哮喘气道阻塞的症状和感知：使用缓解药物的临床意义
2019/08/27
摘要
背景：由于气道阻塞，哮喘引起呼吸不足（呼吸困难）的不适感。气道阻塞感觉差的患者有延迟寻求医疗和治疗不足的风险，这可能导致可避免的死亡。相反，那些感知能力强的人会因服用缓解药物、焦虑和不必要的医疗资源使用而面临过度治疗和医源性不良反应的风险。本文旨在评估哮喘症状错误感知以及如何识别和管理受影响患者尤其是缓解药物使用的证据。
方法：我们对哮喘气道功能感知的研究进行了系统的文献检索。检索OVID [Medline和Medline（R）进行中（PubMed）]，Embase和Adisearch / Odyssey数据库，只搜索1990-2018年英语发表的人类研究，对年龄、性别或种族没有限制。
结果：结果发现，在诱发性支气管收缩或支气管扩张期间或在气道阻力变化期间评估的感知不足和感知过度在所有年龄组中都是常见的，并且衰老，疾病严重程度，吸烟，性别，种族，心理因素和药物是都与感知差异有关。重要的是，气道炎症与感知受损和重度或近乎致命的哮喘病史有关。另外知识差距也对气道感知有影响，例如个体患者的感知是否随时间而变化，以及感知对患者使用缓解药物的影响。
结论：我们发现气道阻塞的异常感知对于哮喘患者的管理具有重要的临床意义。
Symptoms and perception of airway obstruction in asthma: clinical implications for use of reliever medications.
Barnes PJ, Szefler SJ, Reddel HK, Chipps BE.
Abstract
BACKGROUND:Asthma causes the unpleasant sensation of breathlessness (dyspnea) due to airway obstruction. Patients with poor perception of airway obstruction are at risk of delay in seeking medical attention and under-treatment, which can lead to avoidable deaths. Conversely, those with heightened perception are at risk of over-treatment and iatrogenic adverse effects with reliever medications, anxiety, and unnecessary use of healthcare resources. To review evidence about symptom misperception in asthma and how to identify and manage affected patients, particularly with regard to reliever medications.
METHODS:We conducted a systematic literature search for studies of perception of airway function in asthma. We searched the OVID [Medline and Medline (R) in process (PubMed)], Embase, and Adisearch/Odyssey databases, restricting our search to human studies published in English from 1990-2018, with no restrictions on age, gender, or racial origins.
RESULTS:We found that both under- and over-perception, assessed during induced bronchoconstriction or bronchodilation or during changes in airway resistance, were common across all age groups, and that aging, disease severity, smoking, gender, ethnicity, psychological factors, and medication are all associated with differences in perception. Importantly, airway inflammation was associated with impaired perception and with a history of severe or near-fatal asthma. We also identified knowledge gaps, such as whether an individual patient's perception varies over time, and the influence perception has on patients' use of reliever medication.
CONCLUSIONS:We found that abnormal perception of airway obstruction has important clinical implications for the management of patients with asthma.
背景：由于气道阻塞，哮喘引起呼吸不足（呼吸困难）的不适感。气道阻塞感觉差的患者有延迟寻求医疗和治疗不足的风险，这可能导致可避免的死亡。相反，那些感知能力强的人会因服用缓解药物、焦虑和不必要的医疗资源使用而面临过度治疗和医源性不良反应的风险。本文旨在评估哮喘症状错误感知以及如何识别和管理受影响患者尤其是缓解药物使用的证据。
方法：我们对哮喘气道功能感知的研究进行了系统的文献检索。检索OVID [Medline和Medline（R）进行中（PubMed）]，Embase和Adisearch / Odyssey数据库，只搜索1990-2018年英语发表的人类研究，对年龄、性别或种族没有限制。
结果：结果发现，在诱发性支气管收缩或支气管扩张期间或在气道阻力变化期间评估的感知不足和感知过度在所有年龄组中都是常见的，并且衰老，疾病严重程度，吸烟，性别，种族，心理因素和药物是都与感知差异有关。重要的是，气道炎症与感知受损和重度或近乎致命的哮喘病史有关。另外知识差距也对气道感知有影响，例如个体患者的感知是否随时间而变化，以及感知对患者使用缓解药物的影响。
结论：我们发现气道阻塞的异常感知对于哮喘患者的管理具有重要的临床意义。
(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. 2019 Jul 19. pii: S0091-6749(19)30941-8. doi: 10.1016/j.jaci.2019.06.040. [Epub ahead of print])
(J Allergy Clin Immunol. 2019 Jul 19. pii: S0091-6749(19)30941-8. doi: 10.1016/j.jaci.2019.06.040. [Epub ahead of print])
Symptoms and perception of airway obstruction in asthma: clinical implications for use of reliever medications.
Barnes PJ, Szefler SJ, Reddel HK, Chipps BE.
Abstract
BACKGROUND:Asthma causes the unpleasant sensation of breathlessness (dyspnea) due to airway obstruction. Patients with poor perception of airway obstruction are at risk of delay in seeking medical attention and under-treatment, which can lead to avoidable deaths. Conversely, those with heightened perception are at risk of over-treatment and iatrogenic adverse effects with reliever medications, anxiety, and unnecessary use of healthcare resources. To review evidence about symptom misperception in asthma and how to identify and manage affected patients, particularly with regard to reliever medications.
METHODS:We conducted a systematic literature search for studies of perception of airway function in asthma. We searched the OVID [Medline and Medline (R) in process (PubMed)], Embase, and Adisearch/Odyssey databases, restricting our search to human studies published in English from 1990-2018, with no restrictions on age, gender, or racial origins.
RESULTS:We found that both under- and over-perception, assessed during induced bronchoconstriction or bronchodilation or during changes in airway resistance, were common across all age groups, and that aging, disease severity, smoking, gender, ethnicity, psychological factors, and medication are all associated with differences in perception. Importantly, airway inflammation was associated with impaired perception and with a history of severe or near-fatal asthma. We also identified knowledge gaps, such as whether an individual patient's perception varies over time, and the influence perception has on patients' use of reliever medication.
CONCLUSIONS:We found that abnormal perception of airway obstruction has important clinical implications for the management of patients with asthma.
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