Clark Vanessa L, Gibson Peter G, Genn Grayson, Hiles Sarah A, Pavord Ian D, McDonald Vanessa M
National Health and Medical Research Council Centre for Research Excellence in Severe Asthma and The Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, NSW, Australia.
School of Nursing and Midwifery, The University of Newcastle, Newcastle, NSW, Australia.
Respirology. 2017 Oct;22(7):1262-1275. doi: 10.1111/resp.13134. Epub 2017 Aug 3.
The management of severe asthma is complex. Multidimensional assessment (MDA) of specific traits has been proposed as an effective strategy to manage severe asthma, although it is supported by few prospective studies. We aimed to systematically review the literature published on MDA in severe asthma, to identify the traits included in MDA and to determine the effect of MDA on asthma-related outcomes. We identified 26 studies and classified these based on study type (cohort/cross-sectional studies; experimental/outcome studies; and severe asthma disease registries). Study type determined the comprehensiveness of the assessment. Assessed traits were classified into three domains (airways, co-morbidities and risk factors). The airway domain had the largest number of traits assessed (mean ± SD = 4.2 ± 1.7) compared with co-morbidities (3.6 ± 2.2) and risk factors (3.9 ± 2.1). Bronchodilator reversibility and airflow limitation were assessed in 92% of studies, whereas airway inflammation was only assessed in 50%. Commonly assessed co-morbidities were psychological dysfunction, sinusitis (both 73%) and gastro-oesophageal reflux disease (GORD; 69%). Atopic and smoking statuses were the most commonly assessed risk factors (85% and 86%, respectively). There were six outcome studies, of which five concluded that MDA is effective at improving asthma-related outcomes. Among these studies, significantly more traits were assessed than treated. MDA studies have assessed a variety of different traits and have shown evidence of improved outcomes. This promising model of care requires more research to inform which traits should be assessed, which traits should be treated and what effect MDA has on patient outcomes.
重度哮喘的管理十分复杂。针对特定特征的多维评估（MDA）已被提议作为管理重度哮喘的有效策略，尽管仅有少数前瞻性研究支持这一策略。我们旨在系统回顾关于重度哮喘多维评估的已发表文献，确定多维评估中包含的特征，并确定多维评估对哮喘相关结局的影响。我们识别出26项研究，并根据研究类型（队列研究/横断面研究；实验性/结局性研究；以及重度哮喘疾病登记）对这些研究进行分类。研究类型决定了评估的全面性。所评估的特征被分为三个领域（气道、共病和风险因素）。与共病（3.6±2.2）和风险因素（3.9±2.1）相比，气道领域评估的特征数量最多（均值±标准差=4.2±1.7）。92%的研究评估了支气管扩张剂可逆性和气流受限情况，而仅有50%的研究评估了气道炎症。常见的共病评估包括心理功能障碍、鼻窦炎（均为73%）和胃食管反流病（GORD；69%）。特应性和吸烟状况是最常评估的风险因素（分别为85%和86%）。有六项结局性研究，其中五项得出结论，认为多维评估在改善哮喘相关结局方面有效。在这些研究中，评估的特征明显多于治疗的特征。多维评估研究评估了各种不同的特征，并显示出结局改善的证据。这种有前景的照护模式需要更多研究，以明确应评估哪些特征、应治疗哪些特征以及多维评估对患者结局有何影响。
