Gibson P G, Wlodarczyk J, Hensley M J, Murree-Allen K, Olson L G, Saltos N
Respiratory Medicine Unit, John Hunter Hospital, New South Wales, Australia.
Ann Intern Med. 1995 Oct 1;123(7):488-92. doi: 10.7326/0003-4819-123-7-199510010-00002.
To compare the action points in published asthma management plans with those derived from quality-control analysis of peak expiratory flow recordings.
Longitudinal observational study.
An ambulatory asthma education and management program in a tertiary care hospital.
35 adults with asthma and exacerbation of asthma.
Peak expiratory flow diaries and symptom recordings.
Asthma action points from published asthma management guidelines had poor operating characteristics. The success rate was 35% when the action point was a peak expiratory flow rate less than 60% of the patient's best peak flow. The success rate improved to 88% when the action point was a peak expiratory flow rate less than 80% of the patient's best peak flow. Published action points had a high failure rate. Peak flow decreased to below the published action points during a stable period of asthma in 7% to 51% of patients studied. Action points defined using quality-control analysis did significantly better. A peak flow value less than 3 standard deviations below the patient's mean peak flow detected 84% of exacerbations and had a low failure rate (19%). Other quality-control tests had sensitivities of 91% and 71%. Quality-control action points could detect exacerbations up to 4.5 days earlier than conventional methods.
Individualized action points can be derived for patients with asthma by applying quality-control analysis to peak flow recordings. These action points are more sensitive in detecting exacerbations of asthma and have fewer false-positive results. Action plans developed in this manner should be more useful for the early detection of deteriorating asthma.
比较已发表的哮喘管理计划中的行动点与从呼气峰值流速记录的质量控制分析得出的行动点。
纵向观察性研究。
一家三级护理医院的门诊哮喘教育与管理项目。
35名患有哮喘且哮喘加重的成年人。
呼气峰值流速日记和症状记录。
已发表的哮喘管理指南中的哮喘行动点操作特性不佳。当行动点为呼气峰值流速低于患者最佳峰值流速的60%时，成功率为35%。当行动点为呼气峰值流速低于患者最佳峰值流速的80%时，成功率提高到88%。已发表的行动点失败率较高。在研究的患者中，7%至51%的患者在哮喘稳定期呼气峰值流速降至已发表的行动点以下。使用质量控制分析定义的行动点表现明显更好。呼气峰值流速值低于患者平均峰值流速3个标准差可检测到84%的病情加重，且失败率较低（19%）。其他质量控制测试的敏感性分别为91%和71%。质量控制行动点比传统方法能提前4.5天检测到病情加重。
通过对呼气峰值流速记录应用质量控制分析，可为哮喘患者得出个体化的行动点。这些行动点在检测哮喘病情加重方面更敏感，假阳性结果更少。以这种方式制定的行动计划对早期发现哮喘病情恶化应更有用。
