利用自然语言处理提取哮喘症状并探讨其与成人轻度哮喘急性加重的关联
2025/12/23
背景：轻度哮喘患者约占需急诊处理的哮喘急性发作病例的30%—40%，且近30%的患者在过去4周内哮喘症状控制不佳或较差。
目的：评估轻度哮喘患者各类哮喘症状的患病率，并探讨这些症状与未来哮喘急性加重之间的关联。
方法：本研究为一项回顾性队列研究。基于管理数据，作者筛选出2013年至2018年间符合轻度哮喘诊断标准的198,873名18至85岁成年患者。利用自然语言处理技术，从临床记录和医患沟通文本中提取患者在索引访视前12个月内咳嗽、喘息、呼吸困难和胸闷四种症状的出现情况。采用具有稳健标准误的泊松回归模型，在控制潜在混杂因素后，分析上述症状与索引访视后12个月内发生哮喘急性加重之间的关联。
结果：咳嗽、喘息、呼吸困难和胸闷的患病率分别为67.0%、47.7%、41.3%和13.2%。共有6.5%的患者在索引访视后12个月内发生哮喘急性加重。在未校正分析中，所有四种症状均与急性加重风险增加相关；校正其他患者特征后，仅喘息（校正后相对风险1.13，99%置信区间：1.07-1.20）和呼吸困难（校正后相对风险1.17，99%置信区间：1.12-1.23）与未来急性加重风险显著相关，且风险随症状记录频率的增加而上升。
结论：存在呼吸困难和喘息症状（尤其是反复出现）的轻度哮喘患者，未来发生哮喘急性加重的风险更高，可能从针对性治疗干预和（或）触发因素规避教育中获益。
关键词：哮喘急性加重；哮喘负担；哮喘症状；胸闷；咳嗽；呼吸困难；电子健康记录；医疗资源使用；低资源使用者；轻度哮喘；喘息
Background:Individuals with mild asthma account for 30% to 40% of asthma exacerbations requiring emergency consultation, and nearly 30% had not-well controlled or poorly controlled asthma symptoms over the previous 4 weeks.
Objective:We sought to estimate the prevalence of various asthma symptoms and assess their association with future acute asthma exacerbations (AAEs) in patients with mild asthma.
Methods:This was a retrospective cohort study. Using administrative data, we identified 198,873 adults aged 18 to 85 years, who met criteria for mild asthma between 2013 and 2018. The presence of cough, wheezing, dyspnea, and chest tightness in the 12 months before the index visit (t0) was extracted from clinical notes and patient/provider communications through natural language processing. We used Poisson regression models with robust SEs to assess the associations between symptoms and AAEs in the 12 months after t0, controlling for potential confounders.
Results:The prevalence of cough, wheezing, dyspnea, and chest tightness was 67.0%, 47.7%, 41.3%, and 13.2%, respectively. Moreover, 6.5% of patients experienced an AAE in the 12 months after t0. All four symptoms were associated with increased AAE risk in the unadjusted analysis. After adjusting for other patient characteristics, only wheezing (adjusted relative risk, 1.13; 99% CI, 1.07-1.20) and dyspnea (1.17; 1.12-1.23) were associated with an increased risk of future AAEs. The risk increased with the frequency of the documented symptoms.
Conclusion:Patients with mild asthma who exhibit symptoms of dyspnea and wheezing (especially on multiple occasions) are at an increased risk for future AAEs and may benefit from therapeutic intervention and/or trigger-avoidance education.
Keywords: Acute asthma exacerbation; Asthma burden; Asthma symptoms; Chest tightness; Cough; Dyspnea; Electronic health records; Health care resource use; Low utilizer; Mild asthma; Wheezing.
