van Schayck C P, Dompeling E, Putters R, Molema J, van Weel C
Department of General Practice, University of Nijmegen, The Netherlands.
Can Fam Physician. 1995 Nov;41:1868-76.
To investigate whether the progression rate of asthma or chronic bronchitis can be predicted from a cross-sectional assessment of features that can be measured by family physicians.
Secondary analysis of data from a 2-year randomized, controlled bronchodilator intervention study in family practice.
Twenty-nine general practices in the eastern part of The Netherlands.
One hundred sixty patients (101 with chronic bronchitis, 59 with asthma) from the 29 general practices.
Predictors were related to the annual decline in lung function (the forced expiratory volume in one second) by means of multiple analysis of variance, controlling for age, sex, smoking habits, initial FEV1 level, bronchial hyperresponsiveness, reversibility of obstruction, and medication during the study.
Predictors of the annual decline in lung function (FEV1), which is believed to be the most important measure for progression.
Only three variables predicted the decline in lung function: having a barrel-shaped chest, experiencing wheezing, and an unusual diurnal peak-flow rate index. Wheezing was the best predictor of the annual decline in lung function. In chronic bronchitis, the decline in FEV1 of wheezing patients was 133 mL/y compared with 62 mL/y for non-wheezing patients (P < 0.05). In asthma with more severe symptoms, wheezing patients had a tendency to decline 156 mL/y compared with 57 mL/y among non-wheezing patients (P = 0.08).
It is nearly impossible to predict the progression rate of asthma or chronic bronchitis from symptoms, physical signs of the chest, and the PEFR. Therefore, patients with a rapid progression rate can probably be detected only by monitoring progression of the disease through repeated lung function testing.
通过对家庭医生可测量的特征进行横断面评估，研究是否能够预测哮喘或慢性支气管炎的进展速度。
对一项在家庭医疗中进行的为期2年的随机对照支气管扩张剂干预研究的数据进行二次分析。
荷兰东部的29家普通诊所。
来自这29家普通诊所的160名患者（101例慢性支气管炎患者，59例哮喘患者）。
通过多因素方差分析，控制年龄、性别、吸烟习惯、初始一秒用力呼气容积（FEV1）水平、支气管高反应性、阻塞可逆性以及研究期间的用药情况，分析预测因素与肺功能年下降率（一秒用力呼气容积）的关系。
肺功能（FEV1）年下降率的预测因素，FEV1年下降率被认为是疾病进展的最重要指标。
只有三个变量可预测肺功能下降：桶状胸、喘息以及异常的日峰流速指数。喘息是肺功能年下降率的最佳预测因素。在慢性支气管炎患者中，喘息患者的FEV1年下降量为133 mL/年，而非喘息患者为62 mL/年（P<0.05）。在症状较重的哮喘患者中，喘息患者的FEV1年下降量倾向于为156 mL/年，而非喘息患者为57 mL/年（P = 0.08）。
几乎不可能根据症状、胸部体征和呼气峰流速（PEFR）预测哮喘或慢性支气管炎的进展速度。因此，可能只有通过重复肺功能检测监测疾病进展，才能发现进展速度较快的患者。
