与重度哮喘控制相关的因素
2010/07/05
前言：哮喘治疗的优先目标在于达到控制。在对哮喘患者的随访中，推荐采用基于哮喘控制的分级。不同因素能够影响哮喘控制水平。哮喘的发病率、哮喘的治疗和其控制程度，都存在某些局部差异。
目的：在常规临床实践中评价与严重哮喘控制相关的因素。
材料与方法：本试验为针对严重哮喘患者的一项前瞻性、横断面、观察性研究。这些患者来自于整个西班牙呼吸科和变态反应科中采用固定的联合皮质类固醇（至少800 μg/天的布地奈德）和吸入性β2肾上腺素受体激动剂治疗。收集人口统计学数据、社会经济学数据及与哮喘相关的临床数据。患者同时完成自我给药的有效性问卷调查[哮喘控制问卷调查（ACQ）]，检测哮喘控制水平。
结果：共有1471名患者入选本研究，其中1224名（83％）患者符合最终分析标准。女性占61％。平均年龄为51 +/- 16岁。过去1年平均哮喘恶化次数为2.0 +/- 2.0次。ACQ 整体评分为1.8 +/- 1.1（0 =无症状; 6 =症状数最大）。仅20.4％的患者哮喘得到很好控制（ACQ < 0.75），55.7%的患者哮喘控制较差（ACQ > 1.5）。多元分析显示，与哮喘控制最大有效性相关的变量为过去1年哮喘恶化次数：当哮喘恶化次数从0增加到1或更高，ACQ评分增加0.56。有工作的哮喘患者，其ACQ评分平均比无工作的及退休的患者低0.23（说明控制情况较好）。哮喘控制水平同时受到治疗依从性、患者对疾病的了解程度、体重指数、性别及前3个月就诊次数的影响。
结论：许多患有严重哮喘的患者对哮喘的控制较差。哮喘恶化次数是对哮喘控制影响最大的变量。对哮喘的了解以及对治疗的依从性也与较好哮喘控制程度相关。
(苏楠 审校)
Hermosa JL, et al. J Asthma. 2010 Mar;47(2):124-130.
Factors associated with the control of severe asthma.
Hermosa JL, Sánchez CB, Rubio MC, Mínguez MM, Walther JL.
Department of Neumology, Hospital Clinico San Carlos, Madrid 28003, Spain. jlrhermosa@yahoo.es
INTRODUCTION: Control is a priority treatment objective in asthma, and classification based on control is recommended in the follow-up of asthmatic patients. Different factors affect this control, and there are several regional differences, both in terms of prevalence and in terms of management and degree of control.
OBJECTIVE: To evaluate the factors associated with control of severe asthma in routine clinical practice.
MATERIAL AND METHODS: This was a prospective, cross-sectional, observational study of patients with severe asthma who were receiving treatment with a fixed combination of a corticosteroid (at least 800 microg/day of budesonide or equivalent) and an inhaled beta(2)-adrenergic agonist in respiratory medicine and allergology clinics throughout Spain. The authors collected demographic and socioeconomic data, as well as clinical data on asthma. The patients also completed a self-administered validated questionnaire-the Asthma Control Questionnaire (ACQ)-about the control of their asthma.
RESULTS: The authors included 1471 patients, of whom 1224 (83%) were valid for the final analysis. Women accounted for 61%. Mean age was 51 +/- 16 years. The mean number of exacerbations during the previous year was 2.0 +/- 2.0. The global score on the ACQ was 1.8 +/- 1.1 (0 = no symptoms; 6 = maximum number of symptoms). Only 20.4% of patients were well controlled (ACQ < 0.75), and 55.7% of patients were poorly controlled (ACQ > 1.5). The multivariate analysis revealed that the variable with the greatest effect on control of asthma was the number of exacerbations during the previous year: when the number of exacerbations increased from 0 to 1 or more, the ACQ score increased by 0.56 points. Employed patients had a mean of 0.23 points less (better control) than unemployed and retired patients. Control of asthma was also significantly affected by adherence to treatment, patient knowledge of the disease, body mass index, gender, and number of visits to a physician in the previous 3 months.
CONCLUSIONS: Many patients with severe asthma have poor control of their disease. The number of exacerbations is the variable with the greatest effect on control of asthma. Knowledge of the disease and adherence to treatment are associated with better control.
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