目的：评估轻度哮喘患者各类哮喘症状的患病率，并探讨这些症状与未来哮喘急性加重之间的关联。
方法：本研究为一项回顾性队列研究。基于管理数据，作者筛选出2013年至2018年间符合轻度哮喘诊断标准的198,873名18至85岁成年患者。利用自然语言处理技术，从临床记录和医患沟通文本中提取患者在索引访视前12个月内咳嗽、喘息、呼吸困难和胸闷四种症状的出现情况。采用具有稳健标准误的泊松回归模型，在控制潜在混杂因素后，分析上述症状与索引访视后12个月内发生哮喘急性加重之间的关联。
结果：咳嗽、喘息、呼吸困难和胸闷的患病率分别为67.0%、47.7%、41.3%和13.2%。共有6.5%的患者在索引访视后12个月内发生哮喘急性加重。在未校正分析中，所有四种症状均与急性加重风险增加相关；校正其他患者特征后，仅喘息（校正后相对风险1.13，99%置信区间：1.07-1.20）和呼吸困难（校正后相对风险1.17，99%置信区间：1.12-1.23）与未来急性加重风险显著相关，且风险随症状记录频率的增加而上升。
结论：存在呼吸困难和喘息症状（尤其是反复出现）的轻度哮喘患者，未来发生哮喘急性加重的风险更高，可能从针对性治疗干预和（或）触发因素规避教育中获益。
关键词：哮喘急性加重；哮喘负担；哮喘症状；胸闷；咳嗽；呼吸困难；电子健康记录；医疗资源使用；低资源使用者；轻度哮喘；喘息
（南方医科大学南方医院 胡玉玲 龚钊乾 赵海金）
（Chen W, Puttock EJ, Xie F, Crawford W, Schatz M, Vollmer WM, Xu S, Zeiger RS. Symptoms of Asthma Extracted Through Natural Language Processing and Their Associations With Acute Asthma Exacerbation in Adults With Mild Asthma. J Allergy Clin Immunol Pract. 2025 Jul;13(7):1719-1729.e7. doi: 10.1016/j.jaip.2025.04.031.）
AbstractBackground:Individuals with mild asthma account for 30% to 40% of asthma exacerbations requiring emergency consultation, and nearly 30% had not-well controlled or poorly controlled asthma symptoms over the previous 4 weeks.
Objective:We sought to estimate the prevalence of various asthma symptoms and assess their association with future acute asthma exacerbations (AAEs) in patients with mild asthma.
Methods:This was a retrospective cohort study. Using administrative data, we identified 198,873 adults aged 18 to 85 years, who met criteria for mild asthma between 2013 and 2018. The presence of cough, wheezing, dyspnea, and chest tightness in the 12 months before the index visit (t0) was extracted from clinical notes and patient/provider communications through natural language processing. We used Poisson regression models with robust SEs to assess the associations between symptoms and AAEs in the 12 months after t0, controlling for potential confounders.
Results:The prevalence of cough, wheezing, dyspnea, and chest tightness was 67.0%, 47.7%, 41.3%, and 13.2%, respectively. Moreover, 6.5% of patients experienced an AAE in the 12 months after t0. All four symptoms were associated with increased AAE risk in the unadjusted analysis. After adjusting for other patient characteristics, only wheezing (adjusted relative risk, 1.13; 99% CI, 1.07-1.20) and dyspnea (1.17; 1.12-1.23) were associated with an increased risk of future AAEs. The risk increased with the frequency of the documented symptoms.
Conclusion:Patients with mild asthma who exhibit symptoms of dyspnea and wheezing (especially on multiple occasions) are at an increased risk for future AAEs and may benefit from therapeutic intervention and/or trigger-avoidance education.
Keywords: Acute asthma exacerbation; Asthma burden; Asthma symptoms; Chest tightness; Cough; Dyspnea; Electronic health records; Health care resource use; Low utilizer; Mild asthma; Wheezing.
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生物与非生物制剂治疗哮喘患者中哮喘控制测试与生活质量评分间的差异
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基于ATLANTIS队列的聚类分析识别不同哮喘表型
