哮喘联盟

   摘要
   目的：哮喘急性发作导致的临床和经济影响已被证实，但对于一次急性发作的严重程度的特征判断仍缺乏共识。哮喘治疗指南描述了中度哮喘急性发作的概念，但并没有给出一个能用于实际操作的清晰定义。
   方法：该项回顾性队列研究的纳入对象为至少连续9个月参加法隆社区卫生计划的成年哮喘患者（ICD-9: 493.XX）。排除被诊断为慢性阻塞性肺疾病或其他下呼吸道疾病的患者。将2周无症状阶段后首次报道的哮喘相关事件作为“指标事件(index event)”。哮喘相关事件分类如下：1) 中度急性加重（基于症状）；2)重度急性加重（基于主诉）。计算哮喘相关事件发生的时间间隔和时间顺序、以及平均费用。
   结果：共纳入3126例合格患者，其中55%的患者在1次复发事件后发生了1次哮喘相关事件。伴随中度急性发作复发后的哮喘相关事件以中度急性发作最常见（20%），且两次急性发作的时间间隔最短（平均83 天[SD 87]）。伴随重度急性发作后的中度急性发作率为16%，两次事件间隔的平均为176.74天(SD 176.94)。
   结论：当患者出现了不需要口服糖皮质激素（OCS）治疗，但足以使其有必要联系临床医生的哮喘不适症状时，即可确定为中度急性发作。至于明确了中度急性发作后是否能采取干预措施来影响未来急性发作的频率和时间，尚有待进一步明确。
 

（刘国梁 审校）
J Asthma. 2013 Mar 20. [Epub ahead of print]

 

Moderate Symptom-based Exacerbations as Predictors of Severe Claims-based Exacerbations in Asthma.

Lane SJ, Petersen H, Seltzer JM, Blanchette CM, Navaratnam P, Allen-Ramey F, Fuhlbrigge A.

Source
Department of Nutrition and Health Care Management, College of Health Sciences, Appalachian State University , Boone, NC 28608.

Abstract
OBJECTIVES: Asthma exacerbations have well-established clinical and economic impact, yet lack consensus on characterization of an episode's severity. Asthma treatment guidelines outline the concept of a moderate asthma exacerbation, however, a clear definition that can be operationalized has not been proposed.
METHODS: Adult asthma (ICD-9: 493.XX) patients, with at least 9 months of continuous enrollment in the Fallon Community Health Plan were included in the retrospective cohort study. Patients diagnosed with COPD or other lower respiratory tract conditions were excluded. The first reported asthma-related event following a 2-week symptom-free period was designated as the index event. Asthma-related events were categorized as: 1) moderate exacerbations (symptom-based), or 2) severe exacerbations (claims-based). Timing between and temporal sequence of asthma-related events along with average costs were calculated.
RESULTS: Of 3,126 eligible patients, 55% reported an asthma-related event followed by a recurrent event(s). Moderate exacerbations followed by recurrent moderate exacerbations were most frequent (20%) with the shortest interval between exacerbations (mean: 83 days [SD 87]). Moderate exacerbations followed by severe exacerbations occurred in 16% of patients with an average of 176.74 (SD 176.94) days between events.
CONCLUSIONS: Patient report of asthma bothersome enough to initiate contact with a clinician, but not requiring oral corticosteriod (OCS), is a definition for a moderate exacerbation that can be operationalized for research purposes. Further work is needed to demonstrate whether identification of moderate exacerbations will allow intervention that impacts the frequency and timing of future exacerbations.
 

J Asthma. 2013 Mar 20. [Epub ahead of print]