队列研究：英国初级保健机构中学龄儿童的肺功能和哮喘控制情况
2019/11/12
摘要
背景：在专科中心通常使用肺功能和呼出气一氧化氮（FeNO）监测儿童哮喘患者。国立卫生与医疗研究院要求所有医疗机构患儿自5岁开始进行肺功能监测。在英国初级保健机构中，哮喘儿童的肺功能和FeNO数据极少。
目的：研究在初级保健机构哮喘儿童中异常肺功能和FeNO的发生率，并探讨其与哮喘控制水平和非计划就诊次数（UHA）的关系。
方法：此试验为前瞻性观察性队列研究，在英国家庭医生中对5-16岁可疑或经医生确诊为哮喘的儿童进行评估。研究肺功能、FeNO、哮喘控制测试（ACT）评分和计划外就诊次数（UHA）。
结果：来自10组家庭医生中的612名儿童里，23.5％存在肺功能异常，36.0％比例FeNO≥35亿，41.8％控制不佳。自述哮喘控制良好儿童中有54％的肺功能异常和/或FeNO升高。 随访时，UHA平均数值从评估前6个月0.31 /儿童下降至评估后6个月0.20 /儿童（p = 0.0004）。ACT中值从20分升至22分（p = 0.032），儿童ACT评分从21分上升至23分（p <0.0001）。
结论：在初级保健医疗结构进行哮喘复查的儿童中，常见肺功能和FeNO异常，其与症状评分关系不大。在没有客观测试的情况下，根据症状进行哮喘随访监测可能会遗漏未来发生重症哮喘发作的高风险儿童。
Lung function and asthma control in school-age children managed in UK primary care: a cohort study.
Lo DK, Beardsmore CS, Roland D, Richardson M, Yang Y, Danvers L, Wilson A, Gaillard EA.
Abstract
BACKGROUND: Spirometry and fraction of exhaled nitric oxide (FeNO) are commonly used in specialist centres to monitor children with asthma. The National Institute for Health and Care Excellence recommends spirometry for asthma monitoring from 5 years in all healthcare settings. There is little spirometry and FeNO data in children managed for asthma in UK primary care to support their use.
OBJECTIVES: To study the prevalence of abnormal spirometry and FeNO in children with asthma managed in primary care and to explore their relationship with asthma control and unplanned healthcare attendances (UHA).
METHODS: Prospective observational cohort study in children aged 5-16 years with suspected or doctor-diagnosed asthma attending an asthma review in UK general practice.Spirometry, FeNO, asthma control test (ACT) scores and number of UHAs were studied.
RESULTS: Of 612 children from 10 general practices, 23.5% had abnormal spirometry, 36.0% had raised FeNO ≥35 parts per billion and 41.8% reported poor control. Fifty-four per cent of children reporting good asthma control had abnormal spirometry and/or raised FeNO. At follow-up, the mean number of UHAs fell from 0.31/child in the 6 months preceding review to 0.20/child over the 6 months following review (p=0.0004). Median ACT scores improved from 20 to 22 (p=0.032), and children's ACT from 21 to 23 (p<0.0001).
CONCLUSIONS: Abnormal lung function and FeNO are common in childrena ttending for asthma review in primary care and relate poorly to symptom scores. A symptoms-based approach to asthma monitoring without objective testing is likely to miss children at high risk of future severe asthma attacks.
背景：在专科中心通常使用肺功能和呼出气一氧化氮（FeNO）监测儿童哮喘患者。国立卫生与医疗研究院要求所有医疗机构患儿自5岁开始进行肺功能监测。在英国初级保健机构中，哮喘儿童的肺功能和FeNO数据极少。
目的：研究在初级保健机构哮喘儿童中异常肺功能和FeNO的发生率，并探讨其与哮喘控制水平和非计划就诊次数（UHA）的关系。
方法：此试验为前瞻性观察性队列研究，在英国家庭医生中对5-16岁可疑或经医生确诊为哮喘的儿童进行评估。研究肺功能、FeNO、哮喘控制测试（ACT）评分和计划外就诊次数（UHA）。
结果：来自10组家庭医生中的612名儿童里，23.5％存在肺功能异常，36.0％比例FeNO≥35亿，41.8％控制不佳。自述哮喘控制良好儿童中有54％的肺功能异常和/或FeNO升高。 随访时，UHA平均数值从评估前6个月0.31 /儿童下降至评估后6个月0.20 /儿童（p = 0.0004）。ACT中值从20分升至22分（p = 0.032），儿童ACT评分从21分上升至23分（p <0.0001）。
结论：在初级保健医疗结构进行哮喘复查的儿童中，常见肺功能和FeNO异常，其与症状评分关系不大。在没有客观测试的情况下，根据症状进行哮喘随访监测可能会遗漏未来发生重症哮喘发作的高风险儿童。
（中日友好医院呼吸与危重症医学科 张鑫 摘译 林江涛 审校）
（Thorax. 2019 Oct 30. pii: thoraxjnl-2019-213068.）
（Thorax. 2019 Oct 30. pii: thoraxjnl-2019-213068.）
Lung function and asthma control in school-age children managed in UK primary care: a cohort study.
Lo DK, Beardsmore CS, Roland D, Richardson M, Yang Y, Danvers L, Wilson A, Gaillard EA.
Abstract
BACKGROUND: Spirometry and fraction of exhaled nitric oxide (FeNO) are commonly used in specialist centres to monitor children with asthma. The National Institute for Health and Care Excellence recommends spirometry for asthma monitoring from 5 years in all healthcare settings. There is little spirometry and FeNO data in children managed for asthma in UK primary care to support their use.
OBJECTIVES: To study the prevalence of abnormal spirometry and FeNO in children with asthma managed in primary care and to explore their relationship with asthma control and unplanned healthcare attendances (UHA).
METHODS: Prospective observational cohort study in children aged 5-16 years with suspected or doctor-diagnosed asthma attending an asthma review in UK general practice.Spirometry, FeNO, asthma control test (ACT) scores and number of UHAs were studied.
RESULTS: Of 612 children from 10 general practices, 23.5% had abnormal spirometry, 36.0% had raised FeNO ≥35 parts per billion and 41.8% reported poor control. Fifty-four per cent of children reporting good asthma control had abnormal spirometry and/or raised FeNO. At follow-up, the mean number of UHAs fell from 0.31/child in the 6 months preceding review to 0.20/child over the 6 months following review (p=0.0004). Median ACT scores improved from 20 to 22 (p=0.032), and children's ACT from 21 to 23 (p<0.0001).
CONCLUSIONS: Abnormal lung function and FeNO are common in childrena ttending for asthma review in primary care and relate poorly to symptom scores. A symptoms-based approach to asthma monitoring without objective testing is likely to miss children at high risk of future severe asthma attacks.
上一篇：
IOS定义的哮喘小气道功能障碍的临床特点和预测因子
下一篇：
加利福尼亚州空气质量变化与儿童哮喘发病率之间的关系，1993-2014
