Department of Allergy, Kaiser Permanente Medical Center, San Diego, Calif.
Department of Allergy, Kaiser Permanente Medical Center, San Diego, Calif.
J Allergy Clin Immunol Pract. 2014 Jan-Feb;2(1):59-64. doi: 10.1016/j.jaip.2013.07.016. Epub 2013 Oct 11.
Maintenance of asthma control over time is a clear goal of national asthma guidelines, but few studies have addressed the natural history of asthma control over time.
To assess the impairment domain of asthma control over time in patients with persistent asthma and to determine predictors and consequences of controlled and uncontrolled asthma over time.
Patients 18-56 years old with persistent asthma who completed baseline (November 2007) and follow-up asthma surveys (April, July, October 2008) were included in the study. The survey included the Asthma Control Test as well as questions regarding other patient and asthma characteristics. Health care utilization (pharmacy and exacerbations) for 2008 was obtained from administrative data.
The baseline and first follow-up surveys were completed by 1267 patients, and all 4 surveys were completed by 782 patients. Patients with well-controlled asthma at baseline were significantly more likely (P < .0001) to have well-controlled asthma over the following year (76.2%-80.4%) than patients with uncontrolled asthma at baseline (33.5%-36.9%). Patients whose asthma control improved over the first several months of follow-up experienced significantly (P < .05) fewer exacerbations over the subsequent year than patients with initially uncontrolled asthma who did not improve.
Degree of asthma control at one point in time is strongly related to the achievement or maintenance of control and to asthma exacerbations over time. Patients with uncontrolled asthma, especially very poorly controlled asthma, should receive intensive management and follow-up in an attempt to achieve well-controlled asthma over time.
维持哮喘的长期控制是国家哮喘指南的明确目标，但很少有研究涉及哮喘控制随时间的自然变化过程。
评估持续性哮喘患者的哮喘控制受损情况，并确定哮喘控制随时间变化的预测因素及其后果。
纳入年龄在 18-56 岁之间、完成了基线（2007 年 11 月）和随访哮喘调查（2008 年 4 月、7 月、10 月）的持续性哮喘患者。调查包括哮喘控制测试以及关于其他患者和哮喘特征的问题。2008 年的医疗保健利用率（药房和加重）来自行政数据。
基线和第一次随访调查完成了 1267 例患者，所有 4 次调查均完成了 782 例患者。基线时哮喘控制良好的患者在随后的一年中更有可能（P <.0001）保持哮喘控制良好（76.2%-80.4%），而基线时哮喘控制不佳的患者则不太可能（33.5%-36.9%）。在随访的最初几个月中哮喘控制情况改善的患者，与最初控制不佳且没有改善的患者相比，在随后的一年中经历哮喘加重的次数明显（P <.05）减少。
在某个时间点的哮喘控制程度与控制的获得或维持以及哮喘加重随时间的变化密切相关。哮喘控制不佳的患者，尤其是控制极差的患者，应接受强化管理和随访，以试图实现长期控制良好的哮喘。
