治疗指南、肺科专家、患者和同居伴侣之间对严重哮喘控制的评价
2010/12/17
摘要
简介：根据已有的证据，近期有关哮喘管理的指南建议提倡根据疾病控制程度而非疾病严重程度来选择治疗策略。
目的：本试验为观察性、基于问卷调查的研究，旨在研究医生、患者及同居伴侣之间怎样评价疾病的控制情况，以及将这些评价与基于治疗指南获得的评价进行对比。
方法：169名严重、持续性哮喘患者入选本项研究。这些患者至少采用大剂量吸入性皮质激素联合长效β2受体激动剂进行治疗。肺科专家、患者及与患者一起生活的同居伴侣对其哮喘严重程度进行评价。将这些评价与通过治疗指南获得的评价进行比较。
结果：患者及其同居伴侣对患者哮喘控制情况的判断好于肺科专家，这些专家的评价认为仅58%患者的哮喘控制水平达到可以接受的程度。且根据哮喘治疗指南，所有患者都需要接受进一步治疗。哮喘指南中所定义的“哮喘未控制状态”是最常用的评价标准，有87.4%的患者活动受限（72.3%），有63.3%的患者其FEV1值≤85%个人最佳值。
结论：在评价严重哮喘控制水平时，患者及其同居伴侣的意见价值是有限的。虽然大样本的临床试验显示，基于治疗指南的哮喘治疗策略有助于哮喘控制，但这些研究主要针对轻度或中度哮喘，因此对10%的严重哮喘患者给予进一步的积极治疗以获得完全控制可能是不恰当的。但在临床实践中，肺科专家一般都采用了该治疗策略。
（苏楠 审校）
J Asthma. 2010 Oct;47(8):853-859.
Insights into severe asthma control as assessed by guidelines, pulmonologist, patient, and partner.
Molimard M, Vervloet D, Le Gros V, Bourdeix I, Ponthieux A.
INSERM, Département de Pharmacologie, Université Victor Segalen, CHU de Bordeaux, Bordeaux, France. Mathieu.Molimard@pharmaco.u-bordeaux2.fr
Abstract
INTRODUCTION: The most recent guidelines on asthma management advocate a treatment strategy based on control of the disease rather than severity, a switch based on reported evidence.
AIMS: This observational, questionnaire-based study set out to investigate how control of the disease is assessed by the physician as well as the patient and his/her live-in partner and to compare these assessments with an assessment made according to the guidelines.
METHODS: In 169 patients with severe, persistent asthma on at least a high-dose inhaled corticosteroid plus an inhaled long-acting β2-agonist, control of the disease was assessed by the pulmonologist, the patient, and the patient’s live-in partner. These assessments were compared with an assessment based on the guidelines. Results. Both patients and partners tended to judge disease control as better than their pulmonologists who, in turn, estimated control as acceptable in 58% of their patients in whom the guidelines would advocate more aggressive treatment. The most common guidelines criteria defining inadequate control in the "uncontrolled" 87.4% of this population were "limitation of physical activity" (72.3%) and "FEV₁" ≤ 85% of personal best" (63.3%).
CONCLUSIONS: To assess control in severe asthma, the patient’s opinion is of limited value, as is that of their partners. Although a guidelines-based strategy has been shown to be effective in clinical trials conducted on large-scale populations in which mild or moderate disease is predominant, more aggressive treatment to achieve definitive control may not be appropriate in the 10% of asthma sufferers with severe disease; in everyday practice, lung specialists appear to implement such a strategy
J Asthma. 2010 Oct;47(8):853-9.
简介：根据已有的证据，近期有关哮喘管理的指南建议提倡根据疾病控制程度而非疾病严重程度来选择治疗策略。
目的：本试验为观察性、基于问卷调查的研究，旨在研究医生、患者及同居伴侣之间怎样评价疾病的控制情况，以及将这些评价与基于治疗指南获得的评价进行对比。
方法：169名严重、持续性哮喘患者入选本项研究。这些患者至少采用大剂量吸入性皮质激素联合长效β2受体激动剂进行治疗。肺科专家、患者及与患者一起生活的同居伴侣对其哮喘严重程度进行评价。将这些评价与通过治疗指南获得的评价进行比较。
结果：患者及其同居伴侣对患者哮喘控制情况的判断好于肺科专家，这些专家的评价认为仅58%患者的哮喘控制水平达到可以接受的程度。且根据哮喘治疗指南，所有患者都需要接受进一步治疗。哮喘指南中所定义的“哮喘未控制状态”是最常用的评价标准，有87.4%的患者活动受限（72.3%），有63.3%的患者其FEV1值≤85%个人最佳值。
结论：在评价严重哮喘控制水平时，患者及其同居伴侣的意见价值是有限的。虽然大样本的临床试验显示，基于治疗指南的哮喘治疗策略有助于哮喘控制，但这些研究主要针对轻度或中度哮喘，因此对10%的严重哮喘患者给予进一步的积极治疗以获得完全控制可能是不恰当的。但在临床实践中，肺科专家一般都采用了该治疗策略。
（苏楠 审校）
J Asthma. 2010 Oct;47(8):853-859.
Insights into severe asthma control as assessed by guidelines, pulmonologist, patient, and partner.
Molimard M, Vervloet D, Le Gros V, Bourdeix I, Ponthieux A.
INSERM, Département de Pharmacologie, Université Victor Segalen, CHU de Bordeaux, Bordeaux, France. Mathieu.Molimard@pharmaco.u-bordeaux2.fr
Abstract
INTRODUCTION: The most recent guidelines on asthma management advocate a treatment strategy based on control of the disease rather than severity, a switch based on reported evidence.
AIMS: This observational, questionnaire-based study set out to investigate how control of the disease is assessed by the physician as well as the patient and his/her live-in partner and to compare these assessments with an assessment made according to the guidelines.
METHODS: In 169 patients with severe, persistent asthma on at least a high-dose inhaled corticosteroid plus an inhaled long-acting β2-agonist, control of the disease was assessed by the pulmonologist, the patient, and the patient’s live-in partner. These assessments were compared with an assessment based on the guidelines. Results. Both patients and partners tended to judge disease control as better than their pulmonologists who, in turn, estimated control as acceptable in 58% of their patients in whom the guidelines would advocate more aggressive treatment. The most common guidelines criteria defining inadequate control in the "uncontrolled" 87.4% of this population were "limitation of physical activity" (72.3%) and "FEV₁" ≤ 85% of personal best" (63.3%).
CONCLUSIONS: To assess control in severe asthma, the patient’s opinion is of limited value, as is that of their partners. Although a guidelines-based strategy has been shown to be effective in clinical trials conducted on large-scale populations in which mild or moderate disease is predominant, more aggressive treatment to achieve definitive control may not be appropriate in the 10% of asthma sufferers with severe disease; in everyday practice, lung specialists appear to implement such a strategy
J Asthma. 2010 Oct;47(8):853-9.
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儿童和青少年难治性哮喘患者的行为问题
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运动增加哮喘患者呼出气冷凝液中的半胱胺酰白三烯浓度
