Identifying problematic severe asthma in the individual child - does lung function matter?
Identifying problematic severe asthma in the individual child - does lung function matter?
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DOI：
10.1111/j.1651-2227.2009.01625.x
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发表时间：
2010-03-01
期刊：
影响因子：
3.8
通讯作者：
Carlsen, K. C. Lodrup
中科院分区：
文献类型：
--
作者：
Lang, A. M.;Konradsen, J.;Carlsen, K. C. Lodrup
目的：肺功能指标（通常FEV 1 < 80%预测值）用于对成人和儿童的哮喘严重程度进行分类，尽管有证据表明肺功能损害在儿童哮喘人群中不太明显。本研究评估的相关性，肺功能测量的歧视严重childhood asthene.Methods：51学龄儿童有问题的严重asthene. Methods，37轻中度哮喘和29名健康对照进行了全面的临床工作了。问题性重度哮喘定义为尽管接受大剂量吸入性皮质类固醇治疗和至少一种其他哮喘控制药物，但哮喘控制不佳的患者。轻度至中度哮喘儿童使用低剂量吸入性类固醇和报告最小的哮喘symptoms.Results：基线FEV 1值显着降低，在有问题的严重哮喘的儿童，但FEV 1 < 80%预测显示出较低的敏感性（41%），区分严重与轻度至中度哮喘。受试者操作的特征分析估计，在该人群中，FEV 1的最佳截止值为90%预测值（敏感性61%，特异性83%）。基线FEV 1/FVC和FEF 25 -75值并不优于上级的FEV 1在区分有问题的严重哮喘，呼出的一氧化氮水平，也不区分两个哮喘研究population. Conclusions：肺功能测定是不敏感的鉴别有问题的严重哮喘儿童。
Aim: Measures of lung function (usually FEV1 < 80% predicted) are used to classify asthma severity in both adults and children, despite evidence that lung function impairment is less pronounced in the paediatric asthma population. The present study assesses the relevance of lung function measurements as discriminators of severe childhood asthma.Methods: Fifty-one school-aged children with problematic severe asthma, 37 mild-to-moderate asthmatics and 29 healthy controls underwent a comprehensive clinical work-up. Problematic severe asthma was defined in patients exhibiting poor asthma control despite high-dose inhaled corticosteroid treatment and at least one other asthma controller drug. Mild-to-moderate asthmatic children used low-dose inhaled steroids and reported minimal asthma symptoms.Results: Baseline FEV1 values were significantly reduced in children with problematic severe asthma, yet FEV1 < 80% predicted showed a low sensitivity (41%) for discriminating severe vs. mild-to-moderate asthma. Receiver-operated characteristic analysis estimated the optimal cut-off of FEV1 to be 90% predicted in this population (sensitivity 61%, specificity 83%). Baseline FEV1/FVC and FEF25-75 values were not superior to FEV1 in discriminating problematic severe asthma, and neither exhaled nitric oxide levels nor bronchial hyperresponsiveness differentiated between the two asthmatic study populations.Conclusion: Spirometric measurements are insensitive discriminators of problematic severe asthma in childhood.