Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Lookout Road, New Lambton, 2305, Australia.
Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia.
BMC Pulm Med. 2020 Mar 18;20(1):66. doi: 10.1186/s12890-020-1101-6.
Uncontrolled severe asthma in children is burdensome and challenging to manage. This study aims to describe outcomes in children with uncontrolled severe asthma managed in a nurse-led severe asthma clinic (SAC).
This retrospective analysis uses data collected from children referred by a paediatric respiratory specialist to a nurse-led SAC for uncontrolled severe asthma between 2014 and 2019. The pre-clinical assessments included a home visit to assess modifiable factors that could be addressed to improve control. A comprehensive lung function analysis was conducted at each visit. Interventions were personalised and included biologic agents. Statistical analysis was performed using nonparametric, two-tailed Mann-Whitney U-test, the parametric Student's t-test, or analysis of variance (ANOVA) as appropriate.
Twenty-three children with a median age of 12 years were seen once, and 16 were followed up. Compared to a non-asthmatic (NA) and asthmatic (A) age-matched cohort, children with severe asthma (SA) had a lower FEV1, and FVC% predicted before and after bronchodilator inhalation, and a higher mean Lung Clearance Index [LCI] (10.5 [SA] versus 7.3 [NA] versus 7.6 [A], p = 0.003). Almost 80% of children with SA had an abnormal LCI, and 48% had a reduced FEV1% at the first SAC visit. Asthma control and FEV1% predicted significantly improved at a follow-up visit, while LCI remained abnormal in the majority of children (83%).
Over time, many children with severe asthma showed improved clinical outcomes and lung function while lung ventilation inhomogeneities persisted. Future appropriately controlled studies are required to determine if a nurse-led multidisciplinary SAC is associated with better outcomes.
儿童未控制的严重哮喘负担沉重，管理具有挑战性。本研究旨在描述在护士主导的严重哮喘门诊（SAC）管理下的未控制严重哮喘患儿的结局。
本回顾性分析使用了从 2014 年至 2019 年期间，由儿科呼吸专家转介至护士主导的 SAC 的未控制严重哮喘儿童的数据。临床前评估包括家庭访问，以评估可以改善控制的可改变因素。每次就诊时都进行全面的肺功能分析。干预措施是个性化的，包括生物制剂。统计分析使用非参数、双尾曼-惠特尼 U 检验、参数学生 t 检验或适当的方差分析（ANOVA）。
23 名中位数年龄为 12 岁的儿童仅就诊 1 次，16 名儿童进行了随访。与非哮喘（NA）和哮喘（A）年龄匹配的队列相比，严重哮喘（SA）患儿的基础和支气管扩张剂吸入后用力肺活量（FEV1）和用力肺活量占预计值的百分比（FVC%）更低，平均肺清除率指数（LCI）更高[10.5（SA）比 7.3（NA）比 7.6（A），p=0.003]。近 80%的 SA 患儿 LCI 异常，48%的患儿首次 SAC 就诊时 FEV1%下降。哮喘控制和 FEV1%预测在随访时显著改善，而大多数患儿的 LCI 仍异常（83%）。
随着时间的推移，许多严重哮喘患儿的临床结局和肺功能得到改善，而肺通气不均性仍然存在。需要进一步进行适当对照的研究来确定护士主导的多学科 SAC 是否与更好的结局相关。
