隐藏在英国初级保健系统中的潜在重症哮喘患者
2021/01/28
摘要
背景：重症哮喘在初级保健中可能未得到充分认识。
目的：识别和量化英国初级保健系统中的潜在重症哮喘（PSA）患者，未转诊的比例，并对初级保健PSA患者与英国三级保健确诊的重症哮喘患者进行比较。
方法：历史队列来自最佳患者照护研究数据库（OPCRD；年龄≥16岁，2014年前确诊为哮喘）和英国重症哮喘登记(UK-ISAR；年龄≥18岁，三级中心确诊严重哮喘)。在OPCRD中，PSA被定义为GINA 2018 step4治疗和≥2个急性加重/年或GINA step5治疗。对这些患者的比例和他们在过去一年的转诊状态进行了量化。比较各组的人口学和临床特征。
结果：207,557例OPCRD哮喘患者中，有16,409例（8%）为PSA。在这些人中，72%的人在过去一年中没有转诊或专科医师评估。与未转诊的患者相比，转诊PSA患者倾向于额外使用ICS/ LABA（54.1 vs 39.8%），每年急性发作更多（中位值3 vs 2)，哮喘控制和肺功能更差(%预测使用支气管扩张剂后FEV1/FVC 0.69 vs 0.72)（p<0.001）。与转诊PSA患者相比，确诊的重度哮喘患者（即UK-ISAR)更年轻(51 vs 65)，更易出现哮喘未控制(91.4% vs 62.5%)、更高的急性加重率（4/年[原始评估] vs 3/年）、额外使用ICS/LABA（67.7% vs 54.1%）和鼻息肉（24.2% vs 6.8）比例更高（p<0.001）。
结论：在英国，大量的PSA患者在初级保健中未得到充分认识。这些患者将受益于更系统的初级保健评估和可能的专家转诊。
Potential severe asthma hidden in UK primary care
Dermot Ryan, Heath Heatley, Liam G Heaney, David J Jackson, Paul E Pfeffer, John Busby, Andrew N Menzies-Gow, Rupert Jones, Trung N Tran, Mona Al-Ahmad, Vibeke Backer, Manon Belhassen, Sinthia Bosnic-Anticevich, Arnaud Bourdin, Lakmini Bulathsinhala, Victoria Carter, Isha Chaudhry, Neva Eleangovan, J Mark FitzGerald, Peter G Gibson, Naeimeh Hosseini, Alan Kaplan, Ruth B Murray, Chin Kook Rhee, Eric Van Ganse, David B Price
Abstract
Background: Severe asthma may be under-recognized in primary care.
Objective: Identify and quantify patients with potential severe asthma (PSA) in UK primary care, the proportion not referred, and compare primary care PSA patients with confirmed severe asthma patients from UK tertiary care.
Methods: Historical cohort study including patients from the Optimum Patient Care Research Database (OPCRD; aged ≥16 years, active asthma diagnosis pre-2014) and UK patients in the International Severe Asthma Registry (UK-ISAR; aged ≥18 years, confirmed severe asthma in tertiary care). In the OPCRD, PSA was defined as GINA 2018 Step 4 treatment and ≥2 exacerbations/year OR at GINA Step 5. The proportion of these patients and their referral status in the last year was quantified. Demographic and clinical characteristics of groups were compared.
Results: Of 207,557 OPCRD patients with asthma, 16,409 (8%) had PSA. Of these, 72% had no referral/specialist review in the past year. Referred PSA patients tended to have greater prevalence of ICS/LABA-add-ons (54.1 vs 39.8%), and experienced significantly (p<0.001) more exacerbations/year (median 3 vs 2/year), worse asthma control and worse lung function (% predicted post-bronchodilator FEV1/FVC 0.69 vs 0.72) versus non-referred patients. Confirmed severe asthmatic patients (i.e. UK-ISAR) were younger (51 vs 65 years; p<0.001), and significantly (p<0.001) more likely to have uncontrolled asthma (91.4% vs 62.5%), a higher exacerbation rate (4/year [initial assessment] vs 3/year), use ICS/LABA add-ons (67.7% vs 54.1%), and have nasal polyposis (24.2% vs 6.8) than referred PSA patients.
Conclusion: Large numbers of patients with PSA in the UK are under-recognized in primary care. These patients would benefit from a more systematic assessment in primary care and possible specialist referral.
