Alzahrani Yahya A, Becker Ellen A
Rush University Medical Center, Chicago, Illinois.
Respir Care. 2016 Jan;61(1):106-16. doi: 10.4187/respcare.04341. Epub 2015 Nov 10.
Both the National Asthma Education and Prevention Program Expert Panel Report 3 and the 2015 Global Initiative for Asthma guidelines identify achieving and maintaining asthma control as goals of therapy, and they emphasize periodic assessment of asthma control once treatment is established. Accurate assessment of asthma control is difficult due to the complexity of asthma control and due to the limitations in the traditional methods of assessment, such as lung function tests, physician assessment, and patients' self-assessment. Relying solely on the role of lung function tests is insufficient to reflect the status of asthma control, since patients with asthma may have normal spirometry between exacerbations. Clinicians often overestimate the level of asthma control. Similarly, it is not uncommon for patients to overestimate how well their asthma is controlled, and, therefore, they under-report asthma symptoms and fail to recognize the impact that asthma has on their daily life. As a result, several tools have been developed to quantify the level of asthma control, identify patients at risk, and evaluate the effect of asthma management. This review examines the commonly used asthma control assessment tools in terms of content, psychometric properties, methods of administration, limitations, and ability to reflect the overall status of asthma control, which can aid clinicians in selecting the most appropriate tool for their needs.
美国国家哮喘教育与预防计划专家小组报告3和2015年全球哮喘防治创议指南均将实现并维持哮喘控制作为治疗目标,并强调在确立治疗方案后要定期评估哮喘控制情况。由于哮喘控制的复杂性以及传统评估方法(如肺功能测试、医生评估和患者自我评估)存在局限性,准确评估哮喘控制情况较为困难。仅依靠肺功能测试不足以反映哮喘控制状况,因为哮喘患者在发作间期肺功能可能正常。临床医生常常高估哮喘控制水平。同样,患者高估自身哮喘控制程度的情况也并不少见,因此他们会少报哮喘症状,并且意识不到哮喘对其日常生活的影响。结果,人们开发了多种工具来量化哮喘控制水平、识别高危患者并评估哮喘管理效果。本综述从内容、心理测量特性、使用方法、局限性以及反映哮喘控制总体状况的能力等方面,对常用的哮喘控制评估工具进行了研究,这有助于临床医生根据自身需求选择最合适的工具。