哮喘控制测试评分与FEV1及NO相关——希腊哮喘患者的治疗影响研究
2011/11/23
摘要
背景:哮喘作为一种常见的慢性病,影响着患者的健康和生活质量。虽然新的哮喘治疗指南都较注重哮喘的控制,但是哮喘控制欠佳的患者不在少数,即使有的还接受过专科的治疗。哮喘控制测试TM(ACT)能根据患者的回忆来评估哮喘控制情况,是一个简便而可靠的哮喘评估工具。
目的:本研究通过观察门诊患者的哮喘初诊和随访情况,评价ACT与反映肺功能和炎症的客观指标【如第一秒用力呼气体积(FEV1)、呼出气一氧化氮(FeNO)】之间是否存在相关性。
方法:160例新近诊断为哮喘的患者入选本研究,包括104例女性和56例男性,平均年龄为39.7 ± 16.6岁。治疗前(第一次)以及初始治疗4~12周后(第二次),受试者完成ACT问卷调查,并进行详细的临床检查、检测FeNO和支气管扩张剂使用前肺活量。
结果:第一次访视时,平均ACT评分为21.27 ± 3.74。根据ACT评分,37例患者(23.1%)被诊断为哮喘完全控制,85例患者(53.1%)为部分控制,38例患者(23.8%)为未控制。哮喘未得到控制的患者,其FeNO水平显著高于部分控制(p =0 .038)和完全控制(p =0.016)的患者。分析显示,ACT评分与支气管扩张剂使用前的FEV1成正相关(r = 0.177, p =0.025),而与FeNO成负相关( r = -0.211, p =0.007)。第二次访视时,平均ACT评分为23.00 ± 2.19。两次访视间的ACT评分变化与FEV1变化(r = 0.538, p <0.001)以及FeNO变化(r = -0.466, p <0.001)均显著相关。与无皮质激素吸入(ICS)治疗的哮喘患者相比,采用糖皮质激素吸入治疗的患者,FEV1和ACT评分均得到显著改善,而且FeNO也有所降低。
结论:通过对希腊哮喘患者的研究可以发现,虽然FEV1仍然是评价哮喘的主要客观指标,但ACT评分同样能反映肺功能和气道炎症。
(林江涛 审校)
J Asthma. 2011 Sep 16. [Epub ahead of print]
Asthma Control Test Is Correlated to FEV(1) and Nitric Oxide in Greek Asthmatic Patients: Influence of Treatment.
Papakosta D, Latsios D, Manika K, Porpodis K, Kontakioti E, Gioulekas D.
Source
Pulmonary Department, Aristotle University of Thessaloniki , Exochi, Thessaloniki , Greece.
Abstract
BACKGROUND:Asthma is a common chronic disease affecting patients’ health status and quality of life. Although recent guidelines focus on asthma control, asthma remains poorly controlled in many patients even under specialist care. Asthma Control Test™ (ACT) is a short, simple, patient-based tool that provides consistent assessment of asthma.
OBJECTIVE:The aim of this study was to estimate the relationship of ACT with objective measures of lung function and inflammation such as forced expiratory volume in 1st second (FEV(1)) and exhaled nitric oxide (FeNO) in outpatients admitted for initial diagnosis of asthma and at follow-up.
METHODS:One hundred and sixty (104 women and 56 men, mean age 39.7 ± 16.6 years) asthmatic patients with newly diagnosed asthma were included in the study. Patients completed the ACT questionnaire and underwent a detailed clinical examination, FeNO measurement, and prebronchodilator spirometry before (visit 1) and 4-12 weeks after initiation of treatment (visit 2).
RESULTS:At visit 1, the mean ACT score was 21.27 ± 3.74. According to ACT score, 37 patients (23.1%) were completely controlled, 85 patients (53.1%) were partly controlled, and 38 patients (23.8%) were uncontrolled. Patients with uncontrolled asthma had statistically higher FeNO values than patients with partly controlled (p = .038) and completely controlled asthma (p = .016). ACT score was found to have a positive correlation with prebronchodilator %FEV(1) (r = 0.177, p = .025) and negative correlation with FeNO ( r = -0.211, p = .007). At visit 2, the mean ACT score was 23.00 ± 2.19. The change in ACT score between the two visits was significantly correlated to changes in FEV(1) (r = 0.538, p < .001) and in FeNO (r = -0.466, p < .001). Patients treated with inhaled corticosteroids (ICSs) showed significant improvement in FEV(1) and in ACT score and a decrease in FeNO compared with patients without ICS treatment.
CONCLUSION:Although FEV(1) remains the main objective parameter for evaluating asthma, ACT score was found to reflect lung function and inflammation in a Greek asthmatic population.
J Asthma. 2011 Sep 16. [Epub ahead of print]