急诊收治的急性哮喘患者的慢性哮喘严重程度的多中心研究
2010/11/03
摘要
目的：启动哮喘控制治疗取决于慢性哮喘严重程度。为促使急诊采用皮质激素吸入治疗（ICS）进行哮喘控制，本研究对急诊收治的急性哮喘患儿的慢性哮喘严重程度进行描述，该严重程度分级基于国家哮喘指南。
方法：研究者对美国14个研究点，因急性哮喘而急诊就诊的2～17岁患儿进行研究。基于三个因素（日间症状、夜间症状和药物使用），对患者严重程度分级：间歇性、轻度持续性、中度持续性和严重持续性。
结果：此项多州参与的研究入选了311名患儿，平均年龄为7.7岁，51%为黑人，89%患者有健康看护者（PCP）。18%患者为间歇性哮喘，82%的为持续性哮喘：37%为轻度持续性、24%为中度持续性、20%为严重持续性。各组之间的人口统计学和PCP状态无显著差异。持续性哮喘患者更可能出现中度至重度哮喘症状(58% versus 19%; p < .001)、较差的哮喘控制（2% vs 18%; p = .002）和过去1年更多的急诊就医（平均：2次 vs 1次; p < .001）。急性哮喘严重程度、急诊治疗和住院率各组间无显著差异。出院用药中ICS比率较低、而持续哮喘患儿则较高（24% vs 4%; p = .003）。
结论：急诊患者持续性哮喘发病率较高，且高于前期研究报道，该结果支持如国家指南推荐的，急诊启用ICS治疗。
（陈欣 审校）
J Asthma. 2010 Sep 13. [Epub ahead of print]
Multicenter Study of Chronic Asthma Severity Among Emergency Department Patients With Acute Asthma.
Sills MR, Ginde AA, Clark S, Camargo CA.
Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A.
Abstract
Objective. The initiation of controller therapy for asthma depends on chronic asthma severity. To facilitate initiation of inhaled corticosteroids (ICSs), the preferred controller therapy, in the emergency department (ED), the objective of the study was to describe chronic asthma severity, as defined by the national asthma guidelines, among children presenting to the ED with acute asthma.
Methods. Investigators at 14 U.S. sites prospectively enrolled consecutive children 2-17 years presenting to the ED with acute asthma. Three factors (daytime symptoms, nighttime symptoms, and medication usage) were used to categorize children into four chronic asthma severity groups: intermittent, mild persistent, moderate persistent or severe persistent.
Results. This multistate cohort of 311 children had a mean age of 7.7 years, was 51% Black, and 89% had a primary care provider (PCP). Regarding chronic severity, 18% were intermittent and 82% persistent: 37% mild persistent, 24% moderate persistent, and 20% severe persistent. Chronic severity groups did not differ by demographics or PCP status. Patients with persistent asthma were more likely to report moderate-severe asthma symptoms (58% versus 19%; p < .001), poor asthma control (2% versus 18%; p = .002), and more ED visits (median, 2 versus 1; p < .001) in the past year. The groups did not differ in acute asthma severity, ED treatment, or admission rate. Rate of discharge prescription for ICSs was low, albeit higher among children with persistent asthma (24% versus 4%; p = .003).
Conclusions. The high prevalence of persistent asthma among ED patients exceeds the prevalence reported previously, and supports ED initiation of ICS, as recommended by national guidelines.
J Asthma. 2010 Sep 13. [Epub ahead of print]
目的：启动哮喘控制治疗取决于慢性哮喘严重程度。为促使急诊采用皮质激素吸入治疗（ICS）进行哮喘控制，本研究对急诊收治的急性哮喘患儿的慢性哮喘严重程度进行描述，该严重程度分级基于国家哮喘指南。
方法：研究者对美国14个研究点，因急性哮喘而急诊就诊的2～17岁患儿进行研究。基于三个因素（日间症状、夜间症状和药物使用），对患者严重程度分级：间歇性、轻度持续性、中度持续性和严重持续性。
结果：此项多州参与的研究入选了311名患儿，平均年龄为7.7岁，51%为黑人，89%患者有健康看护者（PCP）。18%患者为间歇性哮喘，82%的为持续性哮喘：37%为轻度持续性、24%为中度持续性、20%为严重持续性。各组之间的人口统计学和PCP状态无显著差异。持续性哮喘患者更可能出现中度至重度哮喘症状(58% versus 19%; p < .001)、较差的哮喘控制（2% vs 18%; p = .002）和过去1年更多的急诊就医（平均：2次 vs 1次; p < .001）。急性哮喘严重程度、急诊治疗和住院率各组间无显著差异。出院用药中ICS比率较低、而持续哮喘患儿则较高（24% vs 4%; p = .003）。
结论：急诊患者持续性哮喘发病率较高，且高于前期研究报道，该结果支持如国家指南推荐的，急诊启用ICS治疗。
（陈欣 审校）
J Asthma. 2010 Sep 13. [Epub ahead of print]
Multicenter Study of Chronic Asthma Severity Among Emergency Department Patients With Acute Asthma.
Sills MR, Ginde AA, Clark S, Camargo CA.
Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A.
Abstract
Objective. The initiation of controller therapy for asthma depends on chronic asthma severity. To facilitate initiation of inhaled corticosteroids (ICSs), the preferred controller therapy, in the emergency department (ED), the objective of the study was to describe chronic asthma severity, as defined by the national asthma guidelines, among children presenting to the ED with acute asthma.
Methods. Investigators at 14 U.S. sites prospectively enrolled consecutive children 2-17 years presenting to the ED with acute asthma. Three factors (daytime symptoms, nighttime symptoms, and medication usage) were used to categorize children into four chronic asthma severity groups: intermittent, mild persistent, moderate persistent or severe persistent.
Results. This multistate cohort of 311 children had a mean age of 7.7 years, was 51% Black, and 89% had a primary care provider (PCP). Regarding chronic severity, 18% were intermittent and 82% persistent: 37% mild persistent, 24% moderate persistent, and 20% severe persistent. Chronic severity groups did not differ by demographics or PCP status. Patients with persistent asthma were more likely to report moderate-severe asthma symptoms (58% versus 19%; p < .001), poor asthma control (2% versus 18%; p = .002), and more ED visits (median, 2 versus 1; p < .001) in the past year. The groups did not differ in acute asthma severity, ED treatment, or admission rate. Rate of discharge prescription for ICSs was low, albeit higher among children with persistent asthma (24% versus 4%; p = .003).
Conclusions. The high prevalence of persistent asthma among ED patients exceeds the prevalence reported previously, and supports ED initiation of ICS, as recommended by national guidelines.
J Asthma. 2010 Sep 13. [Epub ahead of print]
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通过哮喘严重程度进行儿童哮喘临床分型
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过敏性哮喘患儿中呼出气一氧化氮水平（FeNO）的决定因素：新生儿呼吸窘迫与低FeNO水平相关的证据
