bronchodilator reversibility from visit-to-visit (change in reversibility) is not a useful index of asthma outcome. (3) Airway responsiveness (bronchial challenge) measures the deg ree to which an individual withstands nonspecific stimuli that trigger asthmatic attacks. The methacholine challenge test is safe and requires less than an hour, but it requires more technical skill than baseline spirometry and is contraindicated in some situations. (4) Ambulatory monitoring, using peak flow meters or hand-held spirometers, provides multiple measurements of the degree of obstruction for days to weeks in the patient's natural setting. PEF meters are very inexpensive and almost all asthmatics can use them, but PEF results are less reliable than the FEV,. The often asymp- tomatic obstruction of an asthmatic has both short-term (within a day and day-to-day) and longer-term variations that are triggered by naturally occurring stimuli. These changes are measured by PEF lability but not by spirometry during clinic visits. (5) Other pulmonary function tests, such as absolute lung Volumes and airways resistance, may provide confirmatory data, but the instruments are large, expensive, and technically demanding. The results of all the above pulmonary function tests are significantly correlated with each other and with symptom scores and medication use in large groups of patients with widely varying degrees of asthma severity. Since a ''gold standard'' with which to measure asthma severity does not currently exist, all of these tests contribute an additional amount of unique information when measuring asthma outcome in a clinical trial.