摘要
   背景：尽管已经有了有效的哮喘治疗措施，以及针对哮喘控制的循证指南，但是仍有部分哮喘患者得不到有效控制。本研究旨在鉴别成人和儿童哮喘患者哮喘难以控制的危险因素。
   方法： 2008年1月25日和5月2日进行两项横断面研究，旨在评价成人和儿童哮喘患者的哮喘控制状态。受试者完成了自填式调查问卷，包括人口统计学数据、病史和目前哮喘用药情况。此外，受试者完成了哮喘控制检测（ACT）或儿童ACT（C-ACT）。应用多重logistic回归分析，鉴别哮喘难控的相关因素。
   结果：美国64个初级医疗机构（35个为成人服务，29个为儿童服务）入选本项研究。其中一项研究包括2238名成人哮喘患者（年龄>=18岁）和2429名儿童（年龄在4～17岁之间）哮喘患者。这些患者定期向保健医生进行医疗咨询。哮喘未得到控制的发生率在成人和儿童患者中分别为58%和46%。多变量分析鉴别的哮喘未得到控制的预测因素在成人和儿童患者中包括：患者自述的哮喘严重程度、依从性差、近期感冒、流感或鼻窦感染史。仅为成人哮喘未控制的危险因素为受教育程度低、保险状态、目前吸烟状态、体重指数（BMI）>30kg/m2以及胃食管症状史。仅为儿童哮喘未控制的危险因素为12～17岁女童、监护者失业以及哮喘恶化史。
   结论：在初级医疗机构中有很大比例哮喘患者其哮喘症状未得到有效控制。识别特定的危险信号，有助于鉴别哪些是哮喘未得到控制的高危险患者，而且有助于早期干预。

（苏楠 审校）
Stanford RH, et al. J Asthma. 2010 Apr;47(3):257-262

Predictors of uncontrolled asthma in adult and pediatric patients: analysis of the Asthma Control Characteristics and Prevalence Survey Studies (ACCESS).

Stanford RH, Gilsenan AW, Ziemiecki R, Zhou X, Lincourt WR, Ortega H.

Department of Health Outcomes, GlaxoSmithKline, Research Triangle Park, North Carolina 27709-3398, USA. richard.h.stanford@gsk.com

Abstract

BACKGROUND: Despite the availability of effective asthma treatments and evidence-based management guidelines focusing on asthma control, many patients have asthma that is inadequately controlled. The objective of this analysis was to identify risk factors for uncontrolled asthma among adult and pediatric patients.

METHODS: Two cross-sectional surveys assessing asthma control status were conducted between January 25 and May 2, 2008, among adult and pediatric patients with asthma. Participants completed a self-administered questionnaire including demographics, medical history, and current asthma medication use. In addition, participants completed either the Asthma Control Test (ACT) or Childhood ACT (C-ACT). Uncontrolled asthma was defined as a score of < or = 19 on the ACT or C-ACT. Multiple logistic regression was used to identify factors related to uncontrolled asthma.

RESULTS: A sample of 64 primary care provider sites (35 for adults and 29 for pediatric patients) across the United States enrolled. One study enrolled 2238 adults (aged > or = 18 years) and the other 2429 children (aged 4-17 years) with asthma. The patients were visiting their health care provider for a scheduled appointment for any reason. The overall prevalence of uncontrolled asthma was 58% and 46% in adult and pediatric patients, respectively. Multivariate analysis identified predictors of uncontrolled asthma in both adults and children including self-reported asthma severity, lack of adherence, and recent history of cold, flu, or sinus infection. The predictors of uncontrolled asthma seen only in adults were less education, insurance status, current smoker, body mass index (BMI) >30 kg/m(2), and history of gastroesophageal symptoms. The predictors of uncontrolled asthma seen only in children were female aged 12-17 years, caregiver unemployment, and history of asthma exacerbation.

CONCLUSIONS: A high proportion of patients with asthma seen in primary care settings are not well controlled. Recognition of specific predictors can signal who may be at higher risk of uncontrolled asthma and provide the opportunity for early interventions.