Bobb Carol, Ritz Thomas
South Lewisham Group Practice, Catford, London, UK.
Respir Med. 2003 Nov;97(11):1180-7. doi: 10.1016/s0954-6111(03)00189-6.
Although allergy is central to the pathophysiology of asthma, little is known about the benefits of a structured approach to allergen diagnosis and management in primary care asthma patients.
We studied effects of a structured allergen evaluation and allergen avoidance advice combined with or without additional allergy skin testing on health status, illness perception, and lung function of asthma patients treated in general practice.
Fifty-four asthma patients were randomly assigned to three groups: (i) Standard asthma care with information on the stepwise treatment approach, a written action plan, and inhaler technique training; (ii) Additional structured allergen evaluation and avoidance advice; (iii) Additional structured allergen evaluation and avoidance advice based on skin prick test results. Patients were seen for one initial appointment at a primary care asthma clinic and a follow-up examination 3 months later. On both occasions, questionnaire measures of symptoms, illness perception, and the perceived control of asthma were administered. Lung function was measured by spirometry (PEF, FEV1). Perceived allergic asthma triggers, the trigger impact, and the trigger control were assessed in both intervention groups.
Following intervention, a decrease in beta-adrenergic inhaler use, an increase in the perceived control of asthma, and a decrease in the bothering from asthma symptoms were observed for all three groups. Intervention groups showed a higher awareness of animal-allergic triggers, and the perceived control of asthma triggers was increased in the group receiving no skin tests. FEV1 showed an improvement in both intervention groups.
Structured allergy evaluation and avoidance advice can improve lung function and the control of asthma in primary care. Further research is needed on the additional benefits of allergy skin testing.
尽管过敏是哮喘病理生理学的核心，但对于基层医疗中哮喘患者采用结构化方法进行过敏原诊断和管理的益处知之甚少。
我们研究了结构化过敏原评估和过敏原回避建议，结合或不结合额外的过敏皮肤试验，对在全科医疗中接受治疗的哮喘患者的健康状况、疾病认知和肺功能的影响。
54名哮喘患者被随机分为三组：（i）接受标准哮喘护理，包括逐步治疗方法的信息、书面行动计划和吸入器技术培训；（ii）额外的结构化过敏原评估和回避建议；（iii）基于皮肤点刺试验结果的额外结构化过敏原评估和回避建议。患者在基层医疗哮喘诊所进行一次初始就诊，并在3个月后进行随访检查。在这两次就诊时，均采用问卷调查症状、疾病认知和哮喘的感知控制情况。通过肺功能仪测量肺功能（呼气峰流速、第一秒用力呼气容积）。在两个干预组中评估感知到的过敏性哮喘触发因素、触发因素影响和触发因素控制情况。
干预后，三组患者的β-肾上腺素能吸入器使用量均减少，哮喘的感知控制增加，哮喘症状困扰减少。干预组对动物过敏原触发因素的认知更高，未接受皮肤试验的组对哮喘触发因素的感知控制有所增加。两个干预组的第一秒用力呼气容积均有所改善。
结构化过敏评估和回避建议可改善基层医疗中哮喘的肺功能和控制情况。关于过敏皮肤试验的额外益处还需要进一步研究。
