Boys Town National Research Hospital, Boys Town, Nebraska 68010, USA.
Allergy Asthma Proc. 2012 Jan-Feb;33(1):54-64. doi: 10.2500/aap.2011.32.3518. Epub 2011 Dec 15.
Past asthma surveys have shown suboptimal management and control of asthma in the United States. No major survey of asthma management has been conducted since the Third Expert Panel Report for the National Asthma Education and Prevention Program (NAEPP) guidelines on diagnosis and treatment of asthma (August 2007). This study was designed to report asthma management and control results from the Asthma Insight and Management survey of U.S. patients and physicians. A telephone-based survey was conducted during 2009 in 2500 patients with asthma, aged ≥12 years, and 309 physicians (104 allergists, 54 pulmonologists, 101 family practitioners, and 50 internists). Patients' asthma control perceptions (71% "completely controlled" or "well controlled") were inconsistent with their NAEPP control level as determined by self-reported symptoms (29% well controlled). Patients and physicians had low expectations for effective asthma management; patients considered asthma well managed if rescue medication was used three times per week (46%), urgent care visits occurred twice per year (67%), or emergency department visits occurred once per year (60%). Asthma-related syncope, seizure, intensive care unit admission, and intubation were associated with uncontrolled asthma based on NAEPP guidelines. Respiratory specialists (allergists/pulmonologists) implemented asthma management recommendations more than other physicians surveyed. However, only 22% of patients visited a specialist for usual asthma care and 48% had never visited a specialist. Despite detailed NAEPP guidance, asthma management and control in U.S. patients is unsatisfactory. Improved asthma control assessment (impairment and risk) and implementation of NAEPP management recommendations are needed to improve asthma control and outcomes.
过去的哮喘调查显示，美国的哮喘管理存在不尽如人意的情况。自美国国家哮喘教育和预防计划（NAEPP）第三次专家组报告发布以来，一直没有对哮喘管理进行过重大调查，该报告于 2007 年 8 月发布了关于哮喘诊断和治疗的指南。本研究旨在报告美国患者和医生的哮喘管理和控制结果，该结果来自哮喘洞察和管理调查。该调查于 2009 年通过电话进行，调查对象为 2500 名年龄≥12 岁的哮喘患者和 309 名医生（104 名过敏科医生、54 名肺病科医生、101 名家庭医生和 50 名内科医生）。患者对哮喘控制的认知（71%为“完全控制”或“良好控制”）与其根据自我报告症状确定的 NAEPP 控制水平不一致（29%为“良好控制”）。患者和医生对有效哮喘管理的期望较低；患者认为，如果每周使用缓解药物三次（46%）、每年紧急护理就诊两次（67%）或每年急诊就诊一次（60%），则哮喘管理良好。根据 NAEPP 指南，哮喘相关晕厥、癫痫、重症监护病房入院和插管与未控制的哮喘有关。与接受调查的其他医生相比，呼吸科专家（过敏科/肺病科医生）更能执行哮喘管理建议。然而，只有 22%的患者因常规哮喘护理而就诊于专家，48%的患者从未就诊于专家。尽管有详细的 NAEPP 指南，但美国患者的哮喘管理和控制仍不理想。需要改善哮喘控制评估（损害和风险）和实施 NAEPP 管理建议，以改善哮喘控制和结果。
