儿童、青少年和成人哮喘控制和严重程度的现实评估：与医疗机构和共患病的关系
2019/12/09
摘要
背景：在现实世界中，我们对患者水平因素和医疗机构与哮喘结局之间的关系知之甚少。
目的：在一个全国性的大样本研究中，我们测定了共患病和医疗机构在儿童和青少年/成人哮喘患者哮喘严重程度和控制水平中的比率和相对贡献。
方法：我们在哮喘IQ数据库识别了28508条独立记录，获得患者水平因素（人口统计学、哮喘特征、共患病）、医疗机构（初级保健医生[PCP]与专科医生[过敏症专科医生或呼吸科专科医生]），以及指南规定的哮喘控制/严重程度。共患率由哮喘严重程度、控制水平和医疗机构确定。根据每种共患病计算哮喘控制和严重程度的比值比（ORs）。
结果：基线人口学资料显示，与PCPs相比，专科医生管理的患者年龄较大，哮喘严重程度更重且哮喘控制水平不佳（p<0.05）。专科医生照护的患者也有更多的合并 症，包括胃食管反流病（GERD；p<0.01）、鼻窦炎（p<0.01）和阻塞性睡眠呼吸暂停（OSA；仅青少年/成人：p<0.01）。GERD、吸烟、抑郁（青少年/成人）、鼻窦炎（儿童）和非裔美国人与哮喘控制不佳相关。烟草暴露（儿童）、鼻窦炎和非裔美国人与疾病严重程度有关。
结论：我们发现了一些与专科医疗、持续性哮喘和哮喘控制不佳独立相关的人口统计学特征和共患病。了解这些关系可能更有助于临床医生照顾哮喘患者。
Real world assessment of asthma control and severity in children, adolescents, and adults with asthma: Relationships to care settings and co-morbidities.
Nyenhuis SM, Akkoyun E, Liu L, Schatz M, Casale TB.
Abstract
BACKGROUND: Little is known about how patient-level factors and care settings relate to asthma outcomes in real-world settings.
OBJECTIVE: We therefore examined the rates and relative contributions of co-morbidities and care settings in terms of asthma severity and control among pediatric and adolescent/adult patients in a large national sample.
METHODS: We examined de-identified patient data from 28,508 unique encounters documented in the Asthma IQ database, obtaining patient level factors (demographics, asthma characteristics, co-morbidities), care setting (primary care physician [PCP] versus specialist physician [Allergist or Pulmonologist]), and guideline-defined levels of asthma control/severity. Rates of co-morbidities were identified by asthma severity and control and by care setting. We calculated odds ratios (ORs) for asthma control and severity based on each co-morbidity.
RESULTS: Baseline demographic data indicated that patients seen by specialists versus PCPs, were older, and had more severe and poorly controlled asthma (p<0.05). Patients cared for by specialists also had more comorbid conditions, including gastroesophageal reflux disease (GERD; p<0.01), rhinosinusitis (p<0.01) and obstructive sleep apnea (OSA; Adolescents/Adults only: p<0.01). GERD, smoke exposure, depression (adolescents/adults), rhinosinusitis (children) and African American race, were associated with uncontrolled asthma. Smoke exposure (children), rhinosinsitis, and African American race, were associated with severe disease.
CONCLUSIONS: We identified several demographics and co-morbidities that are independently associated with the specialist care setting, persistent asthma and poor asthma control. Awareness of these relationships may be helpful for clinicians caring for asthma patients.
背景：在现实世界中，我们对患者水平因素和医疗机构与哮喘结局之间的关系知之甚少。
目的：在一个全国性的大样本研究中，我们测定了共患病和医疗机构在儿童和青少年/成人哮喘患者哮喘严重程度和控制水平中的比率和相对贡献。
方法：我们在哮喘IQ数据库识别了28508条独立记录，获得患者水平因素（人口统计学、哮喘特征、共患病）、医疗机构（初级保健医生[PCP]与专科医生[过敏症专科医生或呼吸科专科医生]），以及指南规定的哮喘控制/严重程度。共患率由哮喘严重程度、控制水平和医疗机构确定。根据每种共患病计算哮喘控制和严重程度的比值比（ORs）。
结果：基线人口学资料显示，与PCPs相比，专科医生管理的患者年龄较大，哮喘严重程度更重且哮喘控制水平不佳（p<0.05）。专科医生照护的患者也有更多的合并 症，包括胃食管反流病（GERD；p<0.01）、鼻窦炎（p<0.01）和阻塞性睡眠呼吸暂停（OSA；仅青少年/成人：p<0.01）。GERD、吸烟、抑郁（青少年/成人）、鼻窦炎（儿童）和非裔美国人与哮喘控制不佳相关。烟草暴露（儿童）、鼻窦炎和非裔美国人与疾病严重程度有关。
结论：我们发现了一些与专科医疗、持续性哮喘和哮喘控制不佳独立相关的人口统计学特征和共患病。了解这些关系可能更有助于临床医生照顾哮喘患者。
(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)
(J Allergy Clin Immunol Pract. 2019 Nov 7. pii: S2213-2198(19)30923-7. doi: 10.1016/j.jaip.2019.10.032. )
(J Allergy Clin Immunol Pract. 2019 Nov 7. pii: S2213-2198(19)30923-7. doi: 10.1016/j.jaip.2019.10.032. )
Real world assessment of asthma control and severity in children, adolescents, and adults with asthma: Relationships to care settings and co-morbidities.
Nyenhuis SM, Akkoyun E, Liu L, Schatz M, Casale TB.
Abstract
BACKGROUND: Little is known about how patient-level factors and care settings relate to asthma outcomes in real-world settings.
OBJECTIVE: We therefore examined the rates and relative contributions of co-morbidities and care settings in terms of asthma severity and control among pediatric and adolescent/adult patients in a large national sample.
METHODS: We examined de-identified patient data from 28,508 unique encounters documented in the Asthma IQ database, obtaining patient level factors (demographics, asthma characteristics, co-morbidities), care setting (primary care physician [PCP] versus specialist physician [Allergist or Pulmonologist]), and guideline-defined levels of asthma control/severity. Rates of co-morbidities were identified by asthma severity and control and by care setting. We calculated odds ratios (ORs) for asthma control and severity based on each co-morbidity.
RESULTS: Baseline demographic data indicated that patients seen by specialists versus PCPs, were older, and had more severe and poorly controlled asthma (p<0.05). Patients cared for by specialists also had more comorbid conditions, including gastroesophageal reflux disease (GERD; p<0.01), rhinosinusitis (p<0.01) and obstructive sleep apnea (OSA; Adolescents/Adults only: p<0.01). GERD, smoke exposure, depression (adolescents/adults), rhinosinusitis (children) and African American race, were associated with uncontrolled asthma. Smoke exposure (children), rhinosinsitis, and African American race, were associated with severe disease.
CONCLUSIONS: We identified several demographics and co-morbidities that are independently associated with the specialist care setting, persistent asthma and poor asthma control. Awareness of these relationships may be helpful for clinicians caring for asthma patients.
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预测支气管热成形术的疗效
