Hermosa Juan Luis Rodriguez, Sánchez Carlos Barcina, Rubio Myriam Calle, Mínguez Mercedes Muñoz, Walther Jose Luis Alvarez-Sala
Department of Neumology, Hospital Clinico San Carlos, Madrid 28003, Spain.
J Asthma. 2010 Mar;47(2):124-30. doi: 10.3109/02770900903518835.
Control is a priority treatment objective in asthma, and classification based on control is recommended in the follow-up of asthmatic patients. Different factors affect this control, and there are several regional differences, both in terms of prevalence and in terms of management and degree of control.
To evaluate the factors associated with control of severe asthma in routine clinical practice.
This was a prospective, cross-sectional, observational study of patients with severe asthma who were receiving treatment with a fixed combination of a corticosteroid (at least 800 microg/day of budesonide or equivalent) and an inhaled beta(2)-adrenergic agonist in respiratory medicine and allergology clinics throughout Spain. The authors collected demographic and socioeconomic data, as well as clinical data on asthma. The patients also completed a self-administered validated questionnaire-the Asthma Control Questionnaire (ACQ)-about the control of their asthma.
The authors included 1471 patients, of whom 1224 (83%) were valid for the final analysis. Women accounted for 61%. Mean age was 51 +/- 16 years. The mean number of exacerbations during the previous year was 2.0 +/- 2.0. The global score on the ACQ was 1.8 +/- 1.1 (0 = no symptoms; 6 = maximum number of symptoms). Only 20.4% of patients were well controlled (ACQ < 0.75), and 55.7% of patients were poorly controlled (ACQ > 1.5). The multivariate analysis revealed that the variable with the greatest effect on control of asthma was the number of exacerbations during the previous year: when the number of exacerbations increased from 0 to 1 or more, the ACQ score increased by 0.56 points. Employed patients had a mean of 0.23 points less (better control) than unemployed and retired patients. Control of asthma was also significantly affected by adherence to treatment, patient knowledge of the disease, body mass index, gender, and number of visits to a physician in the previous 3 months.
Many patients with severe asthma have poor control of their disease. The number of exacerbations is the variable with the greatest effect on control of asthma. Knowledge of the disease and adherence to treatment are associated with better control.
控制是哮喘治疗的首要目标，建议在哮喘患者的随访中基于控制情况进行分类。不同因素影响这一控制情况，在患病率、管理以及控制程度方面均存在一些地区差异。
评估在常规临床实践中与重度哮喘控制相关的因素。
这是一项针对重度哮喘患者的前瞻性、横断面观察性研究，这些患者在西班牙各地的呼吸内科和变态反应科诊所接受皮质类固醇（至少800微克/天布地奈德或等效药物）与吸入型β₂肾上腺素能激动剂的固定复方治疗。作者收集了人口统计学和社会经济数据以及哮喘的临床数据。患者还完成了一份关于哮喘控制情况的自我管理有效问卷——哮喘控制问卷（ACQ）。
作者纳入了1471例患者，其中1224例（83%）可用于最终分析。女性占61%。平均年龄为51±16岁。前一年的平均发作次数为2.0±2.0次。ACQ的总体评分为1.8±1.1（0 = 无症状；6 = 症状最多）。只有20.4%的患者控制良好（ACQ < 0.75），55.7%的患者控制不佳（ACQ > 1.5）。多因素分析显示，对哮喘控制影响最大的变量是前一年的发作次数：当发作次数从0次增加到1次或更多时，ACQ评分增加0.56分。在职患者的平均得分比失业和退休患者低0.23分（控制更好）。哮喘控制还受到治疗依从性、患者对疾病的了解、体重指数、性别以及前3个月看医生次数的显著影响。
许多重度哮喘患者疾病控制不佳。发作次数是对哮喘控制影响最大的变量。对疾病的了解和治疗依从性与更好的控制相关。
