Predictors of short-term clinical response to acute asthma care in adults.
Predictors of short-term clinical response to acute asthma care in adults.
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成人急性哮喘护理短期临床反应的预测因子。
DOI：
10.1093/intqhc/14.1.69
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发表时间：
2002
期刊：
影响因子：
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通讯作者：
Anderson,RonJ
中科院分区：
文献类型：
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作者：
Coyle,YvonneM;Hynan,LindaS;Gruchalla,RebeccaS;Anderson,RonJ
目的：我们评估了在经常需要急诊科（艾德）就诊和住院治疗以控制哮喘的成人中，潜在患者危险因素对急性哮喘护理短期临床反应的影响。设计和设置：前瞻性队列研究，包括1997年3月至1999年8月在美国公立医院艾德接受急性哮喘治疗的成人患者，研究参与者：309名患者完成了研究。主要指标：我们确定了预测急性哮喘护理后2-3周内呼气峰流速（PEFR）变化较低的患者危险因素。结果：单因素分析显示，哮喘知识水平低与PEFR变化呈显著正相关（r = 0.15，P = 0.01），哮喘知识水平低与PEFR变化呈显著正相关（r= 0.15，P = 0.01）。控制患者病例组合的多变量分析表明，室内过敏和暴露[B= 32.76，95%可信区间（CI）= 3.98- 61.53，P = 0.03]显著预测PEFR变化较低。当随访前2-3周内未接受皮质类固醇治疗作为潜在的患者危险因素时，多变量分析没有变化。结论：该研究表明，需要针对患者危险因素、室内过敏原暴露和哮喘知识不足进行干预，以促进成人急性哮喘护理的短期临床反应，尤其是在经济上处于不利地位的市中心居民中。
Objective.We assessed the effects of potential patient risk factors on short-term clinical response to acute asthma care among adults who often require emergency department (ED) visits and hospitalizations to manage their asthma.Design and setting.Prospective cohort study that included adult patients treated for acute asthma, which was conducted in a US public hospital ED between March 1997 and August 1999, with a 2- to 3-week follow-up.Study participants.Three hundred and nine patients completed the study.Main measures.We identified patient risk factors that predicted lower peak expiratory flow rate (PEFR) change over 2–3 weeks following acute asthma care. Potential risk factors were indoor allergy and exposure, smoking, upper respiratory infection in the last month, lower asthma knowledge, and medication non-adherence.Results.Univariate analyses indicated that lower asthma knowledge significantly and positively correlated with lower PEFR change (r= 0.15,P= 0.01). Multivariate analysis that controlled for patient case-mix indicated that indoor allergy and exposure [b= 32.76, 95% confidence interval (CI) = 3.98–61.53,P= 0.03] significantly predicted lower PEFR change. There was no change in the multivariate analysis when the absence of treatment with corticosteroids during the 2–3 weeks before follow-up was added as a potential patient risk factor.Conclusion.The study suggests that interventions are needed to target the patient risk factors, indoor allergen exposure and poor asthma knowledge, to promote short-term clinical response to acute asthma care in adults, especially among economically disadvantaged inner-city residents.