Hyland Michael E, Whalley Ben, Halpin David M G, Greaves Colin J, Seamark Clare, Blake Sue, Pinnuck Margaret, Ward David, Hawkins Adam, Seamark Dave
School of Psychology, University of Plymouth, Plymouth, Devon, UK.
Prim Care Respir J. 2012 Dec;21(4):405-11. doi: 10.4104/pcrj.2012.00061.
Being able to identify patients at risk of exacerbations is useful as it enables resources to be targeted at these patients.
To test the theoretically-derived prediction that the frequency of non-asthma related visits to the general practitioner (GP) predicts exacerbations.
Clinical and demographic data and both self-report and prescription-based adherence data were obtained from 166 patients diagnosed with asthma attending a GP clinic, all of whom were prescribed inhaled corticosteroids (ICS). Asthma exacerbations (treated by the GP or in hospital) and non-asthma visits and symptoms were assessed from notes for the subsequent 5 years.
Exacerbations correlated with non-asthma visits (0.35), severity as measured by BTS step (0.28), and with prescription-based adherence (0.28). Asthma severity correlated with non-asthma visits (0.35). Receiver operating curves showed that ≥2 non-asthma visits per year provided 79% sensitivity and 58% specificity for detecting ≥3 exacerbations over 5 years. Poor adherence predicted outcomes only for patients with high levels of non-asthma visits (≥3) and only for those reporting regular-but-less ICS use but not symptom-directed ICS use.
Non-asthma visits are a good predictor of asthma exacerbations, particular in non-adherent patients. These results are consistent with a mechanism where exacerbations result from a combination of random oscillating specific and non-specific inflammatory processes. It is important to consider the total patient rather than just the lung when managing patients with asthma.
能够识别有病情加重风险的患者很有用，因为这样可以将资源集中用于这些患者。
检验理论推导的预测，即全科医生（GP）处非哮喘相关就诊频率可预测病情加重。
从一家全科医生诊所的166例确诊哮喘患者处获取临床和人口统计学数据以及基于自我报告和处方的依从性数据，所有患者均被处方吸入性糖皮质激素（ICS）。从随后5年的记录中评估哮喘病情加重情况（由全科医生治疗或住院治疗）以及非哮喘就诊情况和症状。
病情加重与非哮喘就诊（0.35）、英国胸科学会（BTS）分级所衡量的严重程度（0.28）以及基于处方的依从性（0.28）相关。哮喘严重程度与非哮喘就诊（0.35）相关。受试者工作特征曲线显示，每年≥2次非哮喘就诊对于检测5年内≥3次病情加重的敏感性为79%，特异性为58%。依从性差仅对非哮喘就诊次数多（≥3次）的患者以及仅对那些报告规律但较少使用ICS而非按需使用ICS的患者的预后有预测作用。
非哮喘就诊是哮喘病情加重的良好预测指标，尤其是在依从性差的患者中。这些结果与一种机制相符，即病情加重是由随机振荡的特异性和非特异性炎症过程共同导致的。在管理哮喘患者时，考虑患者整体情况而非仅关注肺部情况很重要。
