Davis Steven Q, Permutt Zachary, Permutt Solbert, Naureckas Edward T, Bilderback Andrew L, Rand Cynthia S, Stein Brian D, Krishnan Jerry A
Department of Medicine, University of Chicago, Chicago, Illinois, USA.
Ann Allergy Asthma Immunol. 2009 Jun;102(6):455-61. doi: 10.1016/S1081-1206(10)60117-2.
Little is known about the perception of airflow obstruction in patients hospitalized for acute asthma.
To evaluate patient perception of airflow obstruction at hospital discharge and at a 2-week follow-up visit and to determine whether symptom control and/or severity of airflow obstruction identified patients at risk for acute asthma after discharge.
In a prospective cohort study of inner-city adults hospitalized for acute asthma from April 1, 2001, through October 31, 2002, symptom control (Asthma Control Questionnaire) and airflow obstruction (forced expiratory volume in 1 second [FEV1] percentage predicted) were evaluated at discharge and 2 weeks after discharge. We evaluated perception of airflow obstruction (symptom control vs FEV1 percentage predicted) and perception of change in airflow obstruction (change in symptom control vs percentage change in FEV1) between the 2 visits. Acute asthma after discharge was defined as an emergency department visit or hospitalization for asthma within 90 days of discharge.
In fifty-one participants, symptom control was not significantly associated with airflow obstruction at hospital discharge (P = .30), indicating poor perception of airflow obstruction. Among the 41 participants (80.4% of those enrolled) who completed the follow-up visit, change in symptom control was not significantly associated with change in airflow obstruction (P = .20), indicating poor perception of change in airflow obstruction. Greater airflow obstruction at follow-up (P = .02) and a smaller improvement in airflow obstruction (P = .03), but not symptom control, were associated with a higher risk of acute asthma after discharge.
Patients hospitalized for acute asthma have poor perception of airflow obstruction and change in airflow obstruction. Objective measurements of lung function should guide treatment decisions after discharge in this population.
对于因急性哮喘住院的患者对气流受限的认知了解甚少。
评估患者出院时及出院后2周随访时对气流受限的认知，并确定症状控制和/或气流受限的严重程度是否能识别出院后有急性哮喘风险的患者。
在一项前瞻性队列研究中，纳入了2001年4月1日至2002年10月31日因急性哮喘住院的市中心成年患者，在出院时及出院后2周评估症状控制情况（哮喘控制问卷）和气流受限情况（第1秒用力呼气容积[FEV1]占预计值的百分比）。我们评估了两次就诊之间对气流受限的认知（症状控制与FEV1占预计值的百分比）以及对气流受限变化的认知（症状控制的变化与FEV1的百分比变化）。出院后急性哮喘定义为出院后90天内因哮喘到急诊科就诊或住院。
在51名参与者中，出院时症状控制与气流受限无显著相关性（P = 0.30），表明对气流受限的认知较差。在完成随访就诊的41名参与者（占入组者的80.4%）中，症状控制的变化与气流受限的变化无显著相关性（P = 0.20），表明对气流受限变化的认知较差。随访时气流受限程度更大（P = 0.02）以及气流受限改善较小（P = 0.03），而非症状控制情况，与出院后急性哮喘风险较高相关。
因急性哮喘住院的患者对气流受限及气流受限变化的认知较差。在该人群出院后，肺功能的客观测量应指导治疗决策。
