Nyenhuis Sharmilee M, Akkoyun Esra, Liu Li, Schatz Michael, Casale Thomas B
Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Ill; Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois at Chicago, Chicago, Ill.
Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Ill.
J Allergy Clin Immunol Pract. 2020 Mar;8(3):989-996.e1. doi: 10.1016/j.jaip.2019.10.032. Epub 2019 Nov 7.
Little is known about how patient-level factors and care settings relate to asthma outcomes in real-world settings.
We therefore examined the rates and relative contributions of comorbidities and care settings in terms of asthma severity and control among pediatric and adolescent/adult patients in a large national sample.
We examined deidentified patient data from 28,508 unique encounters documented in the Asthma Specialist Tool to Help Manage Asthma and Improve Quality database, obtaining patient-level factors (demographics, asthma characteristics, comorbidities), care setting (primary care physician [PCP] vs specialist physician [allergist or pulmonologist]), and guideline-defined levels of asthma control/severity. Rates of comorbidities were identified by asthma severity and control and by care setting. We calculated odds ratios for asthma control and severity based on each comorbidity.
Baseline demographic data indicated that patients seen by specialists versus PCPs were older, and had more severe and poorly controlled asthma (P < .05). Patients cared for by specialists also had more comorbid conditions, including gastroesophageal reflux disease (GERD; P < .01), rhinosinusitis (P < .01), and obstructive sleep apnea (adolescents/adults only: P < .01). GERD, smoke exposure, depression (adolescents/adults), rhinosinusitis (children), and African American race were associated with uncontrolled asthma. Smoke exposure (children), rhinosinusitis, and African American race were associated with severe disease.
We identified several demographics and comorbidities that are independently associated with the specialist care setting, persistent asthma, and poor asthma control. Awareness of these relationships may be helpful for clinicians caring for patients with asthma.
在现实环境中，关于患者层面的因素和护理环境如何与哮喘结局相关，人们了解甚少。
因此，我们在一个大型全国样本中，研究了儿科和青少年/成人患者中合并症和护理环境在哮喘严重程度和控制方面的发生率及相对贡献。
我们检查了哮喘专科管理与改善质量数据库中记录的28508次独立就诊的去识别化患者数据，获取患者层面的因素（人口统计学、哮喘特征、合并症）、护理环境（初级保健医生[PCP]与专科医生[过敏症专科医生或肺科医生]）以及指南定义的哮喘控制/严重程度水平。根据哮喘严重程度、控制情况和护理环境确定合并症的发生率。我们基于每种合并症计算哮喘控制和严重程度的比值比。
基线人口统计学数据表明，与由初级保健医生诊治的患者相比，由专科医生诊治的患者年龄更大，哮喘更严重且控制不佳（P <.05）。由专科医生护理的患者也有更多的合并症，包括胃食管反流病（GERD；P <.01）、鼻窦炎（P <.01）和阻塞性睡眠呼吸暂停（仅青少年/成人：P <.01）。GERD、接触烟雾、抑郁症（青少年/成人）、鼻窦炎（儿童）和非裔美国人种族与未控制的哮喘相关。接触烟雾（儿童）、鼻窦炎和非裔美国人种族与严重疾病相关。
我们确定了几种人口统计学和合并症，它们与专科护理环境、持续性哮喘和哮喘控制不佳独立相关。了解这些关系可能有助于照顾哮喘患者的临床医生。
