开发和验证新的哮喘问卷，以帮助学龄儿童和青少年达到高水平的控制
2023/12/20
摘要
背景：保持良好的哮喘控制可最小化急性恶化和肺功能下降的风险，是哮喘管理的主要目标。日本儿科哮喘指南（JPGL）采用了与其他指南不同的控制状态分类标准，强调更高水平的控制。我们先前开发了一个由护理者完成的用于评估和实现学龄前儿童最佳哮喘控制的问卷。在这项研究中，我们旨在开发一个适用于学龄儿童和青少年的问卷。
方法：一个包含14个患者项目和34个护理者项目的工作问卷被分发给362名年龄在6-15岁的哮喘患者及其护理者。另外，医生也填写了一份调查问卷，以确定 JPGL定义的控制水平。利用从三分之二的受试者中随机选择的完成问卷的数据进行 logistic 回归分析，构建一个预测控制水平的模型。使用其余的问卷进行验证。
结果：选择了一个包含患者的自我评估控制状态、过去一个月的情况，以及患者的夜间/清晨哮喘症状和护理者的哮喘症状频率、呼吸困难、急救性β-激动剂使用和哮喘住院次数的7个问题的组合。7 个项目的模型显示出良好的统计拟合效果，AIC 为 110.5。该模型被命名为学龄儿童和青少年最佳哮喘控制测试（Best ACT-S）。Best ACT-S 分数在不同JPGL定义的控制水平、治疗决策的升降级和前一年是否有急性恶化的不同组别之间呈现出显著差异。
结论：Best ACT-S是一份有效的调查问卷，适用于以最佳哮喘控制为目标的儿童/青少年。
Development and validation of a new asthma questionnaire to help achieve a high level of control in school-age children and adolescents
Matsunaga M, Sato Y, Nagao M, Ikeda M, Motomura C, Kameda M, Yoshida Y, Terada A, Miyairi I, Fujisawa T
Abstract
Background:Maintaining good asthma control minimizes the risk of exacerbations and lung function decline and is a primary goal of asthma management. The Japanese Pediatric Asthma Guidelines (JPGL) employs different classification criteria for control status from other guidelines, stressing a higher level of control. Based on JPGL, we previously developed a caregiver-completed questionnaire for assessing and achieving best asthma control in preschoolers. In this study, we aimed to develop a questionnaire for school-age children and adolescents.
Methods:A working questionnaire comprising 14 items for patients and 34 items for caregivers was administered to 362 asthma patients aged 6-15 years and their caregivers. Separately, physicians filled out a questionnaire to determine JPGL-defined control. Logistic regression analysis was performed to construct a model to predict control levels using data from a randomly selected set of completed questionnaires from two-thirds of the subjects. Validation was performed using the remaining questionnaires.
Results:A set of 7 questions, encompassing self-assessed control status at the time of the visit and in the past month, and nocturnal/early morning asthma symptoms for patients and frequency of asthma symptoms, dyspnea, rescue beta-agonist use, and asthma hospitalization for caregivers, were selected and the 7-item model showed a good statistical fit with AIC of 110.5. The model has been named the Best Asthma Control Test for School Children and Adolescents (Best ACT-S). Best ACT-S scores differed significantly in the hypothetical direction among the groups of different JPGL-defined control levels, step-up/down treatment decisions, and presence/non-presence of exacerbations in the previous year.
Conclusion:The Best ACT-S is a valid questionnaire for children/adolescents aiming for best asthma control.
背景：保持良好的哮喘控制可最小化急性恶化和肺功能下降的风险，是哮喘管理的主要目标。日本儿科哮喘指南（JPGL）采用了与其他指南不同的控制状态分类标准，强调更高水平的控制。我们先前开发了一个由护理者完成的用于评估和实现学龄前儿童最佳哮喘控制的问卷。在这项研究中，我们旨在开发一个适用于学龄儿童和青少年的问卷。
方法：一个包含14个患者项目和34个护理者项目的工作问卷被分发给362名年龄在6-15岁的哮喘患者及其护理者。另外，医生也填写了一份调查问卷，以确定 JPGL定义的控制水平。利用从三分之二的受试者中随机选择的完成问卷的数据进行 logistic 回归分析，构建一个预测控制水平的模型。使用其余的问卷进行验证。
结果：选择了一个包含患者的自我评估控制状态、过去一个月的情况，以及患者的夜间/清晨哮喘症状和护理者的哮喘症状频率、呼吸困难、急救性β-激动剂使用和哮喘住院次数的7个问题的组合。7 个项目的模型显示出良好的统计拟合效果，AIC 为 110.5。该模型被命名为学龄儿童和青少年最佳哮喘控制测试（Best ACT-S）。Best ACT-S 分数在不同JPGL定义的控制水平、治疗决策的升降级和前一年是否有急性恶化的不同组别之间呈现出显著差异。
结论：Best ACT-S是一份有效的调查问卷，适用于以最佳哮喘控制为目标的儿童/青少年。
(中日友好医院呼吸与危重症医学科 沈焜路 摘译 林江涛 审校)
(Allergol Int. 2023 Dec 7. DOI: 10.1016/j.alit.2023.11.001)
(Allergol Int. 2023 Dec 7. DOI: 10.1016/j.alit.2023.11.001)
Development and validation of a new asthma questionnaire to help achieve a high level of control in school-age children and adolescents
Matsunaga M, Sato Y, Nagao M, Ikeda M, Motomura C, Kameda M, Yoshida Y, Terada A, Miyairi I, Fujisawa T
Abstract
Background:Maintaining good asthma control minimizes the risk of exacerbations and lung function decline and is a primary goal of asthma management. The Japanese Pediatric Asthma Guidelines (JPGL) employs different classification criteria for control status from other guidelines, stressing a higher level of control. Based on JPGL, we previously developed a caregiver-completed questionnaire for assessing and achieving best asthma control in preschoolers. In this study, we aimed to develop a questionnaire for school-age children and adolescents.
Methods:A working questionnaire comprising 14 items for patients and 34 items for caregivers was administered to 362 asthma patients aged 6-15 years and their caregivers. Separately, physicians filled out a questionnaire to determine JPGL-defined control. Logistic regression analysis was performed to construct a model to predict control levels using data from a randomly selected set of completed questionnaires from two-thirds of the subjects. Validation was performed using the remaining questionnaires.
Results:A set of 7 questions, encompassing self-assessed control status at the time of the visit and in the past month, and nocturnal/early morning asthma symptoms for patients and frequency of asthma symptoms, dyspnea, rescue beta-agonist use, and asthma hospitalization for caregivers, were selected and the 7-item model showed a good statistical fit with AIC of 110.5. The model has been named the Best Asthma Control Test for School Children and Adolescents (Best ACT-S). Best ACT-S scores differed significantly in the hypothetical direction among the groups of different JPGL-defined control levels, step-up/down treatment decisions, and presence/non-presence of exacerbations in the previous year.
Conclusion:The Best ACT-S is a valid questionnaire for children/adolescents aiming for best asthma control.
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