评估哮喘控制与肺功能和脉冲震荡技术的关系。
Assessment of spirometry and impulse oscillometry in relation to asthma control.
机构信息
Scottish Centre for Respiratory Research, Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, DD1 9SY, UK.
出版信息
Lung. 2015 Feb;193(1):47-51. doi: 10.1007/s00408-014-9674-6. Epub 2014 Dec 17.
INTRODUCTION
Guidelines advocate the use of spirometry to assess pulmonary function in asthmatic patients. Commonly used measures include forced expiratory volume in 1 s (FEV1), forced expiratory ratio (FEV1/FVC), and forced mid-expiratory flow between 25 and 75 % of forced vital capacity (FEF25-75). Impulse oscillometry (IOS) is an effort-independent test performed during tidal breathing. IOS may be used to assess the total and central airway resistance at 5 Hz (R5) and 20 Hz (R20), respectively, and hence derive the peripheral airway resistance from the difference (R5-R20). We compared spirometry and IOS as tests of global airway function (i.e., FEV1, FEV1/FVC, R5) and putative measures of small airways function (i.e., FEF25-75, R5-R20) and their relationship to oral steroid and short-acting beta-agonist (SABA) use as surrogates for long-term asthma control.
METHODS
Spirometry and IOS measurements from physician-diagnosed asthmatics were linked to a health informatics database for oral steroid and SABA use 1 year prior to the index measurements.
RESULTS
Four hundred forty-two patients had both spirometry and IOS, mean FEV1 = 86 % predicted, 94 % on ICS, median dose 800 µg/day. IOS and spirometry measures were equally predictive of impaired asthma control for both oral steroid and SABA use. For oral steroid use, the adjusted odds ratio, OR (95 % CI) is as follows: FEV1 < 80 %: 1.56(0.99-2.47), p = 0.056; FEV1/FVC < 0.70: 1.67(1.03-2.69), p = 0.037; FEF25-75 < 60 %: 1.84(1.18-2.86), p = 0.007; R5 > 150 %: 1.91(1.25-2.95), p = 0.003; and R5-R20 > 0.1 kPa L(-1) s 1.73(1.12-2.66), p = 0.013. For SABA use, the adjusted OR (95 % CI) is as follows: FEV1 < 80 %: 2.22(1.43-3.44), p < 0.001; FEV1/FVC < 0.70: 2.26(1.44-3.57), p < 0.001; FEF25-75 < 60 %: 2.51(1.65-3.82), p < 0.001; R5 > 150 %: 1.76(1.18-2.63), p = 0.006; and R5-R20 > 0.1 kPa L(-1) s: 2.94(1.94-4.46), p < 0.001.
CONCLUSION
Spirometry or IOS measurements were equally useful as potential markers of asthma control in persistent asthmatic patients.
简介
指南提倡使用肺活量测定法来评估哮喘患者的肺功能。常用的指标包括 1 秒用力呼气量（FEV1）、用力呼气比值（FEV1/FVC）以及用力呼出 25%至 75%肺活量时的中间呼气流速（FEF25-75）。脉冲震荡（IOS）是一种在潮气呼吸时进行的无需用力的测试。IOS 可用于分别评估 5 Hz（R5）和 20 Hz（R20）时的总气道阻力和中央气道阻力，并由此得出外周气道阻力的差值（R5-R20）。我们比较了肺活量测定法和 IOS，以评估气道整体功能（即 FEV1、FEV1/FVC、R5）和可能的小气道功能指标（即 FEF25-75、R5-R20），并将其与口服皮质类固醇和短效β-激动剂（SABA）的使用情况进行了比较，以作为长期哮喘控制的替代指标。
方法
将经医生诊断的哮喘患者的肺活量测定法和 IOS 测量值与健康信息数据库相关联，以了解他们在进行指数测量前 1 年内口服皮质类固醇和 SABA 的使用情况。
结果
共有 442 例患者同时进行了肺活量测定法和 IOS 检查，平均 FEV1 为预计值的 86%，94%的患者使用 ICS，中位剂量为 800 μg/天。IOS 和肺活量测定法的测量结果均能预测口服皮质类固醇和 SABA 使用情况对哮喘控制的影响。对于口服皮质类固醇的使用，调整后的比值比（OR）（95%CI）如下：FEV1 < 80%：1.56（0.99-2.47），p = 0.056；FEV1/FVC < 0.70：1.67（1.03-2.69），p = 0.037；FEF25-75 < 60%：1.84（1.18-2.86），p = 0.007；R5 > 150%：1.91（1.25-2.95），p = 0.003；以及 R5-R20 > 0.1 kPa L(-1) s：1.73（1.12-2.66），p = 0.013。对于 SABA 的使用，调整后的 OR（95%CI）如下：FEV1 < 80%：2.22（1.43-3.44），p < 0.001；FEV1/FVC < 0.70：2.26（1.44-3.57），p < 0.001；FEF25-75 < 60%：2.51（1.65-3.82），p < 0.001；R5 > 150%：1.76（1.18-2.63），p = 0.006；以及 R5-R20 > 0.1 kPa L(-1) s：2.94（1.94-4.46），p < 0.001。
结论
在持续性哮喘患者中，肺活量测定法或 IOS 测量结果同样可作为哮喘控制的潜在标志物。
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