Plaza-Martín A M, Vennera M C, Galera J, Herráez L
Allergy and Clinical Immunology Department, Sant Joan de Déu Hospital, Esplugues de Llobregat, 08950 Barcelona, Spain.
Pneumology Department, Hospital Clinic of Barcelona, 08036 Barcelona, Spain.
Allergol Immunopathol (Madr). 2014 Nov-Dec;42(6):510-7. doi: 10.1016/j.aller.2014.02.003. Epub 2014 Jun 16.
Severe asthma is often poorly controlled and its prevalence in Spanish children is unknown. The aim was to determine the prevalence of difficult-to-control severe asthma in children, the agreement of asthma control between physicians and Spanish Guidelines for Asthma Management (GEMA), and the health-related quality of life (HRQoL) for children and parents.
Observational, cross-sectional, two-phase, multicentre study. In the first phase, all children who attended pneumology and allergy units during a three-month period were classified according to physicians' criteria as patients with: asthma, severe asthma, or difficult-to-control severe asthma. Patients aged 6-14 years with severe asthma (difficult-to-control or controlled) were included in the second phase.
12,376 asthmatic children were screened in the first phase. According to physicians' criteria, 8.8% (95% CI 8.3-9.3%) had severe asthma. Of these, 24.2% (95% CI, 21.7-26.8%) had difficult-to-control severe asthma. 207 patients with severe asthma (mean age 10.8 ± 2.3 years; 61.4% male; mean of 5.5 ± 3.4 years since asthma diagnosis) were included in the second phase. Compared to the patients with controlled asthma, children with difficult-to-control asthma had a higher number of exacerbations, emergency room or unscheduled primary care visits in the previous year (p<0.0001, all) and poor HRQoL (p<0.0001, both children and caregivers). 33.3% of patients with controlled asthma according to physicians' criteria were poorly controlled according to GEMA.
Around one in four asthmatic children with severe disease had difficult-to-control asthma, although one third was underestimated by physicians. Children with difficult-to-control severe asthma had a poor HRQoL that also affected their parents.
重度哮喘往往控制不佳，其在西班牙儿童中的患病率尚不清楚。目的是确定儿童难治性重度哮喘的患病率、医生与西班牙哮喘管理指南（GEMA）之间哮喘控制的一致性，以及儿童及其父母的健康相关生活质量（HRQoL）。
观察性、横断面、两阶段、多中心研究。在第一阶段，根据医生的标准，将在三个月期间到肺病科和过敏科就诊的所有儿童分为以下几类患者：哮喘、重度哮喘或难治性重度哮喘。6至14岁患有重度哮喘（难治性或已控制）的患者纳入第二阶段。
第一阶段筛查了12376名哮喘儿童。根据医生的标准，8.8%（95%CI 8.3 - 9.3%）患有重度哮喘。其中，24.2%（95%CI，21.7 - 26.8%）患有难治性重度哮喘。第二阶段纳入了207名重度哮喘患者（平均年龄10.8±2.3岁；61.4%为男性；自哮喘诊断以来平均5.5±3.4年）。与哮喘已控制的患者相比，难治性哮喘儿童在前一年的急性加重次数、急诊或非预约初级保健就诊次数更多（p<0.0001，均如此），且HRQoL较差（p<0.0001，儿童和照料者均如此）。根据医生标准哮喘已控制的患者中，33.3%根据GEMA标准控制不佳。
约四分之一患有重度疾病的哮喘儿童患有难治性哮喘，尽管有三分之一被医生低估。难治性重度哮喘儿童的HRQoL较差，这也影响到了他们的父母。
