Subspecialty differences in asthma characteristics and management
Subspecialty differences in asthma characteristics and management
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DOI：
10.4065/83.7.786
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发表时间：
2008-07-01
影响因子：
8.9
通讯作者：
Israel, Elliot
中科院分区：
文献类型：
--
作者：
Chen, Hubert;Johnson, Charles A.;Israel, Elliot
目的：确定过敏专科和肺专科之间哮喘特征和管理的性质和程度差异。患者和方法：我们使用了3342名参加哮喘流行病学和自然史：结局和治疗方案（TENOR）研究的成年人的基线数据，该研究是一项多中心观察性队列研究，从美国各地的亚专科实践中招募。从2001年1月1日至2004年4月30日，通过研究协调员管理的访谈和自我管理的有效问卷，收集了医生亚专科、哮喘史、过敏状态、肺功能、药物使用和近期医疗保健使用的信息。结果：在TENOR研究中，2407例（72%）患者接受了过敏症医生的治疗，935例（28%）患者接受了肺科医生的治疗。与那些接受过敏症治疗的患者相比，接受肺科医生治疗的患者更有可能是黑人，受教育程度较低，收入较低。根据医生评估、全球哮喘分类倡议、肺功能、功能和哮喘控制问题的数量，肺部患者有更严重的哮喘。定期使用短效β受体激动剂和全身性皮质类固醇的患者在肺病科治疗的患者中也高于过敏科治疗的患者，这与哮喘严重程度较高一致。虽然过敏性疾病的证据在这两类患者中都很普遍，但接受过敏专科医生治疗的患者更有可能接受皮肤测试或免疫治疗。在针对人口统计学差异进行调整的多变量分析中，肺病专家治疗的患者在过去3个月内更有可能报告因哮喘而使用医疗保健服务。结论：一般来说，肺病科治疗的哮喘患者社会经济地位较低，病情更严重，需要更多的药物治疗，并且报告了更多的医疗保健使用。
OBJECTIVE: To determine the nature and extent to which asthma characteristics and management differ between allergy and pulmonary subspecialists.PATIENTS AND METHODS: We used baseline data from 3342 adults enrolled In The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study, a multicenter, observational cohort recruited from subspecialty practices across the United States. Information on physician subspecialty, asthma history, allergic status, lung function, medication use, and recent health care use was collected from January 1, 2001, through April 30, 2004, via study coordinator-administered interviews and self-administered validated questionnaires.RESULTS: In the TENOR study, 2407 patients (72%) were treated by allergists and 935 (28%) by pulmonologists. Patients treated by pulmonologists were more likely to be black, be less educated, and have lower incomes than those treated by allergists. Pulmonary patients had more severe asthma as indicated by physician assessment, Global Initiative for Asthma classification, lung func,tion, and number of asthma control problems. Regular use of a short-acting beta-agonist and systemic corticosteroid use were also higher among pulmonologist-treated patients than allergist-treated patients, consistent with greater asthma severity. Although evidence of allergic disease was prevalent in both types of patients, those treated by an allergist were more likely to receive skin testing or immunotherapy. In multivariate analyses adjusted for demographic differences, patients treated by pulmonologists were more likely to report health care use for asthma in the past 3 months.CONCLUSION: In general, asthma patients treated by pulmonologists have lower socioeconomic status, have more severe disease, require more medication, and report greater health care use than those treated by allergists.