哮喘联盟

   摘要
   背景：客观指标可被用于评估哮喘急性发作。本研究主要目的在于探索电子日记评估哮喘急性加重（SEs）的敏感性和特异性，次要目的在于明确表型变量与急性发作的风险增加有关。
   方法：在BIOAIR研究中，169例哮喘患者（93例为重度（SA），76例为轻度-重度（MA））使用电子日记记录肺功能、临床症状和药物使用情况，记录时间为期1年。采用ROC曲线分析数据并与医生诊断的急性发作相结合。病史与基线临床数据被用作评估急性发作的危险因素。
   结果：122例医生诊断的哮喘急性发作的患者，在SA组有104例（1.1次/患者/年），MA组中18例（0.2次/患者/年），63例重度患者使用了美国胸科协会和欧洲呼吸协会的评判标准。在急性发作期间，1秒内呼气峰流速（PEF）和肺活量明显减弱，同时昼夜临床症状明显增加。连续2天白天症状增加综合PEF下降20%或增加20%可发现SEs，其敏感性和特异性分别达65%和95%。SEs最强危险因素是哮喘控制问卷评评分低分值的，痰液嗜酸性粒细胞≥3%，体重指数＞25和低生活质量（George's呼吸问卷）以及ORs在3.61和2.22之间（P＜0.05）。
   结论：对PEF和哮喘症状进行定期的电子监测能评估SEs，具有一定的敏感性和特异性。这可能适用于以互联网为基础的个人哮喘控制。

 

(刘国梁 审校)
Thorax. 2013 Apr 6. doi: 10.1136/thoraxjnl-2012-201815. [Epub ahead of print]

Detection of exacerbations in asthma based on electronic diary data: results from the 1-year prospective BIOAIR study.
 

Kupczyk M, Haque S, Sterk PJ, Nizankowska-Mogilnicka E, Papi A, Bel EH, Chanez P, Dahlén B, Gaga M, Gjomarkaj M, Howarth PH, Johnston SL, Joos GF, Kanniess F, Tzortzaki E, James A, Middelveld RJ, Dahlén SE; on behalf of the BIOAIR investigators.
 

Abstract
BACKGROUND: Objective measures are required that may be used as a proxy for exacerbations in asthma. The aim was to determine the sensitivity and specificity of electronic diary data to detect severe exacerbations (SEs) of asthma. A secondary aim was to identify phenotypic variables associated with a higher risk of exacerbation.
METHODS: In the BIOAIR study, 169 patients with asthma (93 severe (SA); 76 mild to moderate (MA)) recorded lung function, symptoms and medication use in electronic diaries for 1 year. Data were analysed using receiver-operator characteristics curves and related to physician-diagnosed exacerbations. Medical history and baseline clinical data were used to assess risk of exacerbation.
RESULTS: Of 122 physician-diagnosed exacerbations, 104 occurred in the SA group (1.1 per patient/year), 18 in the MA group (0.2 per patient/year) and 63 were severe using American Thoracic Society/European Respiratory Society criteria. During exacerbations, peak expiratory flow (PEF) and forced expiratory volume in 1 s significantly decreased, whereas day and night symptoms significantly increased. An algorithm combining a 20% decrease in PEF or a 20% increase in day symptoms on 2 consecutive days was able to detect SEs with 65% sensitivity and 95% specificity. The strongest risk factors for SEs were low Asthma Control Questionnaire score, sputum eosinophils ≥3%, body mass index >25 and low quality of life (St George's Respiratory Questionnaire), with ORs between 3.61 and 2.22 (p<0.05).
CONCLUSIONS: Regular electronic monitoring of PEF and asthma symptoms provides an acceptable sensitivity and specificity for the detection of SEs and may be suitable for personal internet-based monitoring of asthma control.
 

Thorax. 2013 Apr 6. doi: 10.1136/thoraxjnl-2012-201815. [Epub ah