可治疗特征对哮喘控制和生活质量的影响
2023/03/21
摘要
背景：尽管目前有哮喘特异性药物治疗，但许多成人哮喘患者的疾病无法控制，生活质量受损。
目的：本研究旨在调查哮喘患者九种特征的患病率，它们与疾病控制和生活质量以及非医疗保健专业人员的转诊率的关系。
方法：回顾性地收集了荷兰两家医院（Amphia Breda，RadboudUMC Nijmegen）哮喘患者的数据。未出现哮喘发作<3个月的，被转诊为首次选择的、门诊的、基于医院的诊断途径的成年患者被认为符合资格。评估了九个特征：呼吸困难、疲劳、抑郁、超重、运动不耐受、缺乏运动、吸烟、过度换气和频繁发作。为了评估疾病控制不佳或生活质量下降的可能性，计算每个性状的比值（or）。通过检查患者档案来评估转诊率。
结果：研究了444名哮喘患者（57%的女性，年龄：48±16岁，预测FEV1：88±17%）。大多数患者（53%）被发现患有未控制的哮喘（ACQ≥1.5分）和生活质量下降（AQLQ＜6分）。一般而言，患者具有3.0±1.8个特征。严重疲劳最为普遍（60%），并显著增加了哮喘失控的可能性（OR（95%可信区间）：3.0（1.9-4.7）），生活质量下降（OR：4.6（2.7-7.9））；大多数转诊患者是呼吸专科护士（33%）。
结论：首次转诊给肺科医生的成人哮喘患者经常表现出非药物干预的特征，尤其是在那些哮喘失控的患者中。然而，向适当干预措施的转介似乎很少。
The impact of treatable traits on asthma control and quality of life
Steffi Mj Janssen, Hanneke Ac van Helvoort, Tjitske A Tjalma, Jeanine C Antons, Remco S Djamin, Sami O Simons, Prof Martijn A Spruit, Alex J van 't Hul
Abstract
Background: Many adult patients with asthma have uncontrolled disease and impaired quality of life, despite current asthma-specific drug therapies.
Objective: This study aimed to investigate the prevalence of nine traits in asthma patients, their associations with disease control and quality of life, and referral rates to non-medical healthcare professionals.
Methods: Retrospectively, data from asthma patients were collected in two Dutch hospitals (Amphia Breda, RadboudUMC Nijmegen). Adult patients without exacerbation <3 months who were referred for a first-ever elective, outpatient, hospital-based diagnostic pathway were deemed eligible. Nine traits were assessed: dyspnea, fatigue, depression, overweight, exercise intolerance, physical inactivity, smoking, hyperventilation and frequent exacerbations. To assess the likelihood of having poor disease control or decreased quality of life, the Odds Ratio (OR) was calculated per trait. Referral rates were assessed by checking patients' files.
Results: 444 adults with asthma were studied (57% women, age: 48±16 years, FEV1: 88±17% predicted). Most patients (53%) were found to have uncontrolled asthma (ACQ ≥1.5 points) and decreased quality of life (AQLQ <6 points). Generally, patients had 3.0±1.8 traits. Severe fatigue was most prevalent (60%), and significantly increased the likelihood of having uncontrolled asthma (OR (95%CI): 3.0 (1.9-4.7)), and decreased quality of life (OR: 4.6 (2.7-7.9)). Referrals to non-MD healthcare professionals were low; most referrals were to a respiratory-specialized nurse (33%).
Conclusion: Adult patients with asthma with a first ever referral to a pulmonologist frequently exhibit traits justifying the deployment of non-pharmacological interventions, especially in those with uncontrolled asthma. However, referrals to appropriate interventions appeared infrequent.
