Stout James W, Visness Cynthia M, Enright Paul, Lamm Carin, Shapiro Gail, Gan Vanthaya N, Adams G Kenneth, Mitchell Herman E
Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 98195-4920, USA.
Arch Pediatr Adolesc Med. 2006 Aug;160(8):844-50. doi: 10.1001/archpedi.160.8.844.
Despite increasing awareness of the National Asthma Education and Prevention Program guidelines, the relative contribution of symptom frequency or pulmonary function to the recommended asthma severity levels remains poorly understood.
To determine whether adding lung function measurements to clinical history substantially changes the asthma severity classification, thereby influencing treatment decisions.
Baseline data were studied from children enrolled in 2 multicenter studies: phase 1 of the National Cooperative Inner-City Asthma Study (1992-1994) (cohort 1) and the Inner-City Asthma Study (1998-2001) (cohort 2).
Fifteen (8 for cohort 1 and 7 for cohort 2) major metropolitan inner-city areas in the United States.
Inner-city children aged 8 through 11 years with asthma.
Proportion of children reclassified from less severe asthma categories based on symptom frequency into more severe categories because of lung function.
Of children with symptoms of mild intermittent asthma, 22.8% in cohort 1 and 27.7% in cohort 2 would be reclassified as having either moderate or severe persistent asthma. Of children with symptoms of mild persistent asthma, 31.2% in cohort 1 and 33.3% in cohort 2 would be similarly reclassified.
In 2 different studies of inner-city children with asthma, approximately one third of the participants were reclassified into higher National Asthma Education and Prevention Program asthma severity categories when pulmonary function was considered in addition to symptom frequency. This may have direct implications for the undertreatment of asthma.
尽管对《国家哮喘教育与预防计划》指南的认识不断提高，但症状频率或肺功能对推荐的哮喘严重程度分级的相对贡献仍未得到充分理解。
确定在临床病史基础上增加肺功能测量是否会显著改变哮喘严重程度分类，从而影响治疗决策。
对参与两项多中心研究的儿童的基线数据进行研究：国家城市内部哮喘合作研究的第一阶段（1992 - 1994年）（队列1）和城市内部哮喘研究（1998 - 2001年）（队列2）。
美国15个（队列1为8个，队列2为7个）主要大都市的城市内部地区。
8至11岁患有哮喘的城市内部儿童。
因肺功能原因从基于症状频率的较轻哮喘类别重新分类为较重类别的儿童比例。
在轻度间歇性哮喘症状的儿童中，队列1中有22.8%，队列中有27.7%会被重新分类为中度或重度持续性哮喘。在轻度持续性哮喘症状的儿童中，队列1中有31.2%，队列2中有33.3%会被类似地重新分类。
在两项针对城市内部哮喘儿童的不同研究中，当除症状频率外还考虑肺功能时，约三分之一的参与者被重新分类为更高的《国家哮喘教育与预防计划》哮喘严重程度类别。这可能对哮喘治疗不足有直接影响。
