Sullivan S D, Wenzel S E, Bresnahan B W, Zheng B, Lee J H, Pritchard M, Kamath T V, Weiss S T
Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, WA, USA.
Allergy. 2007 Jun;62(6):655-60. doi: 10.1111/j.1398-9995.2007.01383.x.
Clinical tools for predicting poor outcomes in asthma patients are lacking. This study investigated the association of asthma control and subsequent severe asthma-related healthcare events in The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study.
The extent of asthma control problems was determined from baseline values of the Asthma Therapy Assessment Questionnaire (ATAQ). Patients self-reported the presence of severe asthma-related events at 6- and 12-month follow up. Poisson regression models determined the adjusted association between baseline control and the likelihood of severe asthma-related events.
At baseline, 2942 patients (mean age, 49.6 years; female, 71.9%) had an ATAQ score (no control problems, 17.0%; 1 control problem, 20.0%; 2 control problems, 30.8%; 3 or 4 control problems, 32.2%) and at least one severe asthma-related event. After adjustment, subjects with three or four control problems were at greater risk for unscheduled office visits [relative risk (RR) = 2.8; 95% confidence interval (CI): 2.4-3.2], course of oral steroids (RR = 2.9; 95% CI: 2.5-3.3), emergency room visits (RR = 4.1; 95% CI: 2.7-6.2) or hospitalization (RR = 13.6; 95% CI: 7.4-24.9), vs no control problems. Progressively poorer levels of asthma control are associated with increasing risk of severe asthma-related events.
This study provides evidence of an association between poor asthma control and future severe asthma-related healthcare events. A validated questionnaire may help clinicians identify patients requiring intervention to prevent future severe asthma-related events.
缺乏用于预测哮喘患者不良预后的临床工具。本研究在哮喘的流行病学和自然史:结局与治疗方案(TENOR)研究中,调查了哮喘控制与随后发生的严重哮喘相关医疗事件之间的关联。
根据哮喘治疗评估问卷(ATAQ)的基线值确定哮喘控制问题的程度。患者在6个月和12个月随访时自我报告是否存在严重哮喘相关事件。泊松回归模型确定了基线控制与严重哮喘相关事件发生可能性之间的校正关联。
在基线时,2942例患者(平均年龄49.6岁;女性占71.9%)有ATAQ评分(无控制问题,17.0%;1个控制问题,20.0%;2个控制问题,30.8%;3或4个控制问题,32.2%)且至少发生过一次严重哮喘相关事件。调整后,有3或4个控制问题的受试者进行非预约门诊就诊的风险更高[相对风险(RR)=2.8;95%置信区间(CI):2.4 - 3.2],口服类固醇疗程(RR = 2.9;95% CI:2.5 - 3.3),急诊就诊(RR = 4.1;95% CI:2.7 - 6.2)或住院(RR = 13.6;95% CI:7.4 - 24.9),而无控制问题的受试者则不然。哮喘控制水平越差,与严重哮喘相关事件的风险增加相关。
本研究提供了哮喘控制不佳与未来严重哮喘相关医疗事件之间存在关联的证据。一份经过验证的问卷可能有助于临床医生识别需要干预以预防未来严重哮喘相关事件的患者。