Matsunaga Natasha Yumi, Oliveira Caio de, Gianfrancesco Livea, Oliveira Marina Simões, Simões Maria Cristina Ribeiro Dos Santos, Morcillo André Moreno, Ribeiro José Dirceu, Ribeiro Maria Angela Gonçalves de Oliveira, Toro Adyléia Aparecida Dalbo Contrera
Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Estadual de Campinas, Campinas, SP, Brasil.
Laboratório de Fisiologia Pulmonar, Universidade Estadual de Campinas, Campinas, SP, Brasil.
J Bras Pneumol. 2020;46(3):e20190102. doi: 10.36416/1806-3756/e20190102. Epub 2020 Mar 13.
Objective To assess the agreement among asthma control measures and functional exercise capacity in children and adolescents with uncontrolled and controlled asthma. Methods Children and adolescents with asthma from 7-17 years old were selected, and they were attended in the "Pediatric Pulmonology Outpatient Clinic of State University of Campinas", in Brazil. All patients had asthma control level assessed by Global Initiative for Asthma questionnaire (GINAq), Asthma Control Test (ACT), spirometry and six-minute-walk-test (6MWT). Patients were classified as uncontrolled or controlled asthma in each test and agreement among measures was assessed by kappa statistics. The ROC curve was calculated for the 6MWT. The spirometric index obtained from spirometry was composed by FEV1, FEV1/FVC and FEF25-75%. Spirometry and 6MWT results were compared between uncontrolled and controlled asthma group by GINAq. Results Of the 138 subjects included, 78 (56.5%) were male with median age of 11 (7-17) years old. GINAq detected 68.8% of patients with uncontrolled asthma. Moderate agreement (p < 0.001; k = 0.56) and high specificity (100%) was observed between GINAq and ACT. In 6MWT, the cut-off point of 82.03% of predicted distance was able to distinguish patients with controlled and uncontrolled asthma. Spirometric index presented 73.4% of sensitivity according to GINAq. The results for 6MWT in patients with uncontrolled asthma were the worst of all. Conclusion This study highlights the importance of assessing more than one measure to differentiate asthma control level. GINAq identified more patients with uncontrolled asthma and presented moderate agreement with ACT. Spirometric index was associated with uncontrolled asthma according to GINAq. 6MWT was a suitable measure to distinguish patients with controlled and uncontrolled asthma.
目的 评估未控制和已控制哮喘的儿童及青少年中哮喘控制措施与功能运动能力之间的一致性。方法 选取7至17岁的哮喘儿童及青少年，他们在巴西坎皮纳斯州立大学的“儿科肺病门诊”就诊。所有患者均通过全球哮喘防治创议问卷（GINAq）、哮喘控制测试（ACT）、肺功能测定和六分钟步行试验（6MWT）评估哮喘控制水平。在每项测试中，患者被分类为未控制或已控制哮喘，并通过kappa统计量评估各项措施之间的一致性。计算6MWT的ROC曲线。肺功能测定获得的肺功能指标由第一秒用力呼气容积（FEV1）、FEV1/用力肺活量（FVC）和25%至75%用力呼气流量（FEF25 - 75%）组成。根据GINAq比较未控制和已控制哮喘组之间的肺功能测定和6MWT结果。结果 在纳入的138名受试者中，78名（56.5%）为男性，中位年龄为11岁（7至17岁）。GINAq检测出68.8%的未控制哮喘患者。GINAq与ACT之间观察到中度一致性（p < 0.001；k = 0.56）和高特异性（100%）。在6MWT中，预测距离的82.03%的截断点能够区分已控制和未控制哮喘的患者。根据GINAq，肺功能指标的敏感性为73.4%。未控制哮喘患者的6MWT结果是所有结果中最差的。结论 本研究强调了评估多种措施以区分哮喘控制水平的重要性。GINAq识别出更多未控制哮喘患者，并与ACT呈现中度一致性。根据GINAq，肺功能指标与未控制哮喘相关。6MWT是区分已控制和未控制哮喘患者的合适措施。
