Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan. k−sekiya@sagamihara−hosp.gr.jp
Allergol Int. 2012 Mar;61(1):143-8. doi: 10.2332/allergolint.11-OA-0331. Epub 2011 Dec 25.
Lung function determined by spirometry and the severity of dyspnea correlate weakly in asthma patients. We attempted to determine the risk factors in asthma patients having persistent airway obstruction despite of having only mild subjective symptoms, and to examine the possibility of improving FEV1 by treating asthma on the basis of the bronchodilator change in FEV1.
We examined asthma patients in their 20s and who visited Sagamihara National Hospital for the first time over a period of four years, by reviewing their clinical records. They underwent tests on the bronchodilator change in FEV1 and a test of airway hyperresponsiveness to histamine dihydrochloride.
One hundred thirty-eight subjects (mean age, 25.6 years; 51 males, 87 females; current smoking, 30.4%; history of childhood asthma, 48.6%) were enrolled. Among them, 18.8% (26/138) showed persistent airway obstruction (postbronchodilator FEV1/FVC (%) <80%). Using the multiple logistic regression model, we found that history of childhood asthma and smoking history were the significant isolated risk factors for persistent airway obstruction. Moreover, we determined that the factors associated with the reversibility of airway obstruction in asthma patients without subjective symptoms were history of childhood asthma.
In this study, patients not undergoing treatment for asthma were examined. History of childhood asthma and smoking history may be the risk factors for persistent airway obstruction in the asthma patients with mild subjective symptoms. Tests on the bronchodilator change in FEV1 should be performed in patients with history of childhood asthma and smoking history, even if they have only mild subjective symptoms.
在哮喘患者中，肺活量计测定的肺功能与呼吸困难的严重程度相关性较弱。我们试图确定在即使仅有轻度主观症状，但仍存在持续性气道阻塞的哮喘患者中，存在的风险因素，并根据 FEV1 中支气管扩张剂的变化来检查改善 FEV1 的可能性，以此治疗哮喘。
我们通过回顾性分析，对在四年间首次到相模原市立医院就诊的 20 多岁哮喘患者的临床记录进行了检查。这些患者接受了 FEV1 中支气管扩张剂变化的检测和对二盐酸组织胺气道高反应性的检测。
共纳入 138 名受试者（平均年龄 25.6 岁；男性 51 名，女性 87 名；当前吸烟率 30.4%；儿童期哮喘史 48.6%）。其中，18.8%（26/138）存在持续性气道阻塞（支气管扩张剂后 FEV1/FVC（%）<80%）。使用多变量逻辑回归模型，我们发现儿童期哮喘史和吸烟史是持续性气道阻塞的独立危险因素。此外，我们还确定了在无主观症状的哮喘患者中，与气道阻塞可逆性相关的因素是儿童期哮喘史。
在本研究中，我们检查了未接受哮喘治疗的患者。儿童期哮喘史和吸烟史可能是轻度主观症状的哮喘患者持续性气道阻塞的危险因素。对于有儿童期哮喘史和吸烟史的患者，即使仅有轻度主观症状，也应进行 FEV1 中支气管扩张剂变化的检测。
