哮喘联盟

   摘要
   致死性哮喘（NFA）在城市内人口中高度流行。NFA患者需要及时干预，这需要对相关危险因素的知识有适当的了解。研究旨在观察和确定与发生在市内的NFA更可能的哮喘恶化的相关显著特征。研究对诊断为急性哮喘发作的出院患者进行了回顾性分析。研究纳入218例患者，致死性哮喘定义为住院期间需要气管插管的患者，其余为非致死性哮喘（NNFA）。研究对2组患者的多方面参数进行了比较；60例患者符合NFA标准。NFA和NNFA两组患者在性别、种族和吸烟史以及哮喘的治疗方式方面无差异。NFA组患者海洛因（40％与25.9％，P<0.05）和可卡因的使用（28.3％与16.5％，P<0.05）更常见。NFA组患者需要重症监护室（ICU）护理的发作史更常见（55％对40.5％，P=0.05）。NFA组患者急性发作的插管史更常见（51.7%与35.4%; P< 0.05）。NNFA组更可能有一位初级保健医生，可以出院回家治疗（65.6％与51.7％，P<0.05；71.7与79.1％，P<0.05）。在多元Logistic回归模型中，包括年龄、性别、种族、海洛因和可卡因的使用、插管史和入住ICU、使用药物史、无创通气的使用、初级保健医生和pH＜7.35、二氧化碳分压大于45mmHg、初始血气的吸入氧浓度（FiO2）> 40%，只有动脉血二氧化碳分压（PaCO2）> 45mmHg [比值比（OR= 6.7；P＜0.001＝＝和吸入氧浓度> 40%（OR = 3.5；P = 0.002）可以预测NFA。使用无创通气是NFA的负性预测因子（OR=0.2；P＜0.001）。哮喘加重时使用机械通气插管患者、入住ICU、或对可卡因或海洛因等毒品成瘾的哮喘患者应该被密切监控以防临床恶化。
 

（杨冬 审校）
Am J Ther. 2014 Oct 3. [Epub ahead of print]

 

Near Fatal Asthma in an Inner City Population.
 

Doshi V1, Shenoy S, Ganesh A, Lankala S, Henkle J.
 

ABSTRACT
Near-fatal asthma (NFA) is highly prevalent in inner city population. Patients who present with NFA require timely intervention, which necessitates knowledge of appropriate associated risk factors. The purpose of the study was to look and identify the salient features of an asthma exacerbation that are more likely to be associated with NFA in inner city population. We conducted a retrospective analysis of patients who were discharged from the hospital with a diagnosis of acute asthma exacerbation. Two hundred eighteen patients were included in the study. Patients who required intubation during the course of their hospitalization were defined as NFA and the rest were defined as non-near-fatal asthma (NNFA). Multiple patient parameters were compared between the 2 groups; 60 patients met the definition of NFA. There was no difference between NFA and NNFA groups with respect to sex, race, and history of smoking and asthma treatment modalities before presentation. NFA was seen more commonly in heroin (40% vs. 25.9%; P < 0.05) and cocaine users (28.3% vs. 16.5%; P < 0.05). A history of exacerbation requiring intensive care unit (ICU) care was more common among the NFA patients (55% vs. 40.5%; P = 0.05). A history of intubation for an exacerbation was more commonly seen in patients presenting with NFA (51.7% vs. 35.4%; P < 0.05). The NNFA group was more likely to have a primary care physician and to be discharged home (65.6% vs. 51.7%, P < 0.05; and 71.7 vs. 79.1%, P < 0.05). In a multi-logistic regression model, including age, sex, race, heroin and cocaine use, history of intubation and ICU admission, medications, use of noninvasive ventilation, primary care physician, and pH <7.35, PCO2 >45 mm Hg, and FiO2 >40% on initial blood gas, NFA was predicted only by PaCO2 >45 [odds ratio (OR = 6.7; P < 0.001)] and FiO2 >40% (OR = 3.5; P = 0.002). Use of noninvasive ventilation was a negative predictor of NFA (OR = 0.2; P < 0.001). Asthmatic patients who carry a history of intubation with mechanical ventilation for an asthma exacerbation, admissions to the ICU, or those who indulge in recreational drugs like cocaine or heroin should be closely monitored for clinical deterioration.
 

Am J Ther. 2014 Oct 3. [Epub ahead of print]