Kucera C M, Greenberger P A, Yarnold P R, Choy A C, Levenson T
Division of Allergy-Immunology, Northwestern Memorial Hospital, Chicago, Illinois, USA.
Allergy Asthma Proc. 1999 Jan-Feb;20(1):29-38. doi: 10.2500/108854199778681521.
It has been recommended that allergist-immunologists use quality of life (QOL) surveys to document their "added value" in patient care. There are little cross-sectional or prospective data regarding longer term follow-up of patients using QOL assessments and none associated with prospective use of an asthma severity index (ASI). Our objective was to identify clinical and psychological correlates of adverse asthma outcomes as assessed using the ASI survey. A 12 item QOL and a nine item ASI survey, spirometry, and history and physical were obtained from patients initially and then every 3 months for a year. The ASI was calculated as follows: one point for each emergency treatment of asthma if not in status asthmaticus, three points for each hospitalization for status asthmaticus, and six points for each intensive care admission or intubation. Patients were 56 adults between ages 18 and 45 with asthma enrolled between May 1994 and February 1996 with the intention to be reassessed quarterly for a year. At enrollment the 56 patients had ASI scores for the previous 12 months ranging from zero to 30. The patient with an ASI of 30 did not return after the initial visit. Of the 13 patients who completed the study, 12 patients had a zero ASI score over a 12-month period; one patient who had an initial score of 26 finished with a score of one. There were no deaths throughout the follow-up period. Of the 43 patients who did not complete the study only six (13.9%) cited local managed care or primary care physician as taking over their care. Initial ASI scores were dichotomized (zero versus greater-than-zero) due to skewness. The forced expiratory volume in one second (FEV1), % predicted FEV1 and peak flow were not related significantly to the dichotomized ASI score. The strongest univariate predictor was the self-assessment of asthma burden using a 78 mm visual analog scale. A two variable model included a query about bodily pain in the last 4 weeks and a self-assessment of general health. The dropout rate was high but only 13.9% of such patients reported that managed care or primary care physicians were responsible. A two variable model was a strong predictor of asthma severity. The single best predictor of asthma severity was a visual analog scale based on the question "How do you think your asthma is?"
有人建议，过敏症专科免疫学家应使用生活质量（QOL）调查来记录他们在患者护理中的“附加价值”。关于使用QOL评估对患者进行长期随访的横断面或前瞻性数据很少，且没有与前瞻性使用哮喘严重程度指数（ASI）相关的数据。我们的目标是确定使用ASI调查评估的哮喘不良结局的临床和心理相关因素。最初从患者那里获取一份包含12个项目的QOL问卷、一份包含9个项目的ASI问卷、肺功能测定结果以及病史和体格检查结果，然后在一年的时间里每3个月进行一次。ASI的计算方法如下：如果不是哮喘持续状态，每次哮喘急诊治疗得1分；每次因哮喘持续状态住院得3分；每次入住重症监护病房或插管得6分。患者为56名年龄在18至45岁之间的成年哮喘患者，于1994年5月至1996年2月入组，计划进行为期一年的每季度一次的重新评估。入组时，这56名患者过去12个月的ASI评分在0至30分之间。ASI评分为30分的患者在初次就诊后未再回来。在完成研究的13名患者中，12名患者在12个月期间的ASI评分为零；一名初始评分为26分的患者最终评分为1分。在整个随访期间没有死亡病例。在未完成研究的43名患者中，只有6名（13.9%）称当地的管理式医疗或初级保健医生接管了他们的治疗。由于数据偏态，将初始ASI评分分为两类（零分与大于零分）。一秒用力呼气量（FEV1）、预测FEV1百分比和峰值流量与二分法ASI评分无显著相关性。最强的单变量预测因素是使用78毫米视觉模拟量表对哮喘负担进行的自我评估。一个双变量模型包括关于过去4周身体疼痛的询问和对总体健康的自我评估。失访率很高，但只有13.9%的此类患者报告称管理式医疗或初级保健医生对此负责。双变量模型是哮喘严重程度的有力预测指标。哮喘严重程度的最佳单一预测指标是基于“你认为你的哮喘情况如何？”这一问题的视觉模拟量表。
