哮喘联盟

摘要
   背景：急性哮喘发作仍然是急诊就医（ED）和住院治疗的常见原因。诸多原因促使患者到急诊进行哮喘治疗。这些因素可能与患者自身或医疗系统有关，这两者可能影响哮喘的控制。本试验研究导致哮喘患者频繁急诊就诊的主要因素。
   方法：过去9个月内，在两家大型附属医院内因支气管哮喘发作而急诊就诊的患者入选本研究，对其进行横断面调查。收集下列数据：人口统计学数据、前一个月的哮喘控制情况、患者治疗的地点和医生、患者是否接受过哮喘宣教或用药宣教以及患者急诊就诊的原因。
   结果：450名患者入选本研究，39.1%的患者为男性，平均年龄为42.3 +/- 16.7岁。哮喘病程平均为155.90 +/- 127.13周。约半数患者未接受任何支气管哮喘相关信息，40.5%的患者未接受任何哮喘药物治疗的相关信息。在前一个月有急诊就诊的患者中，大部分(97.7%) 哮喘未得到控制或部分控制。急诊就诊的患者，大部分接受雾化吸入支气管扩张剂(86.7%) 和吸氧(75.1%)治疗。此外，20.9%的患者认为急诊比门诊更快控制哮喘症状，21.1%的患者认为哮喘症状非常严重，不能等待门诊就诊。无哮喘宣教和哮喘未得到控制是导致患者哮喘频繁急诊就医（每年3次或以上）的主要原因（P值分别为0.0145和0.0003）。哮喘控制与皮质激素吸入治疗（P=0.0401）和哮喘宣教（P=0.0117）密切相关。
   结论：本研究显示，有许多可以避免的因素导致哮喘未得到控制和因哮喘频繁急诊就医。

（刘国梁 审校）
BMC Pulm Med. 2012 Dec 17;12(1):80. [Epub ahead of print]

 

Factors associated with patient visits to the emergency department for asthma therapy.

Al-Jahdali H, Anwar A, Al-Harbi A, Baharoon S, Halwani R, Al Shimemeri A, Al-Muhsen S.

ABSTRACT:
BACKGROUND: Acute asthma attacks remain a frequent cause of emergency department (ED) visits and hospital admission. Many factors encourage patients to seek asthma treatment at the emergency department. These factors may be related to the patient himself or to a health system that hinders asthma control. The aim of this study was to identify the main factors that lead to the frequent admission of asthmatic patients to the ED.
METHODS: A cross-sectional survey of all the patients who visited the emergency room with bronchial asthma attacks over a 9-month period was undertaken at two major academic hospitals. The following data were collected: demographic data, asthma control in the preceding month, where and by whom the patients were treated, whether the patient received education about asthma or its medication and the patients' reasons for visiting the ED.
Result: Four hundred fifty (N = 450) patients were recruited, 39.1% of whom were males with a mean age of 42.3 +/- 16.7. The mean duration of asthma was 155.90 +/- 127.13 weeks. Approximately half of the patients did not receive any information about bronchial asthma as a disease, and 40.7% did not receive any education regarding how to use asthma medication. Asthma was not controlled or partially controlled in the majority (97.7%) of the patients preceding the admission to ED. The majority of the patients visited the ED to receive a bronchodilator by nebuliser (86.7%) and to obtain oxygen (75.1%). Moreover, 20.9% of the patients believed that the ED managed them faster than the clinic, and 21.1% claimed that their symptoms were severe enough that they could not wait for a clinic visit. No education about asthma and uncontrolled asthma are the major factors leading to frequent ED visits (three or more visits/year), p-value = 0.0145 and p-value = 0.0003, respectively. Asthma control also exhibited a significant relationship with inhaled corticosteroid ICS use (p-value =0.0401) and education about asthma (p-value =0.0117).
CONCLUSION: This study demonstrates that many avoidable risk factors lead to uncontrolled asthma and frequent ED visits.

BMC Pulm Med. 2012 Dec 17;12(1):80. [Epub ahead of print]