成人轻度哮喘急性加重的风险因素评估
2025/03/04
摘要
背景：哮喘急性发作人群中轻度哮喘占30% - 40%，目前对诱发轻度哮喘出现急性发作的危险因素仍少有关注。
目的：确定诱发轻度哮喘患者发生急性加重的危险因素。
方法：本研究为一项回顾性队列研究。根据一家大型管理式医疗机构的数据，纳入了2013至2018年，年龄18-85岁，且符合轻度哮喘诊断标准的199010名成人患者。对每位哮喘患者进行了一次首诊访视，并使用首次访视时或前一年的信息来分析下一年发生哮喘急性加重的潜在危险因素。急性加重定义为因哮喘急性发作住院或急诊就诊，或使用全身性皮质类固醇（肌注、静脉或口服）。采用具有稳健标准误（SE）的泊松回归模型，对哮喘急性加重的风险比进行估计。
结果：在研究队列中，参与者的平均年龄为44岁，其中女性占比64%。在首次访视后的一年内，6.5%的患者曾发生哮喘急性发作。通过多变量模型分析，我们发现年龄、性别、种族、民族、吸烟状况、体重指数、既往急性哮喘治疗史、合并症以及其他临床特征均是预测未来哮喘急性发作风险的显著因素。
结论：在推广基于人群的哮喘疾病管理策略过程中，不仅涵盖中度至重度哮喘患者，还应将轻度哮喘患者纳入管理范围。
关键词： 哮喘急性发作；哮喘负担；电子健康记录；医疗保健资源利用；低利用率；轻度哮喘；风险因素
文献来源：(Chen W, Puttock EJ, Schatz M, et al. Risk factors for acute asthma exacerbations in adults with mild asthma[J]. J Allergy Clin Immunol Pract , 2024, 12(10): 2705-2716.e6)
背景：哮喘急性发作人群中轻度哮喘占30% - 40%，目前对诱发轻度哮喘出现急性发作的危险因素仍少有关注。
目的：确定诱发轻度哮喘患者发生急性加重的危险因素。
方法：本研究为一项回顾性队列研究。根据一家大型管理式医疗机构的数据，纳入了2013至2018年，年龄18-85岁，且符合轻度哮喘诊断标准的199010名成人患者。对每位哮喘患者进行了一次首诊访视，并使用首次访视时或前一年的信息来分析下一年发生哮喘急性加重的潜在危险因素。急性加重定义为因哮喘急性发作住院或急诊就诊，或使用全身性皮质类固醇（肌注、静脉或口服）。采用具有稳健标准误（SE）的泊松回归模型，对哮喘急性加重的风险比进行估计。
结果：在研究队列中，参与者的平均年龄为44岁，其中女性占比64%。在首次访视后的一年内，6.5%的患者曾发生哮喘急性发作。通过多变量模型分析，我们发现年龄、性别、种族、民族、吸烟状况、体重指数、既往急性哮喘治疗史、合并症以及其他临床特征均是预测未来哮喘急性发作风险的显著因素。
结论：在推广基于人群的哮喘疾病管理策略过程中，不仅涵盖中度至重度哮喘患者，还应将轻度哮喘患者纳入管理范围。
关键词： 哮喘急性发作；哮喘负担；电子健康记录；医疗保健资源利用；低利用率；轻度哮喘；风险因素
文献来源：(Chen W, Puttock EJ, Schatz M, et al. Risk factors for acute asthma exacerbations in adults with mild asthma[J]. J Allergy Clin Immunol Pract , 2024, 12(10): 2705-2716.e6)
（南方医科大学南方医院 黄海伦 龚钊乾 赵文驱 赵海金）
Abstract
Background: Although individuals with mild asthma account for 30% to 40% of acute asthma exacerbations (AAEs), relatively little attention has been paid to risk factors for AAEs in this population.
Objective: To identify risk factors associated with AAEs in patients with mild asthma.
Methods: This was a retrospective cohort study. We used administrative data from a large managed care organization to identify 199,010 adults aged 18 to 85 years who met study criteria for mild asthma between 2013 and 2018. An asthma-coded qualifying visit (index visit) was identified for each patient. We then used information at the index visit or from the year before the index visit to measure potential risk factors for AAEs in the subsequent year. An AAE was defined as either an asthma-coded hospitalization or emergency department visit, or an asthma-related systemic corticosteroid administration (intramuscular or intravenous) or oral corticosteroid dispensing. Poisson regression models with robust SEs were used to estimate the adjusted risk ratios for future AAEs.
Results: In the study cohort, mean age was 44 years and 64% were female; 6.5% had AAEs within 1 year after the index visit. In multivariate models, age, sex, race, ethnicity, smoking status, body mass index, prior acute asthma care, and a variety of comorbidities and other clinical characteristics were significant predictors for future AAE risk.
Conclusion: Population-based disease management strategies for asthma should be expanded to include people with mild asthma in addition to those with moderate to severe disease.
Keywords: Acute asthma exacerbation; Asthma burden; Electronic health records; Health care resource utilization; Low utilizer; Mild asthma; Risk factor.
Background: Although individuals with mild asthma account for 30% to 40% of acute asthma exacerbations (AAEs), relatively little attention has been paid to risk factors for AAEs in this population.
Objective: To identify risk factors associated with AAEs in patients with mild asthma.
Methods: This was a retrospective cohort study. We used administrative data from a large managed care organization to identify 199,010 adults aged 18 to 85 years who met study criteria for mild asthma between 2013 and 2018. An asthma-coded qualifying visit (index visit) was identified for each patient. We then used information at the index visit or from the year before the index visit to measure potential risk factors for AAEs in the subsequent year. An AAE was defined as either an asthma-coded hospitalization or emergency department visit, or an asthma-related systemic corticosteroid administration (intramuscular or intravenous) or oral corticosteroid dispensing. Poisson regression models with robust SEs were used to estimate the adjusted risk ratios for future AAEs.
Results: In the study cohort, mean age was 44 years and 64% were female; 6.5% had AAEs within 1 year after the index visit. In multivariate models, age, sex, race, ethnicity, smoking status, body mass index, prior acute asthma care, and a variety of comorbidities and other clinical characteristics were significant predictors for future AAE risk.
Conclusion: Population-based disease management strategies for asthma should be expanded to include people with mild asthma in addition to those with moderate to severe disease.
Keywords: Acute asthma exacerbation; Asthma burden; Electronic health records; Health care resource utilization; Low utilizer; Mild asthma; Risk factor.
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