Allergy Asthma Proc. 2019 Mar 1;40(2):111-115. doi: 10.2500/aap.2019.40.4203.
There are no validated quantitative tools for assessing asthma exacerbation, which may cause significant variation in determining the severity of exacerbation across caregivers. A modified Pulmonary Index Score (mPIS) has been proposed as a quantitative indicator of the severity of childhood asthma exacerbation. However, the utility of mPIS as a treatment decision-making tool has not been investigated. The aim of the present study was to clarify the utility of therapeutic strategies based on mPIS in children hospitalized for asthma exacerbation. This was a case-control study of patients admitted to our hospital between 2010 and 2015. In addition to the conventional therapy based on Japanese guidelines, treatment adaptation by using mPIS began in 2013. Children admitted after 2013 were regarded as being in the case group and those before 2012 were the control group. The length of the hospital stay and the duration of continuous isoproterenol inhalation therapy (CIT) were compared as clinical outcomes. The targeted number of patients was 346 (182 cases and 164 controls). The mean ± standard error age was 3.5 ± 0.2 years in the case group and 3.4 ± 0.2 years in the control group. Male patients constituted 64.3% of the case group and 60.4% of the control group. The mean ± standard error length of hospital stay was significantly shortened in the case group (8.1 ± 0.2 days versus 9.6 ± 0.2 days, p < 0.001). The mean ± standard error duration of CIT was also shortened in the case group (2.3 ± 0.1 days versus 3.9 ± 0.3 days, p < 0.001). An mPIS-based therapeutic strategy may have reduced the length of hospital stay by enabling timely adjustments to clinical interventions and enabling caregivers to perform a more-accurate assessment of asthma exacerbation.
目前尚无评估哮喘恶化的经验证的定量工具，这可能导致护理人员在确定哮喘恶化严重程度方面存在显著差异。已经提出了改良的肺部指数评分（mPIS）作为儿童哮喘恶化严重程度的定量指标。然而，尚未研究 mPIS 作为治疗决策工具的效用。本研究旨在阐明基于 mPIS 的治疗策略在因哮喘恶化而住院的儿童中的应用价值。
这是一项病例对照研究，纳入了 2010 年至 2015 年期间在我院住院的患者。除了基于日本指南的常规治疗外，自 2013 年开始还根据 mPIS 进行治疗调整。2013 年后入院的患儿被视为病例组，2012 年前入院的患儿被视为对照组。将住院时间和持续异丙肾上腺素吸入治疗（CIT）的时间作为临床结局进行比较。
本研究的目标患者数量为 346 例（病例组 182 例，对照组 164 例）。病例组的平均年龄±标准误差为 3.5±0.2 岁，对照组为 3.4±0.2 岁。病例组中男性患儿占 64.3%，对照组为 60.4%。病例组的平均住院时间显著缩短（8.1±0.2 天比 9.6±0.2 天，p<0.001）。病例组的 CIT 持续时间也缩短（2.3±0.1 天比 3.9±0.3 天，p<0.001）。
基于 mPIS 的治疗策略可能通过及时调整临床干预措施并使护理人员更准确地评估哮喘恶化，从而缩短了住院时间。
