Vennera María del Carmen, Picado César, Herráez Lys, Galera Jordi, Casafont Jordi
Servei de Pneumologia, Hospital Clínic, Universitat de Barcelona, Barcelona, España; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, España; Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Barcelona, España.
Servei de Pneumologia, Hospital Clínic, Universitat de Barcelona, Barcelona, España; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, España; Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Barcelona, España.
Arch Bronconeumol. 2014 Sep;50(9):384-91. doi: 10.1016/j.arbres.2014.03.002. Epub 2014 Apr 26.
Despite current treatments, more than half of patients with asthma are not controlled. The objective was to evaluate the correlation between control perceived by patients and physicians, compared with control evaluated according to criteria of the Spanish Guidelines for Asthma Management (GEMA), and to investigate the factors associated with that control.
Multicenter, cross-sectional, observational study including 343 patients with severe persistent asthma according to GEMA criteria seen in the Department of Pulmonology and Allergology. The correlation between asthma control perceived by the patient, the physician and according to clinical judgment based on the GEMA criteria was calculated, and a multivariate analysis was used to determine variables related to the perception of asthma control.
According to GEMA criteria, only 10.2% of patients were well controlled, 27.7% had partial control and 62.1% were poorly controlled. Both the physicians and the patients overestimated control: 75.8% and 59.3% of patients had controlled asthma according to the patient and the physician, respectively, and were not controlled according to GEMA (P<.0001). Patients with uncontrolled asthma according GEMA had higher body mass index (P=.006) and physical inactivity (P=.016). Factors associated with a perceived lack of control by both physicians and patients were: nocturnal awakenings (≥ 1 day/week), frequent use of rescue medication (≥ 5 days/week) and significant limitation in activities. Discrepant factors between physicians and patients were dyspnea and emergency room visits (patients only), FEV1 ≤ 80% and a poorer understanding of the disease by the patient (physicians only).
Only 10% of patients with severe asthma evaluated in this study are controlled according to GEMA criteria. Patients and physicians overestimate control and the overestimation by patients is greater. Physical inactivity and obesity are associated with a lack of control according to GEMA.
尽管有目前的治疗方法，但超过一半的哮喘患者病情未得到控制。目的是评估患者和医生所感知的控制情况与根据西班牙哮喘管理指南（GEMA）标准评估的控制情况之间的相关性，并调查与该控制相关的因素。
多中心、横断面、观察性研究，纳入了343例根据GEMA标准诊断为重度持续性哮喘的患者，这些患者来自肺科和过敏科。计算患者、医生所感知的哮喘控制情况与基于GEMA标准的临床判断之间的相关性，并使用多变量分析来确定与哮喘控制感知相关的变量。
根据GEMA标准，只有10.2%的患者病情得到良好控制，27.7%的患者部分控制，62.1%的患者控制不佳。医生和患者均高估了控制情况：分别有75.8%和59.3%的患者根据患者和医生的判断哮喘得到了控制，但根据GEMA标准并未得到控制（P<0.0001）。根据GEMA标准哮喘未得到控制的患者体重指数较高（P=0.006）且身体活动不足（P=0.016）。医生和患者均认为缺乏控制的相关因素包括：夜间觉醒（≥每周1天）、频繁使用急救药物（≥每周5天）以及活动严重受限。医生和患者之间存在差异的因素包括呼吸困难和急诊就诊（仅患者）、第一秒用力呼气容积（FEV1）≤80%以及患者对疾病的理解较差（仅医生）。
本研究中评估的重度哮喘患者中只有10%根据GEMA标准得到了控制。患者和医生高估了控制情况，且患者的高估更为严重。身体活动不足和肥胖与根据GEMA标准的控制不佳相关。
