Predicting episodes of poor asthma control in treated patients with asthma
Predicting episodes of poor asthma control in treated patients with asthma
复制标题
DOI：
10.1016/j.jaci.2006.09.006
复制
发表时间：
2006-12-01
影响因子：
14.2
通讯作者：
Anthonisen, N. R.
中科院分区：
文献类型：
--
作者：
McCoy, Karen;Shade, David M.;Anthonisen, N. R.
背景：哮喘发作是一种危险、昂贵、难以预测的疾病。目的：了解哮喘患者在4周的观察期间有哮喘发作和发作的特征。方法：对2 032名哮喘志愿者(年龄3-，女性占62%)在接种流感疫苗和服用安慰剂后两个2周的间隔时间进行研究。分析基线数据，包括几份哮喘问卷，以预测后续哮喘事件的预测，这些事件记录在日记中，详细记录了高峰流量、药物使用和医疗保健使用。结果：在28天的日记收集期间，43.2%的参与者至少有一次哮喘控制不良。大多数事件的特点是增加了抢救药物的使用或减少了高峰流量，但近15%的参与者出现了以全身皮质类固醇使用为特征的恶化，或计划外医疗访问，或两者兼而有之。10岁以下儿童发病频率最高。其他危险因素包括吸烟、非裔美国人种族、低肺功能和既往严重哮喘史。预测效果最好的是症状问卷，前两周的简单问卷和较复杂的问卷或反映病程较长的问卷都有效。在回归分析中，问卷结果、吸烟、肺功能、种族和哮喘史都与10岁以上的人的哮喘发作有关，而只有哮喘史对10岁以上的人有预测作用。结论：症状问卷可以预测10岁以上的人随后的哮喘发作，但在年轻人中不是。临床意义：简单的评估可能有助于确定最有可能发生未来哮喘发作的患者。
Background: Asthma exacerbations are dangerous, expensive, and difficult to anticipate.Objective: To characterize patients with asthma who had asthma episodes and exacerbations during 4 weeks of observation.Methods: A total of 2032 volunteers with asthma (age, 3-64 years; 62% female subjects) were studied over two 2-week intervals after flu vaccine and placebo. Baseline data, including several asthma questionnaires, were analyzed for prediction of subsequent asthma events as recorded on diaries detailing peak flow, medication use, and health care use.Results: During 28 days of diary collection, 43.2% of participants had at least 1 episode of poor asthma control. Most episodes were characterized by increased use of rescue medications or reductions in peak flow, but nearly 15% of participants had exacerbations characterized by use of systemic corticosteroids, unscheduled health care visits, or both. Episode frequency was highest in children < 10 years of age. Additional risk factors were smoking, African American ethnicity, low lung function, and past history of severe asthma. The best predictors were symptom questionnaires, and a simple questionnaire concerning the preceding 2 weeks worked as well as more complex questionnaires or those reflecting longer periods. In regression analyses, questionnaire results, smoking, lung function, ethnicity, and asthma history all were associated with asthma episodes in people older than 10 years, whereas only asthma history was predictive in those < 10 years.Conclusion: Symptom questionnaires are predictive of subsequent asthma episodes in people older than age 10 years, but not in younger people.Clinical implications: Simple assessments may be helpful in identifying patients most at risk for future asthma episodes.