老年人哮喘控制不佳的预测因素。
The predictors of poorly controlled asthma in elderly.
机构信息
Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
出版信息
Allergy Asthma Immunol Res. 2012 Sep;4(5):270-6. doi: 10.4168/aair.2012.4.5.270. Epub 2012 Mar 27.
PURPOSE
To evaluate asthma control in elderly individuals and identify the factors that predict poor control.
METHODS
A retrospective, observational study evaluating 108 elderly individuals with asthma (59 females: ≥60 years, mean age: 70.5 years) was conducted at Ajou University Hospital from October 2010 to March 2011. Subjects were classified into two groups according to scores on the asthma control test (ACT). Group I consisted of 38 patients with ACT scores ≤19 (poor controllers) and group II included 70 patients with ACT scores >19 (controllers). Clinical data was analyzed. Spirometry was performed, and the ACT and asthma quality-of-life survey were completed. Medication possession ratios were calculated to evaluate compliance.
RESULTS
Of the 108 enrolled subjects, 54.6% were female, 7.5% were obese, and 49.0% were atopic. The mean age of the patients was 70.5, and the average of time patients had suffered from asthma was 15.5 years. Comorbid conditions were found in more than 80% of the patients. Allergic rhinitis was most common comorbid condition; this was followed by cardiovascular disease and degenerative arthritis (76.9%, 65.7%, and 51.9%, respectively). Many patients (35.2%) were in poorly controlled states characterized by significantly lower asthma quality of life scores (P<0.001) and higher admission rates (P=0.034). Multivariate logistic regression analysis showed that a history of pulmonary tuberculosis was a predictor of poorly controlled asthma in elderly individuals even after adjusting for age, sex, smoking, lung function and other comorbidities (OR=4.70, CI=1.06-20.81, P=0.042).
CONCLUSIONS
The asthma of more than one-third of elderly individuals with this condition was poorly controlled, and a history of pulmonary tuberculosis may have contributed to this outcome. Proper evaluation and management of comorbid conditions in elderly patients with asthma is essential for the achievement of better control of the disease and a higher quality of life for those who suffer from it.
目的
评估老年哮喘患者的控制情况，并确定预测控制不佳的因素。
方法
本研究为回顾性、观察性研究，于 2010 年 10 月至 2011 年 3 月在韩国 Ajou 大学医院对 108 例老年哮喘患者（59 例女性：≥60 岁，平均年龄：70.5 岁）进行了评估。根据哮喘控制测试（ACT）评分，将患者分为两组。组 I 包括 38 例 ACT 评分≤19 分（控制不佳组）的患者，组 II 包括 70 例 ACT 评分>19 分（控制良好组）的患者。分析临床资料。进行肺功能检查，填写 ACT 和哮喘生活质量调查问卷。计算药物维持率以评估依从性。
结果
在纳入的 108 例患者中，54.6%为女性，7.5%为肥胖，49.0%为特应性。患者的平均年龄为 70.5 岁，哮喘平均患病时间为 15.5 年。超过 80%的患者存在合并症。最常见的合并症是过敏性鼻炎（76.9%），其次是心血管疾病（65.7%）和退行性关节炎（51.9%）。许多患者（35.2%）处于控制不佳状态，表现为哮喘生活质量评分明显降低（P<0.001）和住院率升高（P=0.034）。多变量逻辑回归分析显示，在校正年龄、性别、吸烟、肺功能和其他合并症后，肺结核病史是老年哮喘患者控制不佳的预测因素（OR=4.70，CI=1.06-20.81，P=0.042）。
结论
超过三分之一的老年哮喘患者病情控制不佳，肺结核病史可能是导致这种结果的原因之一。对老年哮喘患者合并症进行适当评估和管理，对于实现更好的疾病控制和提高患者生活质量至关重要。
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