Krasnodębska Paulina, Hermanowicz-Salamon Joanna, Domagała-Kulawik Joanna, Chazan Ryszarda
Studenckie Koło Naukowe przy Katedrze i Klinice Chorób Wewnętrznych, Pneumonologii i Alergologii, Samodzielny Publiczny Centralny Szpital Kliniczny, Warszawski Uniwersytet Medyczny, ul. Banacha 1a, 02–097 Warszawa.
Pneumonol Alergol Pol. 2012;80(3):198-208.
Asthma treatment requires control and monitoring. According to Global Initiative For Asthma (GINA) asthma severity is described by degree of control. The aim of the present study was to compare self-patients' opinions about asthma control with Asthma Control Test (ACT) scores. Furthermore factors associated with asthma control were analyzed in the examined group of patients. Age, BMI, the length and the degree of asthma treatment, concomitant diseases, physical activity, exposition to the tobacco smoke, needs for education and self-control were assessed.
The study was based on a 36-point questionnaire that evaluated last two years of asthma duration, the reference data were obtained by objective evaluation with ACT. Fifty three patients, 37 women and 16 men, median age 54 years (24-80 years), from outpatients clinic were enrolled into the study. According to ACT score the patients (pts) were divided into 3 groups: 25 points - well controlled asthma (group 1), 20-24 points - partially controlled asthma (group 2) and less than 20 points - lack of asthma control (group 3). Kruskal-Wallis test and Chi-square test were used to compare the characteristics of subjects in different ACT groups. Pearson's test was used for assessment of correlation between different parameters.
Twenty seven of 53 pts (51%) were treated with low dose of inhaled steroids and long acting beta-agonists (third degree of treatment according to GINA). During last two years the treatment was intensified in 37 pts (70%) due to exacerbation, and 19 of them (36%) were hospitalized in the course of exacerbation. Although 36 out of 53 pts (68%) claimed their asthma was fully controlled, ACT showed full control only in 5/53 (9%) of cases, partial control in 18/53 (34%), lack of control - in 30/53 (57%). Older age (p 〈 0.05) and longer duration of the disease (p 〈 0.01) were the factors significantly influencing lack of asthma control. A tendency towards worse asthma control was combined also with overweight and greater number of concomitant diseases (mainly coronary artery disease, diabetes and gastro-esophageal reflux). The presence of influenza vaccinations in medical history was associated with better asthma control (p = 0.05).
A discrepancy between subjective assessment of asthma control and ACT score was observed in the examined group of patients. The frequency of asthma exacerbations (according to questionnaire) was describing the degree of asthma control more precisely than self-assessment. Older age and longer disease duration were combined with significantly worse asthma control. Better asthma control was combined with the presence of influenza vaccinations in medical history.
哮喘治疗需要进行控制和监测。根据全球哮喘防治创议（GINA），哮喘严重程度由控制程度来描述。本研究的目的是比较患者对哮喘控制的自我看法与哮喘控制测试（ACT）得分。此外，还对所研究患者组中与哮喘控制相关的因素进行了分析。评估了年龄、体重指数、哮喘治疗的时长和程度、伴随疾病、身体活动、接触烟草烟雾情况、教育需求和自我控制能力。
该研究基于一份36分的问卷，该问卷评估了过去两年的哮喘病程，通过ACT进行客观评估获取参考数据。来自门诊的53名患者（37名女性和16名男性），中位年龄54岁（24 - 80岁）被纳入研究。根据ACT得分，患者被分为3组：25分——哮喘控制良好（第1组），20 - 24分——哮喘部分控制（第2组），低于20分——哮喘未得到控制（第3组）。采用Kruskal - Wallis检验和卡方检验来比较不同ACT组受试者的特征。使用Pearson检验评估不同参数之间的相关性。
53名患者中有27名（51%）接受低剂量吸入性糖皮质激素和长效β受体激动剂治疗（根据GINA为第三级治疗）。在过去两年中，37名患者（70%）因病情加重而加强了治疗，其中19名（36%）在病情加重过程中住院治疗。尽管53名患者中有36名（68%）声称其哮喘得到了完全控制，但ACT显示仅5/53（9%）的病例为完全控制，18/53（34%）为部分控制，30/53（57%）为未得到控制。年龄较大（p 〈 0.05）和病程较长（p 〈 0.01）是显著影响哮喘未得到控制的因素。哮喘控制情况变差的趋势还与超重以及更多的伴随疾病（主要是冠状动脉疾病、糖尿病和胃食管反流）有关。病史中有流感疫苗接种与更好的哮喘控制相关（p = 0.05）。
在所研究的患者组中观察到哮喘控制的主观评估与ACT得分之间存在差异。哮喘加重的频率（根据问卷）比自我评估更准确地描述了哮喘控制程度。年龄较大和病程较长与明显更差的哮喘控制相关。更好的哮喘控制与病史中有流感疫苗接种相关。
