哮喘联盟

   摘要
   目的：虽然采取了质量改进措施以预防哮喘相关的急诊(ED)就诊，但是急诊就诊率并未下降。我们旨在确定接受低水平服务人群中与ED就诊相关的因素。
   方法：我们对来自三个为低收入人群提供服务的门诊中心的哮喘患者进行病例-对照分析。实验组为2008.8.1—2010.7.31期间因哮喘急性发作到ED就诊≥1次的18-45岁的哮喘患者。对照组为同一时间段内因非哮喘原因到门诊就诊≥1次的18-45岁的哮喘患者。采用病例审查收集数据。数据包括：人口统计学数据、过去接受哮喘教育或咨询肺科专家的情况、近期吸烟情况、进行指标随访前一年的流感疫苗接种情况和哮喘药物治疗情况。
   结果：共纳入244例患者和475例对照者。实验组和对照组在年龄、性别或种族上无明显差异。与对照组相比，实验组更易接受哮喘教育(优势比[OR] 4.09, 95%可信区间 [CI] 2.57-6.50或咨询肺科专家(优势比[OR] 2.31, 95%可信区间 [CI]1.15-4.66)。进行指标随访的前一年，与对照组相比，实验组更易接受除了吸入皮质类固醇激素以外的其他药物治疗(ICS; OR 1.74, 95% CI 1.14-2.66)，但是较少接受流感疫苗接种(OR 0.49, 95% CI 0.34-0.71)、短效β-受体激动剂治疗（OR 0.43, 95% CI 0.24-0.78）或单用ICS治疗(OR 0.53, 95% CI 0.34-0.84)。
   结论：以下因素与ED就诊相关：严重疾病的标志物、流感疫苗接种缺乏和未使用ICS或短效β-受体激动剂治疗。
 

（杨冬 审校）
South Med J. 2015 May;108(5):276-80. doi: 10.14423/SMJ.0000000000000275.


 

Factors associated with emergency department visits in asthma exacerbation.
 

Wells RE1, Garb J1, Fitzgerald J1, Kleppel R1, Rothberg MB1.
 

Abstract
OBJECTIVES:Despite quality improvement initiatives to prevent asthma-related emergency department (ED) visits, rates have not declined. We sought to determine factors associated with ED visits in an underserved population.
METHODS:We performed a case-control analysis of asthma patients at three ambulatory care centers serving low-income populations. Cases consisted of asthmatic patients aged 18 to 45 years with ≥1 ED visit for an asthma exacerbation between August 1, 2008 and July 31, 2010. Controls were patients with asthma aged 18 to 45 years with ≥1 outpatient visit during the same period but with no asthma-related ED visit. Data were collected by chart review and included demographics, past referral for asthma education or to a pulmonologist, recent tobacco use, influenza vaccination, and asthma medication prescriptions in the year before the index visit.
RESULTS:Among 244 cases and 475 controls, there were no significant differences in age, sex, or ethnicity. Cases were more likely than controls to have ever been referred for asthma education (odds ratio [OR] 4.09, 95% confidence interval [CI] 2.57-6.50) or to a pulmonologist (OR 2.31, 95% CI 1.15-4.66). In the year before the index visit, cases were more likely than controls to receive other medications in addition to inhaled corticosteroids (ICS; OR 1.74, 95% CI 1.14-2.66) but less likely to receive influenza vaccination (OR 0.49, 95% CI 0.34-0.71), a short-acting β-agonist (OR 0.43, 95% CI 0.24-0.78), or ICS alone (OR 0.53, 95% CI 0.34-0.84).
CONCLUSIONS:Markers of severe disease were associated with ED visits, as well as a lack of an influenza vaccination and failure to prescribe either ICS or short-acting β-agonists.
 

South Med J. 2015 May;108(5):276-80. doi: 10.14423/SMJ.0000000000000275.