Meys Roy, Franssen Frits M E, Van 't Hul Alex J, Bakke Per S, Caruso Massimo, Dahlén Barbro, Fowler Stephen J, Geiser Thomas, Howarth Peter H, Horváth Ildikó, Krug Norbert, Behndig Annelie F, Singer Florian, Musial Jacek, Shaw Dominick E, Montuschi Paolo, Zee Anke H Maitland-van der, Sterk Peter J, Roberts Graham, Kermani Nazanin Z, Incalzi Raffaele A, Louis Renaud, Andersson Lars I, Wagers Scott S, Dahlén Sven-Erik, Chung Kian Fan, Adcock Ian M, Spruit Martijn A
Department of Research and Development, Hornerheide 1, 6085 NM, Ciro, Horn, The Netherlands.
NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Health Qual Life Outcomes. 2024 Dec 20;22(1):109. doi: 10.1186/s12955-024-02321-3.
Knowledge about the clinical importance of patient-reported outcome measures (PROMs) in severe asthma is limited.
To assess whether and to what extent asthma exacerbations affect changes in PROMS over time and asthma-specific PROMs can predict exacerbations in adult patients with severe asthma in usual care.
Data of 421 patients with severe asthma (62% female; mean age 51.9 ± 13.4 years; mean FEV 67.5 ± 21.3%pred) from the U-BIOPRED cohort were analyzed. The included PROMs were: Asthma Control Questionnaire (ACQ5); Asthma Quality of Life Questionnaire (AQLQ); Hospital Anxiety and Depression scale (HADS); Epworth Sleepiness Scale (ESS); Medication Adherence Report Scale (MARS); Sino-Nasal Outcomes Test (SNOT20). Participants were assessed at baseline and after 12-18 months of usual care.
PROMs showed very weak to weak correlations with clinical characteristics such as age, body mass index, FEV, FeNO and eosinophilic cell count. Patients presenting no exacerbations during follow-up showed a statistically significant improvement in all PROMs (except for MARS), whereas individuals experiencing > 2 exacerbations showed a deterioration. Baseline ACQ5 was a predictor of exacerbations with an AUC of 0.590 (95%CI 0.514-0.666).
The association of PROMs with clinical measures was poor in severe asthmatics. Moreover, PROMs were prone to changes in usual care, with exacerbations playing a key role. PROMs need to be systematically evaluated in severe asthma to improve clinical care based on specific patient's needs.
关于患者报告结局指标（PROMs）在重度哮喘中的临床重要性的知识有限。
评估哮喘急性加重是否以及在多大程度上随时间影响PROMs的变化，以及哮喘特异性PROMs能否预测常规治疗中成年重度哮喘患者的急性加重。
分析了U-BIOPRED队列中421例重度哮喘患者的数据（62%为女性；平均年龄51.9±13.4岁；平均FEV为预测值的67.5±21.3%）。纳入的PROMs包括：哮喘控制问卷（ACQ5）；哮喘生活质量问卷（AQLQ）；医院焦虑抑郁量表（HADS）；爱泼沃斯嗜睡量表（ESS）；药物依从性报告量表（MARS）；鼻窦结局测试（SNOT20）。在基线时和常规治疗12 - 18个月后对参与者进行评估。
PROMs与年龄、体重指数、FEV、呼出气一氧化氮（FeNO）和嗜酸性粒细胞计数等临床特征的相关性非常弱至弱。随访期间未出现急性加重的患者在所有PROMs（MARS除外）上均有统计学意义的改善，而经历>2次急性加重的个体则出现恶化。基线ACQ5是急性加重的预测指标，曲线下面积（AUC）为0.590（95%可信区间0.514 - 0.666）。
在重度哮喘患者中，PROMs与临床指标的关联性较差。此外，PROMs在常规治疗中容易发生变化，急性加重起关键作用。在重度哮喘中需要对PROMs进行系统评估，以根据特定患者的需求改善临床护理。