背景：重症哮喘在初级保健中可能未得到充分认识。
目的：识别和量化英国初级保健系统中的潜在重症哮喘（PSA）患者，未转诊的比例，并对初级保健PSA患者与英国三级保健确诊的重症哮喘患者进行比较。
方法：历史队列来自最佳患者照护研究数据库（OPCRD；年龄≥16岁，2014年前确诊为哮喘）和英国重症哮喘登记(UK-ISAR；年龄≥18岁，三级中心确诊严重哮喘)。在OPCRD中，PSA被定义为GINA 2018 step4治疗和≥2个急性加重/年或GINA step5治疗。对这些患者的比例和他们在过去一年的转诊状态进行了量化。比较各组的人口学和临床特征。
结果：207,557例OPCRD哮喘患者中，有16,409例（8%）为PSA。在这些人中，72%的人在过去一年中没有转诊或专科医师评估。与未转诊的患者相比，转诊PSA患者倾向于额外使用ICS/ LABA（54.1 vs 39.8%），每年急性发作更多（中位值3 vs 2)，哮喘控制和肺功能更差(%预测使用支气管扩张剂后FEV1/FVC 0.69 vs 0.72)（p<0.001）。与转诊PSA患者相比，确诊的重度哮喘患者（即UK-ISAR)更年轻(51 vs 65)，更易出现哮喘未控制(91.4% vs 62.5%)、更高的急性加重率（4/年[原始评估] vs 3/年）、额外使用ICS/LABA（67.7% vs 54.1%）和鼻息肉（24.2% vs 6.8）比例更高（p<0.001）。
结论：在英国，大量的PSA患者在初级保健中未得到充分认识。这些患者将受益于更系统的初级保健评估和可能的专家转诊。
(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. 2020 Dec 9;S2213-2198(20)31327-1. doi: 10.1016/j.jaip.2020.11.053.)
(J Allergy Clin Immunol Pract. 2020 Dec 9;S2213-2198(20)31327-1. doi: 10.1016/j.jaip.2020.11.053.)
Potential severe asthma hidden in UK primary care
Dermot Ryan, Heath Heatley, Liam G Heaney, David J Jackson, Paul E Pfeffer, John Busby, Andrew N Menzies-Gow, Rupert Jones, Trung N Tran, Mona Al-Ahmad, Vibeke Backer, Manon Belhassen, Sinthia Bosnic-Anticevich, Arnaud Bourdin, Lakmini Bulathsinhala, Victoria Carter, Isha Chaudhry, Neva Eleangovan, J Mark FitzGerald, Peter G Gibson, Naeimeh Hosseini, Alan Kaplan, Ruth B Murray, Chin Kook Rhee, Eric Van Ganse, David B Price
Abstract
Background: Severe asthma may be under-recognized in primary care.
Objective: Identify and quantify patients with potential severe asthma (PSA) in UK primary care, the proportion not referred, and compare primary care PSA patients with confirmed severe asthma patients from UK tertiary care.
Methods: Historical cohort study including patients from the Optimum Patient Care Research Database (OPCRD; aged ≥16 years, active asthma diagnosis pre-2014) and UK patients in the International Severe Asthma Registry (UK-ISAR; aged ≥18 years, confirmed severe asthma in tertiary care). In the OPCRD, PSA was defined as GINA 2018 Step 4 treatment and ≥2 exacerbations/year OR at GINA Step 5. The proportion of these patients and their referral status in the last year was quantified. Demographic and clinical characteristics of groups were compared.
Results: Of 207,557 OPCRD patients with asthma, 16,409 (8%) had PSA. Of these, 72% had no referral/specialist review in the past year. Referred PSA patients tended to have greater prevalence of ICS/LABA-add-ons (54.1 vs 39.8%), and experienced significantly (p<0.001) more exacerbations/year (median 3 vs 2/year), worse asthma control and worse lung function (% predicted post-bronchodilator FEV1/FVC 0.69 vs 0.72) versus non-referred patients. Confirmed severe asthmatic patients (i.e. UK-ISAR) were younger (51 vs 65 years; p<0.001), and significantly (p<0.001) more likely to have uncontrolled asthma (91.4% vs 62.5%), a higher exacerbation rate (4/year [initial assessment] vs 3/year), use ICS/LABA add-ons (67.7% vs 54.1%), and have nasal polyposis (24.2% vs 6.8) than referred PSA patients.
Conclusion: Large numbers of patients with PSA in the UK are under-recognized in primary care. These patients would benefit from a more systematic assessment in primary care and possible specialist referral.
