Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
J Allergy Clin Immunol Pract. 2023 Nov;11(11):3425-3434.e4. doi: 10.1016/j.jaip.2023.07.007. Epub 2023 Jul 14.
The recall periods and response scales of existing surveys of asthma control are poorly suited for studying acute exacerbations.
To develop an instrument able to predict exacerbations after the onset of acute symptoms and with a recall window sufficiently short to study recovery.
We developed the six-item Acute Asthma Exacerbation Survey (AAES). Data were collected at baseline, acute, and recovery visits within an established longitudinal protocol for participants with severe asthma. Participants scheduled acute study visits at the first sign of a cold. Nasal lavage samples and lung function measurements were also collected. The AAES data were analyzed using Cronbach α, Spearman correlations, and Kruskal-Wallace methods. We used logistic regression for predictors of bursts of oral corticosteroids (OCS).
Of 130 participants studied at baseline, 52 returned for an acute visit. The AAES scores were elevated at the acute visit and returned to baseline after recovery independently of respiratory virus detection. Cronbach α for the AAES was 0.853, 0.822, and 0.889 at the three respective visits. Compared with participants not needing burst OCS, those with exacerbations had higher acute AAES scores (16 [13.5-18] vs 11.5 [8.2-14], median [interquartile range]; P = .017) and a larger reduction from baseline in lung function. For each 3-point increase in AAES scores, the odds ratio for burst OCS use was 1.64 (95% CI, 1.04-2.57; P = .030).
The AAES is internally consistent and dynamically responsive during acute asthma exacerbations. Additional validation studies are warranted to support future trials and aid in clinical decision-making.
现有的哮喘控制调查的回顾期和反应量表不适用于研究急性加重。
开发一种能够预测急性症状发作后恶化的工具，并且回顾期足够短以研究恢复情况。
我们开发了六分量的急性哮喘加重调查（AAES）。在一项针对严重哮喘患者的既定纵向方案中，参与者在基线、急性和恢复就诊时收集数据。参与者在出现感冒症状的第一时间安排急性就诊。还收集了鼻洗液样本和肺功能测量值。使用 Cronbach α、Spearman 相关性和 Kruskal-Wallis 方法分析 AAES 数据。我们使用逻辑回归分析预测口服皮质类固醇（OCS）爆发的因素。
在基线研究的 130 名参与者中，有 52 名返回进行急性就诊。AAES 评分在急性就诊时升高，并在恢复后独立于呼吸道病毒检测恢复到基线。AAES 在三个相应就诊时的 Cronbach α 值分别为 0.853、0.822 和 0.889。与不需要爆发 OCS 的参与者相比，那些发生加重的患者的急性 AAES 评分更高（16 [13.5-18] vs 11.5 [8.2-14]，中位数 [四分位距]；P =.017），肺功能从基线的下降幅度更大。AAES 评分每增加 3 分，OCS 爆发使用的比值比为 1.64（95% CI，1.04-2.57；P =.030）。
AAES 在急性哮喘加重期间具有内部一致性和动态反应性。需要进一步的验证研究来支持未来的试验，并帮助临床决策。
