Chen Wansu, Puttock Eric J, Xie Fagen, Crawford William, Schatz Michael, Vollmer William M, Xu Stanley, Zeiger Robert S
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif.
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif.
J Allergy Clin Immunol Pract. 2025 Jul;13(7):1719-1729.e7. doi: 10.1016/j.jaip.2025.04.031. Epub 2025 Apr 26.
Individuals with mild asthma account for 30% to 40% of asthma exacerbations requiring emergency consultation, and nearly 30% had not-well controlled or poorly controlled asthma symptoms over the previous 4 weeks.
We sought to estimate the prevalence of various asthma symptoms and assess their association with future acute asthma exacerbations (AAEs) in patients with mild asthma.
This was a retrospective cohort study. Using administrative data, we identified 198,873 adults aged 18 to 85 years, who met criteria for mild asthma between 2013 and 2018. The presence of cough, wheezing, dyspnea, and chest tightness in the 12 months before the index visit (t) was extracted from clinical notes and patient/provider communications through natural language processing. We used Poisson regression models with robust SEs to assess the associations between symptoms and AAEs in the 12 months after t, controlling for potential confounders.
The prevalence of cough, wheezing, dyspnea, and chest tightness was 67.0%, 47.7%, 41.3%, and 13.2%, respectively. Moreover, 6.5% of patients experienced an AAE in the 12 months after t. All four symptoms were associated with increased AAE risk in the unadjusted analysis. After adjusting for other patient characteristics, only wheezing (adjusted relative risk, 1.13; 99% CI, 1.07-1.20) and dyspnea (1.17; 1.12-1.23) were associated with an increased risk of future AAEs. The risk increased with the frequency of the documented symptoms.
Patients with mild asthma who exhibit symptoms of dyspnea and wheezing (especially on multiple occasions) are at an increased risk for future AAEs and may benefit from therapeutic intervention and/or trigger-avoidance education.
轻度哮喘患者占需要紧急会诊的哮喘急性加重病例的30%至40%，近30%的患者在过去4周内哮喘症状控制不佳或很差。
我们试图估计轻度哮喘患者各种哮喘症状的患病率，并评估其与未来急性哮喘加重（AAE）的关联。
这是一项回顾性队列研究。利用管理数据，我们确定了198873名年龄在18至85岁之间、在2013年至2018年期间符合轻度哮喘标准的成年人。通过自然语言处理从临床记录以及患者/提供者沟通中提取索引就诊（t）前12个月内咳嗽、喘息、呼吸困难和胸闷的情况。我们使用带有稳健标准误的泊松回归模型来评估症状与t后12个月内AAE之间的关联，并对潜在混杂因素进行控制。
咳嗽、喘息、呼吸困难和胸闷的患病率分别为67.0%、47.7%、41.3%和13.2%。此外，6.5%的患者在t后12个月内经历了一次AAE。在未调整分析中，所有四种症状都与AAE风险增加相关。在对其他患者特征进行调整后，只有喘息（调整后相对风险，1.13；99%CI，1.07 - 1.20）和呼吸困难（1.17；1.12 - 1.23）与未来AAE风险增加相关。风险随着记录症状的频率增加而增加。
出现呼吸困难和喘息症状（尤其是多次出现）的轻度哮喘患者未来发生AAE的风险增加，可能会从治疗干预和/或避免触发因素教育中获益。
