哮喘控制评估：SERENA研究
2013/11/13
摘要
背景:一些研究显示许多哮喘患者均未达到哮喘控制。哮喘控制是目前的主要治疗目标。
目的:采用哮喘控制测试表(ACT)评价真实临床实践中的哮喘控制水平，以及明确经吸入糖皮质激素和长效β受体激动剂(LABA)治疗后疾病未获控制的潜在危险因素。
方法:SERENA是由意大利16个呼吸团队共同完成的多中心、横断面、为期6个月观察性、非干预性研究。纳入对象为经中等剂量的ICS联合LABA治疗年龄大于18岁的门诊哮喘患者。根据ACT评分评估的哮喘控制水平将患者分为3组(25：控制；20-24：部分控制； <20：未控制)。
结果:总共548例患者，396例符合纳入标准。仅有9.1%的患者达到哮喘控制，部分控制和未控制的哮喘患者分别占39.6% 和51.3%。患者平均年龄为54.5 ± 15.8，平均患病时间为16.1 ± 14.1年。女性患者(63% )多于男性患者(37%)，并且女性中哮喘未控制的患病率最高(63.1%)。哮喘未控制组的平均FEV1%预计值更低(p < 0.001)。哮喘控制组发生至少一次急性发作、计划外就诊和/或住院(22.2%, 8.3%, 8.3%)患者百分比均低于部分控制组(50%, 38.6%, 9.2%)和未控制组(83.2%, 66.2%, 27.8%) (p < 0.0001)。依次进行多变量logistic回归分析显示，女性、FEV1和急性发作是哮喘未控制的最强独立因素。
结论:本研究强调采用经验证的哮喘控制评估工具以及过去一年中急性发作/就医情况定期评估哮喘控制状况在临床实践中的重要性。临床医生应该意识到尽管使用了药物规律治疗，仍然有很大比例的哮喘患者未控制。
（林江涛 审校）
Respir Med. 2013 Sep 3. pii: S0954-6111(13)00321-1. doi:10.1016/j.rmed.2013.08.019.[Epub ahead of print]
Assessment of asthma control: The SERENA study.
Corrado A, Renda T, Polese G, Rossi A; SERENA (Studio ossERvazionalE per il monitoraggio dell'asma non coNtrollAto)/AIPO Study Group.
Abstract
BACKGROUND: several studies suggest that many asthmatic subjects have uncontrolled asthma. The control of asthma is now considered the major goal of therapy.
OBJECTIVES: to ascertain the level of asthma control, by Asthma Control Test (ACT), in "real-life" clinical practice and the potential risk factors for uncontrolled disease in patients treated with inhaled corticosteroids (ICS) and long-acting beta-adrenergic agonists (LABA).
METHODS: SERENA is a multi-centre, cross-sectional, 6-month observational, non-interventional study carried out in 16 Pulmonary Units in Italy. Asthmatic outpatients aged over 18, undergoing treatment with ICS at medium-high daily doses associated with LABA, were enrolled. The patients were divided in 3 subgroups according to the level of asthma control by ACT score (25:controlled; 20-24:partly controlled; <20: uncontrolled).
RESULTS: Out of a total of 548 patients, 396 met the inclusion criteria. Only 9.1% of patients had asthma controlled, while partly controlled and uncontrolled asthma accounted for 39.6% and 51.3% respectively. The mean age was 54.5 ± 15.8 and the mean duration of asthma was 16.1 ± 14.1 years. There were more females than males (63% vs 37%) and females had highest prevalence of uncontrolled asthma (63.1%). The mean values of FEV1% predicted were lower in the uncontrolled group (p < 0.001). The percentage of patients with at least 1 exacerbation, unscheduled visit and/or admissions was lower in controlled (22.2%, 8.3%, 8.3%) than in partly controlled (50%, 38.6%, 9.2%) and uncontrolled (83.2%, 66.2%, 27.8%) groups (p < 0.0001). The multivariate ordinal logistic regression analysis identified female sex, FEV1 and exacerbations as the strongest independent factors associated with the uncontrolled disease.
CONCLUSION: This study highlights the importance in clinical practice of a periodic assessment by a validated asthma control instrument and exacerbations/health care contacts during previous year. Clinicians should be aware that a significant proportion of patients can have uncontrolled asthma, despite regular pharmacological treatment.
Respir Med. 2013 Sep 3. pii: S0954-6111(13)00321-1. doi:10.1016/j.rmed.2013.08.019.[Epub ahead of print]
