Differences between asthma exacerbations and poor asthma control
Differences between asthma exacerbations and poor asthma control
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DOI：
10.1016/s0140-6736(98)06128-5
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发表时间：
1999-01-30
期刊：
影响因子：
168.9
通讯作者：
Woolcock, A
中科院分区：
文献类型：
--
作者：
Reddel, H;Ware, S;Woolcock, A
背景呼气峰流量（PEF）的变化增加是哮喘控制不佳的特征，并且已推荐测量PEF的昼夜变化来评估哮喘的严重程度，包括在急性发作期间。我们的目的是测试是否哮喘急性发作有相同的PEF特征哮喘control.Methods从43例最初控制不佳的哮喘患者的电子PEF记录进行了检查，所有急性发作后发生的PEF达到一个平台，吸入皮质类固醇治疗。PEF的昼夜变异性进行了比较，在急性发作，运行（哮喘控制不良），和稳定的哮喘期间之前，每个acceleration.Findings的昼夜变异性为21.3%，在哮喘控制不良和改善到53%（稳定哮喘）与吸入性皮质类固醇治疗。26例患者在2-16个月内发生40次急性加重; 38例（95%）急性加重与临床呼吸道感染症状相关。在急性加重期间，连续PEF值在几天内线性下降，然后线性改善。然而，急性发作期间的昼夜变异性（7.7%）并不显著高于稳定期哮喘（5.4%，p = 0.1）。PEF数据与哮喘急性发作时吸入β 2受体激动剂的反应受损一致，但与哮喘控制不佳时的反应无关。昼夜变化的计算可能无法检测到肺功能的重要变化。与哮喘控制不佳相比，急性发作期间的PEF变化显著不同，表明这些条件之间β 2-肾上腺素受体功能的差异。
Background Increased variation in peak expiratory flow (PEF) is characteristic of poorly controlled asthma, and measurement of diurnal variability of PEF has been recommended for assessment of asthma severity, including during exacerbations. We aimed to test whether asthma exacerbations had the same PEF characteristics as poor asthma control.Methods Electronic PEF records from 43 patients with initially poorly controlled asthma were examined for all exacerbations that occurred after PEF reached a plateau with inhaled corticosteroid treatment. Diurnal variability of PEF was compared during exacerbations, run-in (poor asthma control), and the period of stable asthma before each exacerbation.Findings Diurnal variability was 21.3% during poor asthma control and improved to 53% (stable asthma) with inhaled corticosteroid treatment. 40 exacerbations occurred in 26 patients over 2-16 months; 38 (95%) of exacerbations were associated with symptoms of clinical respiratory infection. During exacerbations, consecutive PEF values fell linearly over several days then improved linearly. However, diurnal variability during exacerbations (7.7%) was not significantly higher than during stable asthma (5.4%, p = 0.1). PEF data were consistent with impaired response to inhaled beta(2)-agonist during exacerbations but not during poorly controlled asthma.Interpretation Asthmatics remain vulnerable to exacerbations during clinical respiratory infections, even after asthma is brought under control. Calculation of diurnal variability may fail to detect important changes in lung function. PEF variation is strikingly different during exacerbations compared with poor asthma control, suggesting differences in beta(2)-adrenoceptor function between these conditions.