Iwasaki Y, Kubota Y, Yokomura I, Ueda M, Hashimoto S, Mizobuchi K, Arimoto T, Hara H, Nakagawa M
Second Department of Medicine, Kyoto Prefectural University of Medicine, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1997 Oct;35(10):1040-6.
The monitoring of peak expiratory flow (PEF) and maintenance of a symptom diary have been proposed as means to monitor asthma severity. This study assessed via longitudinal analysis, the usefulness and limitation of daily PEF monitoring (amplitude percent mean) as an index for asthma severity, and the usefulness of recording daily intake of beta-agonists as a measure of symptom severity. Nine subjects with moderate to severe asthma were treated with inhaled beclomethasone dipropionate (BDP). Sustained-release theophylline and oral corticosteroids supplemented inhaled BDP according to both individual symptom prevalence and PEF measurements. The patients kept records four times daily of their PEF and asthmatic symptoms (cough, sputum and number of attacks), from the beginning to the end of treatment. They also recorded the daily frequency of beta-agonist inhalation (as needed for symptomatic relief). Minimum daily PEF (expressed as percent best) correlated significantly with symptom scores: cough (r = -0.69), sputum (r = -0.69) and attack (r = -0.69). Minimum PEF correlated strongly with the daily frequency of beta agonist inhalation (r = 0.76). Each symptom score and the daily frequency of beta-agonist inhalation was zero when the minimum PEF was approximately 80%. We evaluated the correlation between minimum PEF and daily PEF variability in all data (r = -0.72): for a minimum PEF > or = 20% (r = -0.72), a minimum PEF > or = 30% (r = -0.77), a minimum PEF > or = 40% (r = -0.82) and a minimum PEF > or = 50% (r = -0.80). We determined the correlation between minimum PEFs of > or = 35 to 45% in 1% increments and daily PEF variability in relation to the severity of asthma. With a minimum PEF > or = 40%, the strongest correlation was demonstrated between minimum PEF and daily PEF variability. Daily PEF variability was a reliable indicator for the management of asthma when the PEF > or = 40%. When the minimum PEF was 80%, daily PEF variability was approximately 10%. When the minimum PEF was 40%, daily PEF variability was 46%, and the daily frequency of beta-agonist inhalation was 2.6. We concluded that, 1) The target values of minimum PEF and daily PEF variability are 80% and 10% respectively in the treatment of asthmatic patients, 2) The daily frequency of beta-agonist inhalation is recommended as an indicator for the severity of asthmatic symptoms, and 3) Daily PEF variability in combination with the daily frequency of beta-agonist inhalation is very useful in the management and early detection of acute asthma.
监测呼气峰值流速（PEF）并记录症状日记被认为是监测哮喘严重程度的方法。本研究通过纵向分析评估了每日PEF监测（平均幅度百分比）作为哮喘严重程度指标的有用性和局限性，以及记录每日β受体激动剂摄入量作为症状严重程度衡量指标的有用性。9名中度至重度哮喘患者接受吸入丙酸倍氯米松（BDP）治疗。根据个体症状发生率和PEF测量结果，缓释茶碱和口服皮质类固醇补充吸入BDP治疗。患者在治疗开始至结束期间每天记录4次PEF和哮喘症状（咳嗽、咳痰和发作次数）。他们还记录了每日β受体激动剂吸入的频率（根据症状缓解需要）。每日最低PEF（以最佳值的百分比表示）与症状评分显著相关：咳嗽（r = -0.69）、咳痰（r = -0.69）和发作（r = -0.69）。最低PEF与每日β受体激动剂吸入频率密切相关（r = 0.76）。当最低PEF约为80%时，每个症状评分和每日β受体激动剂吸入频率均为零。我们评估了所有数据中最低PEF与每日PEF变异性之间的相关性（r = -0.72）：最低PEF≥20%（r = -0.72）、最低PEF≥30%（r = -0.77）、最低PEF≥40%（r = -0.82）和最低PEF≥50%（r = -0.80）。我们确定了最低PEF≥35%至45%（以1%递增）与每日PEF变异性之间与哮喘严重程度相关的相关性。当最低PEF≥40%时，最低PEF与每日PEF变异性之间显示出最强的相关性。当PEF≥40%时，每日PEF变异性是哮喘管理的可靠指标。当最低PEF为80%时，每日PEF变异性约为10%。当最低PEF为40%时，每日PEF变异性为46%，每日β受体激动剂吸入频率为2.6。我们得出结论：1）哮喘患者治疗中最低PEF和每日PEF变异性的目标值分别为80%和10%；2）建议将每日β受体激动剂吸入频率作为哮喘症状严重程度的指标；3）每日PEF变异性与每日β受体激动剂吸入频率相结合在急性哮喘的管理和早期检测中非常有用。
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