O'Loghlen Sean B, Levesque Linda, Fisher Thomas, DeWit Yvonne, Whitehead Marlo, To Teresa, Lougheed M Diane
Department of Medicine, Queen's University, Kingston, ON, Canada.
Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.
J Allergy Clin Immunol Pract. 2020 Sep;8(8):2643-2650.e2. doi: 10.1016/j.jaip.2020.03.045. Epub 2020 Apr 15.
Impaired symptom perception is often listed as a risk factor for life-threatening asthma, but there is limited evidence to support this.
We aimed to determine whether impaired perception of bronchoconstriction (BC) and/or dynamic hyperinflation (DH) are risk factors for severe asthma exacerbations.
In this prospective cohort study, individuals with asthma underwent high-dose methacholine challenge testing. Changes in forced expiratory volume in 1 second (FEV) (% predicted) and inspiratory capacity (IC) (% predicted) were measured to assess the degree of BC and DH, respectively, during high-dose methacholine bronchoprovocation. Participants rated dyspnea intensity during testing and were categorized as poor, normal, and over perceivers of BC and DH based on perception scores at standardized changes (20%, 30%, and 40%) in FEV (% predicted) and IC (% predicted). We compared the rates of severe asthma exacerbations (defined as one of emergency department [ED] visit or hospitalization) between groups, using Ontario's administrative health databases.
Poor perceivers had higher rates of ED visits and hospitalizations as compared with normal perceivers at 4 of 6 threshold decreases in FEV and IC studied. Poor perceivers of severe DH had a 6-fold increase in asthma exacerbations (odds ratio, 5.7; 95% confidence interval, 1.31-25.03).
Health services utilization is increased in individuals with asthma who have poor perception of BC and DH. Poor perceivers of severe DH appear to be at the highest risk of exacerbations.
症状感知受损常被列为危及生命的哮喘的一个风险因素，但支持这一观点的证据有限。
我们旨在确定支气管收缩（BC）和/或动态肺过度充气（DH）感知受损是否为严重哮喘发作的风险因素。
在这项前瞻性队列研究中，哮喘患者接受了高剂量乙酰甲胆碱激发试验。在高剂量乙酰甲胆碱支气管激发试验期间，分别测量1秒用力呼气容积（FEV）（预测值%）和吸气容量（IC）（预测值%）的变化，以评估BC和DH的程度。参与者在测试过程中对呼吸困难强度进行评分，并根据FEV（预测值%）和IC（预测值%）在标准化变化（20%、30%和40%）时的感知评分，分为BC和DH感知差、正常和过度感知者。我们使用安大略省的行政卫生数据库比较了各组之间严重哮喘发作（定义为急诊科就诊或住院之一）的发生率。
在所研究的FEV和IC的6个阈值降低中，有4个阈值下，与正常感知者相比，感知差的患者急诊科就诊和住院率更高。严重DH感知差的患者哮喘发作增加了6倍（比值比，5.7；95%置信区间，1.31 - 25.03）。
对BC和DH感知差的哮喘患者的医疗服务利用率增加。严重DH感知差的患者似乎发作风险最高。
