在哮喘流行情况及自然史研究中，哮喘控制始终不佳（符合专家小组报告3指南中疾病受损领域）的患者，未来哮
2009/12/15
背景：鉴别那些存在哮喘恶化风险的患者能够帮助医生采取正确的治疗手段来改善哮喘相关预后。
目的：本试验评估2007年哮喘指南诊断所定义的疾病受损水平是否能预测未来哮喘恶化的风险。
方法：本研究从哮喘流行情况及自然史研究中选取82例6～11岁儿童人和725例12岁以上的青年/成人。哮喘结局及治疗方案研究的研究数据包括了基线状态、治疗12个月及24个月后的哮喘指南中所有受损领域的全部项目。研究将入选患者分为2个队列研究：（1）从基线状态至2年随访内哮喘持续控制较差（VPC）的患者；（2）基线状态开始哮喘控制有所改善并在2年随访期内保持较好的哮喘控制状态（包括哮喘控制一般和控制较好的患者）。基于年龄分组，采用多元logistic 回归计算第30个月时哮喘恶化风险的优势比（OR）和95％CI。
结果：经校正后，与哮喘控制改善组相比，2年内哮喘持续控制较差的儿童住院、急诊就诊或糖皮质激素用量突增的风险增加6倍（OR：6.4; 95% CI：1.2-34.5）。青年/成人哮喘持续控制较差患者更可能出现糖皮质激素用量突增（OR, 2.8; 95% CI, 1.7-4.8）或更易出现住院、急诊就诊或糖皮质激素使用突增（OR, 3.2; 95% CI, 1.9-5.3）。
结论：基于2007年哮喘指南疾病受损领域的哮喘持续控制较差是哮喘恶化较强的预测因子。
（苏楠 审校）
J Allergy Clin Immunol. 2009 Oct 5.
Consistently very poorly controlled asthma, as defined by the impairment domain of the Expert Panel Report 3 guidelines, increases risk for future severe asthma exacerbations in The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study.
Haselkorn T, Fish JE, Zeiger RS, Szefler SJ, Miller DP, Chipps BE, Simons FE, Weiss ST, Wenzel SE, Borish L, Bleecker ER; for the TENOR Study Group.
BACKGROUND: Identification of patients at risk for asthma exacerbations can assist physicians in addressing disease management and improve asthma-related health outcomes.
OBJECTIVE: We sought to evaluate whether level of impairment, as defined by the 2007 asthma guidelines, predicts risk for future asthma exacerbations.
METHODS: The study included children aged 6 to 11 years (n = 82) and adolescent/adult patients aged 12 years and older (n = 725) from The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens study with data representing all components of the impairment domain of the asthma guidelines at baseline, month 12, and month 24. Patients were categorized into 2 cohorts: (1) consistently very poorly controlled (VPC) asthma from baseline through 2 years of follow-up and (2) improved from VPC asthma at baseline (including patients who improved to not well-controlled or well-controlled asthma), with improvement maintained through 2 years of follow-up. Odds ratios (ORs) and 95% CIs for risk of asthma exacerbations at month 30 were generated by using multivariable logistic regression by age group.
RESULTS: After adjustment, children with consistently VPC asthma over the 2-year period demonstrated a 6-fold increased risk of hospitalization, emergency department visit, or corticosteroid burst (OR, 6.4; 95% CI, 1.2-34.5) compared with the improved group. Adolescent/adult patients with consistently VPC asthma were more likely to have a corticosteroid burst (OR, 2.8; 95% CI, 1.7-4.8) or have a hospitalization, emergency department visit, or corticosteroid burst (OR, 3.2; 95% CI, 1.9-5.3).
CONCLUSIONS: Consistently VPC asthma, as defined by the impair
J Allergy Clin Immunol. 2009 Oct 5.
目的：本试验评估2007年哮喘指南诊断所定义的疾病受损水平是否能预测未来哮喘恶化的风险。
方法：本研究从哮喘流行情况及自然史研究中选取82例6～11岁儿童人和725例12岁以上的青年/成人。哮喘结局及治疗方案研究的研究数据包括了基线状态、治疗12个月及24个月后的哮喘指南中所有受损领域的全部项目。研究将入选患者分为2个队列研究：（1）从基线状态至2年随访内哮喘持续控制较差（VPC）的患者；（2）基线状态开始哮喘控制有所改善并在2年随访期内保持较好的哮喘控制状态（包括哮喘控制一般和控制较好的患者）。基于年龄分组，采用多元logistic 回归计算第30个月时哮喘恶化风险的优势比（OR）和95％CI。
结果：经校正后，与哮喘控制改善组相比，2年内哮喘持续控制较差的儿童住院、急诊就诊或糖皮质激素用量突增的风险增加6倍（OR：6.4; 95% CI：1.2-34.5）。青年/成人哮喘持续控制较差患者更可能出现糖皮质激素用量突增（OR, 2.8; 95% CI, 1.7-4.8）或更易出现住院、急诊就诊或糖皮质激素使用突增（OR, 3.2; 95% CI, 1.9-5.3）。
结论：基于2007年哮喘指南疾病受损领域的哮喘持续控制较差是哮喘恶化较强的预测因子。
（苏楠 审校）
J Allergy Clin Immunol. 2009 Oct 5.
Consistently very poorly controlled asthma, as defined by the impairment domain of the Expert Panel Report 3 guidelines, increases risk for future severe asthma exacerbations in The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study.
Haselkorn T, Fish JE, Zeiger RS, Szefler SJ, Miller DP, Chipps BE, Simons FE, Weiss ST, Wenzel SE, Borish L, Bleecker ER; for the TENOR Study Group.
BACKGROUND: Identification of patients at risk for asthma exacerbations can assist physicians in addressing disease management and improve asthma-related health outcomes.
OBJECTIVE: We sought to evaluate whether level of impairment, as defined by the 2007 asthma guidelines, predicts risk for future asthma exacerbations.
METHODS: The study included children aged 6 to 11 years (n = 82) and adolescent/adult patients aged 12 years and older (n = 725) from The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens study with data representing all components of the impairment domain of the asthma guidelines at baseline, month 12, and month 24. Patients were categorized into 2 cohorts: (1) consistently very poorly controlled (VPC) asthma from baseline through 2 years of follow-up and (2) improved from VPC asthma at baseline (including patients who improved to not well-controlled or well-controlled asthma), with improvement maintained through 2 years of follow-up. Odds ratios (ORs) and 95% CIs for risk of asthma exacerbations at month 30 were generated by using multivariable logistic regression by age group.
RESULTS: After adjustment, children with consistently VPC asthma over the 2-year period demonstrated a 6-fold increased risk of hospitalization, emergency department visit, or corticosteroid burst (OR, 6.4; 95% CI, 1.2-34.5) compared with the improved group. Adolescent/adult patients with consistently VPC asthma were more likely to have a corticosteroid burst (OR, 2.8; 95% CI, 1.7-4.8) or have a hospitalization, emergency department visit, or corticosteroid burst (OR, 3.2; 95% CI, 1.9-5.3).
CONCLUSIONS: Consistently VPC asthma, as defined by the impair
J Allergy Clin Immunol. 2009 Oct 5.
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美国人群中哮喘和喘息与血清胆固醇之间的新关系
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社会和环境应激因子在家庭和儿童期哮喘中的作用
