The Strategy for Predicting Future Exacerbation of Asthma Using a Combination of the Asthma Control Test and Lung Function Test
The Strategy for Predicting Future Exacerbation of Asthma Using a Combination of the Asthma Control Test and Lung Function Test
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DOI：
10.1080/02770900902972160
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发表时间：
2009-01-01
影响因子：
1.9
通讯作者：
Tohda, Yuji
中科院分区：
文献类型：
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作者：
Sato, Ryuji;Tomita, Katsuyuki;Tohda, Yuji
背景据报道，各种因素可用于预测未来的加重。Objective.本研究旨在确定基于患者的问卷调查（如哮喘控制试验（ACT）评分）与客观评估（如1秒用力呼气量（FEV 1）和/或呼出一氧化氮（FENO））相结合对预测成人哮喘患者未来加重的有效性。方法.因此，我们招募了78名轻度至中度哮喘患者，他们临床稳定3个月，都定期接受吸入性类固醇治疗。所有受试者都接受了常规的哮喘控制评估，包括ACT评分、肺功能测定和FENO，然后随访直至发生严重急性发作。使用基于分类和回归树（CART）分析的决策树确定和验证重度急性发作风险增加的预测因子。使用ROC曲线下面积（AUC）（95%置信区间[CI]）评估所开发模型的特性。结果CART分析自动选择的变量和截止点，ACT评分23和FEV 1 91.8%，具有最大的能力来区分未来一年内是否加重。当通过阳性试验（LP）的似然比计算概率时，ACT评分23被确定为具有60.3%的概率（通过LP的1.82计算），而组合ACT评分23和预测FEV 1的百分比91.8%被确定为具有85.0%的概率（通过LP评分5.43计算），用于预测未来加重。结论这些结果表明，结合ACT评分和预测FEV 1的百分比，而不是FENO，可以充分分层一年内未来加重的风险。
Background. Various factors have been reported to be useful for predicting future exacerbations. Objective. This study was intended to determine a usefulness of a combination of a patient-based questionnaire, such as the Asthma Control Test (ACT) score with objective assessments, such as forced expiratory volume in 1 second (FEV1) and/or exhaled nitric oxide (FENO), for predicting future exacerbations in adult asthmatics. Methods. We therefore enrolled 78 subjects with mild to moderate asthma, who were clinically stable for 3 months who all had been regularly receiving inhaled steroid treatment. All subjects underwent a routine assessment of asthma control including the ACT score, spirometry, and FENO, and then were followed up until a severe exacerbation occurred. The predictors of an increased risk of severe exacerbation were identified and validated using decision trees based on a classification and regression tree (CART) analysis. The properties of the developed models were the evaluated with the area under the ROC curve (AUC) (95% confidence interval [CI]). Results. The CART analysis automatically selected the variables and cut-off points, the ACT score 23 and FEV1 91.8%, with the greatest capacity for discriminating future exacerbations within one year or not. When the probalility was calculated by the likelihood ratio of a positive test (LP), the ACT score 23 was identified with a 60.3% probability, calculated by 1.82 of LP, whereas the combined ACT score 23 and the percentage of predicted FEV1 91.8% were identified with an 85.0% probability, calculated by an LP score of 5.43, for predicting future exacerbation. Conclusion. These results demonstrated that combining the ACT score and percentage of predicted FEV1, but not FENO, can sufficiently stratify the risk for future exacerbations within one year.