焦虑，抑郁和哮喘控制：标准化治疗后的变化
2018/03/05
摘要
背景：据报道焦虑和抑郁在哮喘患者中普遍存在，并且与急性加重频率高，医疗资源使用增加以及哮喘控制不佳有关。我们的研究不仅调查了哮喘诊断与基线时抑郁/焦虑症状和哮喘控制的关联性，还调查了6个月的专科监护期。
方法：共3,182名中重度哮喘患者入组。 所有患者均在基线和6个月时进行肺功能，ACT和HADS（医院焦虑和抑郁量表）评估。 治疗由专家根据指南决定。
结果:根据HADS，在基线时，分别有24.2％和12％的患者被诊断为焦虑症和抑郁症。6个月后，焦虑和抑郁改善，分别影响15.3％和8.1％的患者（p <0.001）; FEV1均值和哮喘控制也得到改善（FEV1由81.6±20.9％到86±20.8％; ACT由15.8±4.7到19.4±4.4;P <0.001）。患有焦虑和抑郁症的患者使用的医疗资源明显增多，且病情更重。多变量分析显示焦虑，抑郁和FEV1较低的患者（OR值0.20,0.34,0.62; p <0.001）分别与哮喘控制不佳相关。多元线性回归分析显示焦虑比抑郁对哮喘控制的影响高4倍（0.326 / 0.85 = 4.075）。
结论：在标准化的哮喘治疗和专科医生的访视之后，患者的这些心理障碍显著改善，并且有更好的哮喘控制和功能参数。
Anxiety, depression, and asthma control: Changes after standardized treatment.
Sastre J1, Crespo A2, Fernandez-Sanchez T3, Rial M4, Plaza V2; investigators of the CONCORD study group.
Abstract
BACKGROUND:It has been documented that anxiety and depression are prevalent in patients with asthma and are associated with greater frequency of exacerbations, increased use of health-care resources, and poor asthma control. Our study examined not only the association of asthma diagnosis with symptoms of depression/anxiety and asthma control at baseline, but also over a 6-month period of specialist supervision.
METHODS:We enrolled 3,182 patients with moderate-severe asthma. All were evaluated with spirometry, ACT, and HADS (Hospital Anxiety and Depression Scale) at baseline and at 6 months. Treatments were decided by specialists according to published guidelines.
RESULTS:At baseline, 24.2% and 12% of patients were diagnosed with anxiety and depression, respectively, according to HADS. After 6 months, anxiety and depression improved, affecting 15.3% and 8.1% of patients, respectively (p<0.001); mean FEV1 and asthma control also improved (FEV1 from 81.6±20.9% to 86±20.8%; ACT from 15.8 ±4.7 to 19.4± 4.4; both p<0.001). Patients with anxiety and depression used significantly more health-care resources and had more exacerbations. A multivariate analysis showed that patients with anxiety, depression, and lower FEV1 (OR 0.20, 0.34, 0.62; p<.001, respectively) were independently associated with poor asthma control. A multiple linear regression analysis showed that anxiety had a nearly four-fold greater influence over asthma control than depression (0.326 / 0.85 = 4.075)
CONCLUSIONS:Under standardized asthma care and after a specific visit with the specialist, patients present significant improvement in these psychological disorders and exhibit better asthma control and functional parameters.
背景：据报道焦虑和抑郁在哮喘患者中普遍存在，并且与急性加重频率高，医疗资源使用增加以及哮喘控制不佳有关。我们的研究不仅调查了哮喘诊断与基线时抑郁/焦虑症状和哮喘控制的关联性，还调查了6个月的专科监护期。
方法：共3,182名中重度哮喘患者入组。 所有患者均在基线和6个月时进行肺功能，ACT和HADS（医院焦虑和抑郁量表）评估。 治疗由专家根据指南决定。
结果:根据HADS，在基线时，分别有24.2％和12％的患者被诊断为焦虑症和抑郁症。6个月后，焦虑和抑郁改善，分别影响15.3％和8.1％的患者（p <0.001）; FEV1均值和哮喘控制也得到改善（FEV1由81.6±20.9％到86±20.8％; ACT由15.8±4.7到19.4±4.4;P <0.001）。患有焦虑和抑郁症的患者使用的医疗资源明显增多，且病情更重。多变量分析显示焦虑，抑郁和FEV1较低的患者（OR值0.20,0.34,0.62; p <0.001）分别与哮喘控制不佳相关。多元线性回归分析显示焦虑比抑郁对哮喘控制的影响高4倍（0.326 / 0.85 = 4.075）。
结论：在标准化的哮喘治疗和专科医生的访视之后，患者的这些心理障碍显著改善，并且有更好的哮喘控制和功能参数。
(中日友好医院呼吸与危重症医学科 王瑞茵 摘译 林江涛 审校)
(J Allergy Clin Immunol Pract. 2018 Feb 14. pii: S2213-2198(18)30094-1.)
(J Allergy Clin Immunol Pract. 2018 Feb 14. pii: S2213-2198(18)30094-1.)
Anxiety, depression, and asthma control: Changes after standardized treatment.
Sastre J1, Crespo A2, Fernandez-Sanchez T3, Rial M4, Plaza V2; investigators of the CONCORD study group.
Abstract
BACKGROUND:It has been documented that anxiety and depression are prevalent in patients with asthma and are associated with greater frequency of exacerbations, increased use of health-care resources, and poor asthma control. Our study examined not only the association of asthma diagnosis with symptoms of depression/anxiety and asthma control at baseline, but also over a 6-month period of specialist supervision.
METHODS:We enrolled 3,182 patients with moderate-severe asthma. All were evaluated with spirometry, ACT, and HADS (Hospital Anxiety and Depression Scale) at baseline and at 6 months. Treatments were decided by specialists according to published guidelines.
RESULTS:At baseline, 24.2% and 12% of patients were diagnosed with anxiety and depression, respectively, according to HADS. After 6 months, anxiety and depression improved, affecting 15.3% and 8.1% of patients, respectively (p<0.001); mean FEV1 and asthma control also improved (FEV1 from 81.6±20.9% to 86±20.8%; ACT from 15.8 ±4.7 to 19.4± 4.4; both p<0.001). Patients with anxiety and depression used significantly more health-care resources and had more exacerbations. A multivariate analysis showed that patients with anxiety, depression, and lower FEV1 (OR 0.20, 0.34, 0.62; p<.001, respectively) were independently associated with poor asthma control. A multiple linear regression analysis showed that anxiety had a nearly four-fold greater influence over asthma control than depression (0.326 / 0.85 = 4.075)
CONCLUSIONS:Under standardized asthma care and after a specific visit with the specialist, patients present significant improvement in these psychological disorders and exhibit better asthma control and functional parameters.
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哮喘急性加重与重度嗜酸粒细胞性哮喘患者肺功能下降相关
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