History of symptom triggers in patients presenting to the emergency department for asthma.
History of symptom triggers in patients presenting to the emergency department for asthma.
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DOI：
10.3109/02770903.2012.690480
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发表时间：
2012-08
期刊：
影响因子：
--
通讯作者：
Mancuso CA
中科院分区：
文献类型：
--
作者：
Peterson MG;Gaeta TJ;Birkhahn RH;Fernández JL;Mancuso CA
了解触发因素对于管理哮喘非常重要，特别是对于因急性发作而寻求急诊科（艾德）护理的患者。本分析的目的是描述艾德患者自我报告的触发因素，并评估触发因素与哮喘知识、严重程度和生活质量之间的相关性。在艾德访视时，根据25个潜在项目的检查表，询问296名患者他们通常的哮喘触发因素是什么，以及他们认为什么特别促成了他们当前的艾德访视。使用标准化量表，患者还被问及哮喘知识，严重程度和生活质量。平均年龄为44岁，72%为女性。患者平均引用了12个触发因素;大多数患者有不同的触发因素，包括呼吸道感染，环境刺激物，情绪，过敏原，天气和运动。触发因素较多的患者更可能是女性（OR 2.0，CI 1.3，3.2，p= 0.002）、肥胖（OR 1.7，CI 1.1，2.5，p= 0.01）和无吸烟史（OR 1.9，CI 1.3，2.9，p= 0.001）。触发因素的数量与当前年龄、诊断时的年龄、教育、社会经济地位或种族/民族之间没有关联。诱发因素越多的患者发作频率越高（OR 1.1，CI 1.1，1.2，p<.0001），生活质量评分更差（OR 1.6，CI 1.1，2.4，p= 0.02），并且更有可能既往因哮喘住院（OR 1.9，CI 1.3，2.9，p=.003）和既往需要口服皮质类固醇（OR 2.9，CI 1.6，5.1，p=.003）。根据我们考虑的变量，除了在较年轻的年龄诊断的患者中更频繁的动物过敏（OR 2.8，CI 1.7，4.5，p<.0001）和引用情绪压力作为触发因素的患者的生活质量更差（OR 2.5，CI 1.5，4.0，p=.0002）之外，几乎没有特定触发因素的聚集。患者将他们目前的艾德就诊归因于多种诱因，特别是呼吸道感染和天气，这些与他们报告的已知诱因一致。因哮喘到艾德就诊的患者报告了跨越不同类别促发剂的多个触发因素，并且具有更多触发因素与更差的临床状态相关。应告知艾德患者，尽管可能无法消除所有触发因素，但即使是减轻某些触发因素也会有所帮助。（ClinicalTrials.gov NCT 00110409）
Understanding triggers is important for managing asthma particularly for patients who seek emergency department (ED) care for exacerbations. The objectives of this analysis were to delineate self-reported triggers in ED patients and to assess associations between triggers and asthma knowledge, severity, and quality of life. At the time of an ED visit, 296 patients were asked what were their usual asthma triggers based on a checklist of 25 potential items, and what they thought specifically precipitated their current ED visit. Using standardized scales, patients also were asked about asthma knowledge, severity and quality of life. Mean age was 44 years and 72% were women. Patients cited a mean of 12 triggers; most patients had diverse triggers spanning respiratory infections, environmental irritants, emotions, allergens, weather, and exercise. Patients with more triggers were more likely to be women (OR 2.0, CI 1.3, 3.2, p=.002), obese (OR 1.7, CI 1.1, 2.5, p=.01), and to not have a smoking history (OR 1.9, CI 1.3, 2.9, p=.001). There were no associations between number of triggers and current age, age at diagnosis, education, socioeconomic status or race/ethnicity. Patients who cited more triggers had more frequent flares (OR 1.1, CI 1.1, 1.2, p<.0001), worse quality of life scores (OR 1.6, CI 1.1, 2.4, p=.02), and were more likely to have been previously hospitalized for asthma (OR 1.9, CI 1.3, 2.9, p=.003) and to have previously required oral corticosteroids (OR 2.9, CI 1.6, 5.1, p=.003). There was little clustering of specific triggers according to the variables we considered except for more frequent animal allergy in patients diagnosed at a younger age (OR 2.8, CI 1.7, 4.5, p<.0001) and worse quality of life in patients citing emotional stress as a trigger (OR 2.5, CI 1.5, 4.0, p=.0002). Patients attributed their current ED visit to multiple precipitants, particularly respiratory infections and weather, and these were concordant with what they reported were known triggers. Patients presenting to the ED for asthma reported multiple triggers spanning diverse classes of precipitants and having more triggers was associated with worse clinical status. ED patients should be instructed that although it may not be possible to eliminate all triggers, mitigating even some triggers can be helpful. (ClinicalTrials.gov NCT00110409)
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