背景：尽管已经制定了有效的哮喘治疗措施以及针对哮喘控制的循证管理指南，但仍有许多患者的哮喘未得到有效控制。本研究旨在成人和儿童哮喘患者中寻找未控制哮喘的危险因素。

    方法：从2008年1月25日～5月2日，在成人和儿童哮喘患者中进行了两项横断面研究，目的为了评价哮喘控制状态。参与者完成自填式问卷调查，其内容包括人口统计学资料、病史、目前的哮喘用药情况。此外，对患者进行哮喘控制测试（ACT）或儿童ACT（C-ACT）。未控制哮喘定义为ACT或C-ACT评分≤19。采用多元回归分析区分与未控制哮喘有关的因素。

    结果：共有美国64个基层医疗机构参与了本项研究，其中35个针对成人，29个针对儿童患者。其中一项研究包括2238名成人（年龄≥18岁）哮喘患者，另一项研究包括2429名儿童（年龄为4～17岁）哮喘患者。患者因各种原因于基层医疗机构内预约就诊。未控制哮喘的发生率在成人和儿童患者分别为58％和46％。多元回归分析显示，在成人和儿童患者中，与未控制哮喘相关的预测因素包括自我主诉的哮喘严重程度、药物使用依从性较差、近期感冒、流感或鼻窦感染。仅与成人患者相关的预测因素还包括受教育程度低、健康保险状态、吸烟、体重指数（BMI）>30 kg/m²及胃食管反流症状等。而仅与儿童患者相关的还包括年龄为12～17岁的女孩、监护人失业及哮喘恶化史。

    结论：在美国基层医疗机构中，未控制哮喘患者所占比例较高。寻找未控制哮喘的预测因素，有助于鉴别哪些患者存在未控制哮喘高风险，且有助于早期干预。

Stanford RH, et al. J Asthma. 2010 Mar 8. [Epub ahead of print]

Predictors of Uncontrolled Asthma in Adult and Pediatric Patients: Analysis of the Asthma Control Characteristics and Prevalence Survey Studies (ACCESS).

Stanford RH, Gilsenan AW, Ziemiecki R, Zhou X, Lincourt WR, Ortega H.

1Department of Health Outcomes, GlaxoSmithKline, Research Triangle Park, North Carolina, USA.

Background. Despite the availability of effective asthma treatments and evidence-based management guidelines focusing on asthma control, many patients have asthma that is inadequately controlled. The objective of this analysis was to identify risk factors for uncontrolled asthma among adult and pediatric patients.

Methods. Two cross-sectional surveys assessing asthma control status were conducted between January 25 and May 2, 2008, among adult and pediatric patients with asthma. Participants completed a self-administered questionnaire including demographics, medical history, and current asthma medication use. In addition, participants completed either the Asthma Control Test (ACT) or Childhood ACT (C-ACT). Uncontrolled asthma was defined as a score of

Results. A sample of 64 primary care provider sites (35 for adults and 29 for pediatric patients) across the United States enrolled. One study enrolled 2238 adults (aged >/=18 years) and the other 2429 children (aged 4-17 years) with asthma. The patients were visiting their health care provider for a scheduled appointment for any reason. The overall prevalence of uncontrolled asthma was 58% and 46% in adult and pediatric patients, respectively. Multivariate analysis identified predictors of uncontrolled asthma in both adults and children including self-reported asthma severity, lack of adherence, and recent history of cold, flu, or sinus infection. The predictors of uncontrolled asthma seen only in adults were less education, insurance status, current smoker, body mass index (BMI) >30 kg/m(2), and history of gastroesophageal symptoms. The predictors of uncontrolled asthma seen only in children were female aged 12-17 years, caregiver unemployment, and history of asthma exacerbation.

Conclusions. A high proportion of patients with asthma seen in primary care settings are not well controlled. Recognition of specific predictors can signal who may be at higher risk of uncontrolled asthma and provide the opportunity for early interventions.