Calfee Carolyn S, Katz Patricia P, Yelin Edward H, Iribarren Carlos, Eisner Mark D
Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA 94115, USA.
Chest. 2006 Nov;130(5):1312-8. doi: 10.1378/chest.130.5.1312.
Psychosocial factors play an important role in outcomes of asthma. Perceived control, a measure of patients' beliefs about their ability to control their disease, has not been studied in association with asthma health outcomes
We used data from a prospective cohort study of patients who were hospitalized for asthma (n = 865). After hospital discharge, we conducted structured telephone interviews to obtain demographic characteristics, asthma history, and psychological variables. Interviews included administration of the Perceived Control of Asthma Questionnaire (PCAQ). We then prospectively measured emergency department (ED) visits and hospitalizations for asthma over time, with a median follow-up time of 1.9 years
Greater perceived control was associated with better physical health status (mean score increment per 2-point change in PCAQ score, 1.13; 95% confidence interval [CI], 0.79 to 1.47), better asthma-related quality of life (mean score increment, -2.24; 95% CI, -2.6 to -1.83), fewer days of restricted activity due to asthma (mean increment, -1.23; 95% CI, -1.62 to -0.83), and lower asthma severity scores (mean score increment, -0.40; 95% CI, -0.53 to -0.27). In a multivariate model, greater perceived control was associated with a significantly decreased prospective risk of ED visits (hazard ratio [HR], 0.92; 95% CI, 0.86 to 0.98; p = 0.008) and hospitalizations for asthma (HR, 0.84; 95% CI, 0.78 to 0.90; p < 0.0001). There was no association found between perceived control and most aspects of preventive care or self-management
Greater perceived control is associated with improved asthma-related health status as well as with a decreased prospective risk of severe asthma attacks resulting in emergency health-care utilization. This difference does not appear to be mediated by changes in preventive care or asthma self-management practices.
心理社会因素在哮喘结局中起重要作用。感知控制是衡量患者对自身控制疾病能力信念的指标，但尚未针对其与哮喘健康结局的关联进行研究。
我们使用了一项对因哮喘住院患者（n = 865）的前瞻性队列研究数据。出院后，我们进行了结构化电话访谈以获取人口统计学特征、哮喘病史和心理变量。访谈包括发放哮喘感知控制问卷（PCAQ）。然后我们前瞻性地测量了随时间推移因哮喘的急诊科（ED）就诊和住院情况，中位随访时间为1.9年。
更高的感知控制与更好的身体健康状况相关（PCAQ评分每增加2分，平均得分增量为1.13；95%置信区间[CI]，0.79至1.47）、更好的哮喘相关生活质量（平均得分增量为 -2.24；95%CI，-2.6至 -1.83）、因哮喘导致的活动受限天数减少（平均增量为 -1.23；95%CI，-1.62至 -0.83）以及更低的哮喘严重程度评分（平均得分增量为 -0.40；95%CI，-0.53至 -0.27）。在多变量模型中，更高的感知控制与ED就诊的前瞻性风险显著降低相关（风险比[HR]，0.92；95%CI，0.86至0.98；p = 0.008）以及因哮喘住院的风险降低相关（HR，0.84；95%CI，0.78至0.90；p < 0.0001）。未发现感知控制与预防保健或自我管理的大多数方面之间存在关联。
更高的感知控制与改善的哮喘相关健康状况以及导致紧急医疗利用的严重哮喘发作的前瞻性风险降低相关。这种差异似乎不是由预防保健或哮喘自我管理实践的变化所介导的。
