van Schayck C P, van Weel C, Folgering H, van Herwaarden C L
Afd. Huisartsgeneeskunde, Katholieke Universiteit, Nijmegen.
Ned Tijdschr Geneeskd. 1993 Jan 23;137(4):183-7.
This cross-sectional study comprised 223 patients with moderate asthma or chronic bronchitis (FEV1 > 50% of the predicted value) from 29 general practices in the catchment area of Nijmegen University. Fifty-six patients were treated by 19 chest physicians, the remaining 167 by 29 general practitioners, without specialist care. In the study population no relevant differences in sex, age, smoking behaviour or severity of the disease (symptoms, lung function, and bronchial hyperreactivity) could be observed between the two groups of patients, except for allergy. Chest physicians prescribed on average almost three times as much medication as general practitioners. We could identify only a weak relationship between the severity of the disease (symptoms and pulmonary function combined) and the prescribed pharmacotherapy: with rising degrees of severity the general practitioner prescribes more bronchodilators, the specialist more inhaled corticosteroids. No relationship could be observed between bronchial hyperreactivity and the prescribed pharmacotherapy. No response to prescribed bronchodilators was found in 16% of the patients treated by the general practitioner and in 20% of the patients treated by the specialist. On the basis of this cross-sectional study no well-defined treatment policy of patients with moderate asthma or chronic bronchitis either by the general practitioner or by the lung specialist could be found.
这项横断面研究纳入了奈梅亨大学集水区29家普通诊所的223例中度哮喘或慢性支气管炎患者（第一秒用力呼气容积>预测值的50%）。56例患者由19名胸科医生治疗，其余167例由29名全科医生治疗，未接受专科护理。在研究人群中，除过敏外，两组患者在性别、年龄、吸烟行为或疾病严重程度（症状、肺功能和支气管高反应性）方面未观察到相关差异。胸科医生开出的药物平均几乎是全科医生的三倍。我们只能确定疾病严重程度（症状和肺功能综合）与所开药物治疗之间存在微弱关系：随着严重程度的增加，全科医生开出更多支气管扩张剂，专科医生开出更多吸入性糖皮质激素。未观察到支气管高反应性与所开药物治疗之间的关系。在全科医生治疗的患者中有16%、专科医生治疗的患者中有20%对所开支气管扩张剂无反应。基于这项横断面研究，未发现全科医生或肺部专科医生对中度哮喘或慢性支气管炎患者有明确的治疗策略。
