Horak Elisabeth, Grässl Gerhard, Skladal Daniela, Ulmer Hanno
University Hospital for Children and Adolescents, University of Innsbruck, Innsbruck, Austria.
Pediatr Pulmonol. 2003 Jan;35(1):23-8. doi: 10.1002/ppul.10218.
A large proportion of children with asthma are managed without recourse to specialized care, and treatment decisions are based solely on symptoms as reported by the children and their parents. We investigated 90 school-age children with the diagnosis of asthma and their accompanying parent to evaluate whether we can obtain better information by using three different means of asking for asthma symptoms: a questionnaire for children (QSR(children)), "smilies," and a visual analogue scale for children (VAS(children)). Furthermore, we analyzed the relationship between these symptom reports and lung function results. Finally, we attempted to determine whether performing a lung function test contributes relevant information toward improving asthma management. Multiple linear regression adjusted for age and gender showed a significant relationship between VAS for children and forced expiratory volume in 1 sec (FEV(1)) (P = 0.047) and maximal expiratory flow at 50% of forced vital capacity (MEF(50)) (P = 0.037). Neither age, gender, QSR for children, "smilies for children" nor all the parents' scores showed a significant association with lung function measurement in the regression model. Subgroup analysis with Spearman's rank correlation coefficients by age group revealed significant correlation in children <10 years between VAS for children, QSR for parents, smilies for parents, and the lung function parameters FEV(1), and MEF(50). Above age 10 years there was no correlation at all, with the accuracy correlation ranging from -0.04 to +0.21. Our data demonstrate that reported symptoms do not reliably correlate with lung function results in asthmatic children and the childrens' parents, and correlation is dependent on the instrument used for symptom evaluation. In children, the VAS, and in parents, the QSR were the most valuable means of obtaining best information on asthma symptoms. This underlines the importance of supplementing information on asthma symptoms with lung function measurements to more reliably assess the severity of asthma.
很大一部分哮喘儿童无需借助专门护理就能得到治疗,治疗决策仅基于儿童及其父母报告的症状。我们对90名被诊断为哮喘的学龄儿童及其陪同的家长进行了调查,以评估通过三种不同询问哮喘症状的方式:儿童问卷(QSR(儿童))、“笑脸”和儿童视觉模拟量表(VAS(儿童)),是否能获得更好的信息。此外,我们分析了这些症状报告与肺功能结果之间的关系。最后,我们试图确定进行肺功能测试是否能为改善哮喘管理提供相关信息。对年龄和性别进行校正的多元线性回归显示,儿童视觉模拟量表与第1秒用力呼气量(FEV(1))(P = 0.047)和用力肺活量50%时的最大呼气流量(MEF(50))(P = 0.037)之间存在显著关系。在回归模型中,年龄、性别、儿童问卷、“儿童笑脸”以及所有家长的评分与肺功能测量均未显示出显著关联。按年龄组用Spearman等级相关系数进行的亚组分析显示,10岁以下儿童中,儿童视觉模拟量表、家长问卷、家长笑脸与肺功能参数FEV(1)和MEF(50)之间存在显著相关性。10岁以上则完全没有相关性,相关系数范围为-0.04至+0.21。我们的数据表明,哮喘儿童及其家长报告的症状与肺功能结果之间并无可靠关联,且这种关联取决于用于症状评估的工具。对于儿童,视觉模拟量表,对于家长,问卷是获取哮喘症状最佳信息的最有价值方式。这凸显了用肺功能测量补充哮喘症状信息以更可靠评估哮喘严重程度的重要性。