背景：尽管目前有哮喘特异性药物治疗，但许多成人哮喘患者的疾病无法控制，生活质量受损。
目的：本研究旨在调查哮喘患者九种特征的患病率，它们与疾病控制和生活质量以及非医疗保健专业人员的转诊率的关系。
方法：回顾性地收集了荷兰两家医院（Amphia Breda，RadboudUMC Nijmegen）哮喘患者的数据。未出现哮喘发作<3个月的，被转诊为首次选择的、门诊的、基于医院的诊断途径的成年患者被认为符合资格。评估了九个特征：呼吸困难、疲劳、抑郁、超重、运动不耐受、缺乏运动、吸烟、过度换气和频繁发作。为了评估疾病控制不佳或生活质量下降的可能性，计算每个性状的比值（or）。通过检查患者档案来评估转诊率。
结果：研究了444名哮喘患者（57%的女性，年龄：48±16岁，预测FEV1：88±17%）。大多数患者（53%）被发现患有未控制的哮喘（ACQ≥1.5分）和生活质量下降（AQLQ＜6分）。一般而言，患者具有3.0±1.8个特征。严重疲劳最为普遍（60%），并显著增加了哮喘失控的可能性（OR（95%可信区间）：3.0（1.9-4.7）），生活质量下降（OR：4.6（2.7-7.9））；大多数转诊患者是呼吸专科护士（33%）。
结论：首次转诊给肺科医生的成人哮喘患者经常表现出非药物干预的特征，尤其是在那些哮喘失控的患者中。然而，向适当干预措施的转介似乎很少。
(中日友好医院呼吸与危重症医学科 顾宪民 摘译 林江涛 审校)
(J Allergy Clin Immunol Pract. 2023 Mar 7;S2213-2198(23)00239-8. doi: 10.1016/j.jaip.2023.02.034.)
(J Allergy Clin Immunol Pract. 2023 Mar 7;S2213-2198(23)00239-8. doi: 10.1016/j.jaip.2023.02.034.)
The impact of treatable traits on asthma control and quality of life
Steffi Mj Janssen, Hanneke Ac van Helvoort, Tjitske A Tjalma, Jeanine C Antons, Remco S Djamin, Sami O Simons, Prof Martijn A Spruit, Alex J van 't Hul
Abstract
Background: Many adult patients with asthma have uncontrolled disease and impaired quality of life, despite current asthma-specific drug therapies.
Objective: This study aimed to investigate the prevalence of nine traits in asthma patients, their associations with disease control and quality of life, and referral rates to non-medical healthcare professionals.
Methods: Retrospectively, data from asthma patients were collected in two Dutch hospitals (Amphia Breda, RadboudUMC Nijmegen). Adult patients without exacerbation <3 months who were referred for a first-ever elective, outpatient, hospital-based diagnostic pathway were deemed eligible. Nine traits were assessed: dyspnea, fatigue, depression, overweight, exercise intolerance, physical inactivity, smoking, hyperventilation and frequent exacerbations. To assess the likelihood of having poor disease control or decreased quality of life, the Odds Ratio (OR) was calculated per trait. Referral rates were assessed by checking patients' files.
Results: 444 adults with asthma were studied (57% women, age: 48±16 years, FEV1: 88±17% predicted). Most patients (53%) were found to have uncontrolled asthma (ACQ ≥1.5 points) and decreased quality of life (AQLQ <6 points). Generally, patients had 3.0±1.8 traits. Severe fatigue was most prevalent (60%), and significantly increased the likelihood of having uncontrolled asthma (OR (95%CI): 3.0 (1.9-4.7)), and decreased quality of life (OR: 4.6 (2.7-7.9)). Referrals to non-MD healthcare professionals were low; most referrals were to a respiratory-specialized nurse (33%).
Conclusion: Adult patients with asthma with a first ever referral to a pulmonologist frequently exhibit traits justifying the deployment of non-pharmacological interventions, especially in those with uncontrolled asthma. However, referrals to appropriate interventions appeared infrequent.
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臭氧引起的幼儿哮喘和喘息的生命过程:中国北方的一个前瞻性出生队列
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罗氟司特用于治疗肥胖患者控制不佳的哮喘时，可能会增加病情加重的风险
