哮喘联盟

   摘要
   目的：比较内科医生、患者和父母对哮喘控制的评估差异。骄傲的父母可能会低估哮喘儿童的症状，该研究旨在探索内科医生是否同意他们的看法。
   研究设计：2011年～2012年，使用C-ACT对4岁～11岁的哮喘儿童和他们的父母进行哮喘控制认知程度评估。儿童胸腔评估使用《全球哮喘防治创议》（GINA）指南进行评估。儿科医生不能使用肺量测定法，只能使用除体格检查外的信息。C-ACT评分分别由患者和父母进一步得出且与内科医生的评估相比较。统计方法也用于测量不同变量可能产生的影响，包括kappa检验，卡方检验，卡方线性趋势检验，McNemar 检验和逻辑回归分析。
   受试者的选择：该研究包括354例父母和4-11岁的中-重度哮喘儿童，129例（36.4%）接受了23名儿科医生的治疗。225例（63.6%）进行了11项儿科胸腔评估。
   结果：C-ACT通常可有效评估哮喘控制（P < 0.001；κ 0.529；CI 0.441，0.617），该评估发现229/354 （53%）的哮喘儿童未受控制。不过，在229例哮喘未控制的儿童中，有124 例(54.1%)被父母（κ 0.245；CI 0.15, 0.34）和96例（41.9%）内科医生评估为哮喘控制（κ0.331； 0.24，0.43）。比较医生-儿童与父母的认知差异发现，96/229（41.9%）的儿童和34/126（27.0%）的父母认为哮喘未控制时，医生认为是控制的（OR 1.95； 1.19，3.24）。儿科胸腔检查和医生检查两者间无显著性差异。
   结论：除增强父母对哮喘儿童症状的认知外，内科医师也应该适当询问儿童，使用儿童对C-ACT的反应作为适当评估哮喘控制的信息来源。
 

（刘国梁 审校）
Pediatr Pulmonol. 2013 Oct 25. doi: 10.1002/ppul.22924. [Epub ahead of print]
 

Disparities in assessments of asthma control between children, parents, and
physicians.
 

Shefer G, Donchin M, Manor O, Levy-Hevroni R, Schechter A, Cohen R, Cohen HA,
Kerem E, Engelhard D.
 

Abstract
OBJECTIVE: Assessment of asthma control in children by physicians, patients and their parents was compared, assuming parents may underestimate symptoms in asthmatic children and exploring whether physicians tend to agree with them.
DESIGN: Asthma control perception was assessed in 4- to 11-year-old asthmatic children and their parents, using C-ACT, during 2011-2012. Pediatric pulmonologists used GINA guidelines for their assessment; pediatricians, not having spirometry, used the information given in addition to physical examination. The C-ACT scores given by the children and their parents were further analyzed separately, and compared with their physicians' assessment. Statistical methods, which also measured possible influence of different variables, included kappa, Chi-square, linear-by-linear association, McNemar test and logistic regression.
PATIENT SELECTION: The study comprised 354 parents and children aged 4-11 years with moderate-severe asthma; 129 (36.4%) were treated by 23 pediatricians; 225 (63.6%) by 11 pediatric pulmonologists.
RESULTS: The C-ACT was generally found valid in assessing asthma control (P < 0.001; κ 0.529; CI 0.441, 0.617) and showed that in 229/354 (53%) of children the asthma was uncontrolled. Nevertheless, of the 229 children who indicated their asthma was uncontrolled, 124 (54.1%) of their parents (κ 0.245; CI 0.15, 0.34) and 96 (41.9%) of their physicians believed it to be controlled (κ 0.331; 0.24, 0.43). Comparing the physician-child discordance vis-à-vis the parents, the significant difference was when 96/229 children (41.9%) and 34/126 parents (27.0%) indicated the asthma was uncontrolled while the physician determined it controlled (OR 1.95; 1.19, 3.24). There were no significant differences between pediatric pulmonologists and pediatricians.
CONCLUSIONS: In addition to increasing awareness of parents to symptoms in their asthmatic children, physicians should question the child appropriately, as well as using the children's responses to C-ACT as an information source for properly assessing asthma control.
 

Pediatr Pulmonol. 2013 Oct 25. doi: 10.1002/ppul.22924. [Epub ahead of print]