Eisner M D, Katz P P, Yelin E H, Henke J, Smith S, Blanc P D
Department of Medicine, University of California San Francisco, USA.
Med Care. 1998 Nov;36(11):1567-77. doi: 10.1097/00005650-199811000-00006.
Accurate measurement of asthma severity is critical for research evaluating asthma health outcomes. There are, however, no widely accepted asthma severity measures. A severity-of-asthma score, which is based on self-reported information, was previously developed and validated in subjects recruited from pulmonary and allergy subspecialty practices. The purpose of this study was to validate the severity-of-asthma score in subjects treated by family practice physicians and to compare asthma severity in subjects treated by family practitioners (n = 150) with those seen by allergists (n = 217) and pulmonologists (n = 384).
The study was an ongoing panel study of adults with asthma. Subjects were a random sample of board-certified family practice, allergy, and pulmonary physicians. Each physician registered patients with asthma aged 18 to 50 years. Of 869 subjects registered, 751 (86%) completed structured telephone interviews. The family practice panel was recruited approximately 3 years after the subspecialty panel.
In the family practice subjects, the severity-of-asthma score demonstrated internal consistency (Cronbach's alpha 0.76) and concurrent validity, correlating strongly with asthma-specific quality of life, SF-36 General Health and Physical Functioning scales, and subject-perceived asthma severity. After controlling for demographic characteristics, a 5-point score increment was associated with increased emergency department visits, urgent physician visits, and restricted activity days. The mean severity score was highest in the pulmonary group (11.8 +/- 6.3), followed by the allergy (10.3 +/- 5.3) and family practice (9.3 +/- 5.5) groups.
The severity-of-asthma score was a valid measure in generalist-treated subjects. Asthma severity varied significantly by physician specialty.
准确测量哮喘严重程度对于评估哮喘健康结局的研究至关重要。然而，目前尚无被广泛接受的哮喘严重程度测量方法。此前已开发出一种基于自我报告信息的哮喘严重程度评分，并在从肺病和过敏专科诊所招募的受试者中进行了验证。本研究的目的是在接受家庭医生治疗的受试者中验证哮喘严重程度评分，并比较接受家庭医生治疗的受试者（n = 150）与过敏科医生（n = 217）和肺科医生（n = 384）所诊治受试者的哮喘严重程度。
该研究是一项正在进行的针对成年哮喘患者的小组研究。受试者是经过委员会认证的家庭医生、过敏科医生和肺科医生的随机样本。每位医生登记年龄在18至50岁之间的哮喘患者。在登记的869名受试者中，751名（86%）完成了结构化电话访谈。家庭医生小组是在专科小组招募约3年后组建的。
在家庭医生诊治的受试者中，哮喘严重程度评分显示出内部一致性（Cronbach's α系数为0.76）和同时效度，与哮喘特异性生活质量、SF - 36总体健康和身体功能量表以及受试者自我感知的哮喘严重程度密切相关。在控制了人口统计学特征后，评分增加5分与急诊就诊次数增加、紧急医生就诊次数增加以及活动受限天数增加相关。肺科组的平均严重程度评分最高（11.8±6.3），其次是过敏科（10.3±5.3）和家庭医生组（9.3±5.5）。
哮喘严重程度评分在全科医生诊治的受试者中是一种有效的测量方法。哮喘严重程度因医生专业不同而有显著差异。
