Basalt Rehabilitation Centre, Department of Pulmonary Rehabilitation, Leiden, the Netherlands; Department of Pulmonary Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+) NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands.
Department of Pulmonary Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
J Allergy Clin Immunol Pract. 2023 Jun;11(6):1823-1833.e4. doi: 10.1016/j.jaip.2023.02.034. Epub 2023 Mar 7.
Many adult patients with asthma have uncontrolled disease and impaired quality of life, despite current asthma-specific drug therapies.
This study aimed to investigate the prevalence of 9 traits in patients with asthma, their associations with disease control and quality of life, and referral rates to nonmedical health care professionals.
Retrospectively, data from patients with asthma were collected in 2 Dutch hospitals (Amphia Breda and RadboudUMC Nijmegen). Adult patients without exacerbation <3 months who were referred for a first-ever elective, outpatient, hospital-based diagnostic pathway were deemed eligible. Nine traits were assessed: dyspnea, fatigue, depression, overweight, exercise intolerance, physical inactivity, smoking, hyperventilation, and frequent exacerbations. To assess the likelihood of having poor disease control or decreased quality of life, the odds ratio (OR) was calculated per trait. Referral rates were assessed by checking patients' files.
A total of 444 adults with asthma were studied (57% women, age: 48 ± 16 years, forced expiratory volume in 1 second: 88% ± 17% predicted). Most patients (53%) were found to have uncontrolled asthma (Asthma Control Questionnaire ≥1.5 points) and decreased quality of life (Asthma Quality of Life Questionnaire <6 points). Generally, patients had 3.0 ± 1.8 traits. Severe fatigue was most prevalent (60%) and significantly increased the likelihood of having uncontrolled asthma (OR: 3.0, 95% confidence interval [CI]: 1.9-4.7) and decreased quality of life (OR: 4.6, 95% CI: 2.7-7.9). Referrals to nonmedical health care professionals were low; most referrals were to a respiratory-specialized nurse (33%).
Adult patients with asthma with a first-ever referral to a pulmonologist frequently exhibit traits justifying the deployment of nonpharmacological interventions, especially in those with uncontrolled asthma. However, referrals to appropriate interventions appeared infrequent.
尽管目前有针对哮喘的特定药物治疗，但许多成年哮喘患者的疾病仍未得到控制，生活质量受损。
本研究旨在调查哮喘患者 9 种特征的流行情况，及其与疾病控制和生活质量的关系，并评估向非医疗保健专业人员转诊的比例。
本研究回顾性地收集了荷兰 2 家医院（安菲亚布雷达和拉德堡德大学医学中心）的哮喘患者数据。首次接受门诊、基于医院的选择性诊断途径且在过去 3 个月内无哮喘加重的成年患者被认为符合条件。评估了 9 种特征：呼吸困难、疲劳、抑郁、超重、运动不耐受、身体活动不足、吸烟、过度通气和频繁加重。为了评估疾病控制不佳或生活质量下降的可能性，按特征计算了优势比（OR）。通过检查患者的病历评估转诊率。
共研究了 444 名成年哮喘患者（57%为女性，年龄：48 ± 16 岁，第 1 秒用力呼气量：88% ± 17%预计值）。大多数患者（53%）存在哮喘未控制（哮喘控制问卷≥1.5 分）和生活质量下降（哮喘生活质量问卷<6 分）。通常，患者有 3.0 ± 1.8 种特征。严重疲劳最为常见（60%），显著增加了哮喘未控制的可能性（OR：3.0，95%置信区间[CI]：1.9-4.7）和生活质量下降（OR：4.6，95% CI：2.7-7.9）。向非医疗保健专业人员的转诊率较低；大多数转诊是到呼吸专科护士（33%）。
首次转诊至肺病专家的成年哮喘患者常表现出需要实施非药物干预的特征，尤其是在哮喘未控制的患者中。然而，向适当干预措施的转诊似乎很少。
