未控制哮喘患者的随访：根据不同控制水平获得哮喘患者的临床特征
2017/08/08
摘要
我们主要研究那些接受了全球哮喘防治创议（GINA）2010（设计此实验时有效的指南）推荐的适当治疗后，仍未获哮喘控制的哮喘患者的控制情况，并分析这些患者哮喘控制不佳的相关因素。
该研究是在常规临床实践背景下，针对GINA2010定义的未控制哮喘患者，进行的一项多中心研究。访问1：我们记录了受试者的人口学特征、哮喘特点和肺功能。然后我们根据GINA2010的标准和哮喘控制测试（ACT）问卷，评估其控制状况。并根据GINA2010进行优化治疗。访问2:3个月后，我们重新评估受试者的肺功能、哮喘控制情况和其哮喘控制失败的相关因素。
我们共招募了1299例哮喘未控制患者（平均年龄46.5± 17.3岁，60.7%女性，25.8%肥胖）。平均1秒钟用力呼气量百分比预测值为76.4±12.8%，使用支气管扩张剂后平均增加了14.9±6.8%。我们发现在评估哮喘控制方面，ACT和GINA2010之间的一致性较差（Kappa=-0.151）。在访问2时，71.2%的哮喘患者仍然没有完全控制。此外，哮喘未控制的患者的年龄较大，体重指数较高，病情较重，病程较长，肺功能也更差。
经过优化治疗，大多数患者仍没有达到GINA2010的最佳控制标准。其未能达到哮喘控制的危险因素是疾病的演变时间、严重程度、年龄、体重和肺功能损害（GINA2014排除）。
Follow-up of patients with uncontrolled asthma: clinical features of asthma patients according to the level of control achieved (the COAS study)
Rosa Munoz-Cano, Alfons Torrego, Joan Bartra, Jaime Sanchez-Lopez, Rosa Palomino, Cesar Picado, Antonio Valero
Abstract
Our aim was to study the asthma control achieved in patients with uncontrolled asthma who had received appropriate treatment according to the Global Initiative for Asthma (GINA) 2010 (valid at the time the study was designed), and to analyse the factors associated with a lack of asthma control.
This was a multicentre study in routine clinical practice performed in patients with uncontrolled asthma according to GINA 2010. At visit 1, we recorded demographics, asthma characteristics and spirometry. We assessed asthma control using GINA 2010 criteria and the Asthma Control Test (ACT). Treatment was optimised according to GINA 2010. At visit 2, 3 months later, we reassessed spirometry, asthma control and factors associated with failure to achieve control.
We recruited 1299 patients with uncontrolled asthma (mean age 46.5±17.3 years, 60.7% women, 25.8% obese). The mean percentage of predicted forced expiratory volume in 1 s was 76.4±12.8% and the mean post-bronchodilator increase was 14.9±6.8%. We observed poor agreement between ACT and GINA 2010 when evaluating asthma control (kappa = −0.151). At visit 2, asthma in 71.2% of patients was still not fully controlled. Patients whose asthma remained uncontrolled were older, had a higher body mass index, greater disease severity, longer disease evolution and worse lung function.
After treatment optimisation, most patients did not achieve optimal control according to GINA 2010. Risk factors for failure to achieve asthma control were time of disease evolution, severity, age, weight and lung function impairment (excluded in the GINA 2014).
我们主要研究那些接受了全球哮喘防治创议（GINA）2010（设计此实验时有效的指南）推荐的适当治疗后，仍未获哮喘控制的哮喘患者的控制情况，并分析这些患者哮喘控制不佳的相关因素。
该研究是在常规临床实践背景下，针对GINA2010定义的未控制哮喘患者，进行的一项多中心研究。访问1：我们记录了受试者的人口学特征、哮喘特点和肺功能。然后我们根据GINA2010的标准和哮喘控制测试（ACT）问卷，评估其控制状况。并根据GINA2010进行优化治疗。访问2:3个月后，我们重新评估受试者的肺功能、哮喘控制情况和其哮喘控制失败的相关因素。
我们共招募了1299例哮喘未控制患者（平均年龄46.5± 17.3岁，60.7%女性，25.8%肥胖）。平均1秒钟用力呼气量百分比预测值为76.4±12.8%，使用支气管扩张剂后平均增加了14.9±6.8%。我们发现在评估哮喘控制方面，ACT和GINA2010之间的一致性较差（Kappa=-0.151）。在访问2时，71.2%的哮喘患者仍然没有完全控制。此外，哮喘未控制的患者的年龄较大，体重指数较高，病情较重，病程较长，肺功能也更差。
经过优化治疗，大多数患者仍没有达到GINA2010的最佳控制标准。其未能达到哮喘控制的危险因素是疾病的演变时间、严重程度、年龄、体重和肺功能损害（GINA2014排除）。
（中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校）
（EuropeanRespiratoryJournal 2017 49: 1501885; DOI: 10.1183/13993003.01885-2015Mar 2;2017）
（EuropeanRespiratoryJournal 2017 49: 1501885; DOI: 10.1183/13993003.01885-2015Mar 2;2017）
Follow-up of patients with uncontrolled asthma: clinical features of asthma patients according to the level of control achieved (the COAS study)
Rosa Munoz-Cano, Alfons Torrego, Joan Bartra, Jaime Sanchez-Lopez, Rosa Palomino, Cesar Picado, Antonio Valero
Abstract
Our aim was to study the asthma control achieved in patients with uncontrolled asthma who had received appropriate treatment according to the Global Initiative for Asthma (GINA) 2010 (valid at the time the study was designed), and to analyse the factors associated with a lack of asthma control.
This was a multicentre study in routine clinical practice performed in patients with uncontrolled asthma according to GINA 2010. At visit 1, we recorded demographics, asthma characteristics and spirometry. We assessed asthma control using GINA 2010 criteria and the Asthma Control Test (ACT). Treatment was optimised according to GINA 2010. At visit 2, 3 months later, we reassessed spirometry, asthma control and factors associated with failure to achieve control.
We recruited 1299 patients with uncontrolled asthma (mean age 46.5±17.3 years, 60.7% women, 25.8% obese). The mean percentage of predicted forced expiratory volume in 1 s was 76.4±12.8% and the mean post-bronchodilator increase was 14.9±6.8%. We observed poor agreement between ACT and GINA 2010 when evaluating asthma control (kappa = −0.151). At visit 2, asthma in 71.2% of patients was still not fully controlled. Patients whose asthma remained uncontrolled were older, had a higher body mass index, greater disease severity, longer disease evolution and worse lung function.
After treatment optimisation, most patients did not achieve optimal control according to GINA 2010. Risk factors for failure to achieve asthma control were time of disease evolution, severity, age, weight and lung function impairment (excluded in the GINA 2014).
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