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1.
目的:观察在哮喘缓解期阶梯治疗中,哮喘控制测试(asthma control test,ACT)与最大呼气峰流速(PEF)作用的相关性,帮助支气管哮喘患者更加准确、简便的进行自我监测,提高患者的依从性。方法:选择我院哮喘专病门诊就诊的78例哮喘患者,吸入糖皮质激素(ICS)进行缓解期的阶梯治疗。要求每日早、晚监测PEF,并记录到哮喘日记上。每月哮喘专病门诊复诊一次,了解PEF值、PEF占个人预计值的百分比(PEFpred%),PEFpred%个人预计值80%为哮喘控制,PEFpred%个人预计值80%为哮喘未控制,同时进行ACT问卷,计算得分,20分为哮喘未控制;20~25分为哮喘控制。结果:ACT评分20~25分组与ACT评分20分组PEFpred%比较,差异有统计学意义(P0.01)。PEFpred%个人预计值80%组与PEFpred%个人预计值80%组ACT评分比较,差异有统计学意义(P0.01)。ACT评分与PEFpred%具有线性相关关系,P0.001。结论:在哮喘缓解期阶梯治疗中,ATC评分与PEF具有良好的相关性,对于没有条件或不能监测PEF的哮喘患者可以用ACT评分作为评估哮喘控制的指标,指导阶梯治疗。  相似文献   

2.
目的探究不同哮喘控制水平患者流感嗜血杆菌感染程度及其与炎症因子水平的相关性。方法选取我院2017年1月至2018年8月间诊断及治疗的285例哮喘患者,根据病情控制情况分为良好控制组(187例)、部分控制组(62例)及未控制组(36例),比较三组流感嗜血杆菌感染情况,包括:检出率及细菌载量,同时比较患者哮喘控制测试量表(ACT)评分,诱导痰中炎症细胞及血清炎症因子水平,使用Pearson相关性分析模型探究流感嗜血杆菌载量与患者哮喘控制水平、炎症细胞及炎症因子水平的相关性。结果三组患者ACT评分、中性粒细胞计数、嗜酸性粒细胞计数及血清IL-25、IL-33水平的差异具有统计学意义(F=7.556,4.557,7.023,16.436,11.772;均P0.05),三组流感嗜血杆菌检出率(42.78%vs 58.06%vs 77.78%;χ~2=16.593,P=0.001)及细菌载量差异均具有统计学意义(t=25.150,P0.001),且组内两两比较差异也具有统计学意义(均P0.05)。Pearson相关性分析显示流感嗜血杆菌载量与ACT评分及嗜酸性粒细胞数具有显著相关性(均P0.05)。结论不同哮喘控制水平患者流感嗜血杆菌感染检出率及炎症因子水平差异明显,流感嗜血杆菌载量与ACT评分及嗜酸性粒细胞具有显著相关性。  相似文献   

3.
摘要:目的 探究不同哮喘控制水平患者流感嗜血杆菌感染程度及其与炎性因子水平的相关性。方法 选取我院2017年1月至2018年8月间诊断及治疗的285例哮喘患者,根据病情控制情况分为良好控制组(187例)、部分控制组(62例)及未控制组(36例),比较三组流感嗜血杆菌感染情况,包括:检出率及细菌载量,同时比较患者哮喘控制测试量表(ACT)评分,诱导痰中炎症细胞及血清炎症因子水平,使用Pearson相关性分析模型探究流感嗜血杆菌载量与患者哮喘控制水平、炎症细胞及炎症因子水平的相关性。结果 三组患者ACT评分、中性粒细胞计数、嗜酸性粒细胞计数及血清IL-25、IL-33水平的差异具有统计学意义(F=7.556,4.557,7.023,16.436,11.772;均P<0.05),三组流感嗜血杆菌检出率(42.78% vs 58.06% vs 77.78%;χ2=16.593,P=0.001)及细菌载量差异均具有统计学意义(t=25.150,P<0.001),且组内两两比较差异也具有统计学意义(均P<0.05)。Pearson相关性分析显示流感嗜血杆菌载量与ACT评分及嗜酸性粒细胞数具有显著相关性(均P<0.05)。结论 不同哮喘控制水平患者流感嗜血杆菌感染检出率及炎症因子水平差异明显,流感嗜血杆菌载量与ACT评分及嗜酸性粒细胞具有显著相关性。  相似文献   

4.
目的:了解哮喘儿童父母的对疾病知识的掌握情况以及儿童的服药依从情况和影响因素,为提高哮喘儿童的控制率提供参考依据。方法:选择2015年1月-2015年12月于上海市第十人民医院儿科门诊诊治的支气管哮喘儿童93例,调查其哮喘控制情况、哮喘服药依从性和父母基本情况与相关知识。依从性与知识知晓率的比较采用双向有序的检验,影响因素采用有序结果的累积优势Logistic回归分析。结果:本次调查93例哮喘儿童中,哮喘完全控制率为23.7%,儿童服药依从性好的比率为25.8%,哮喘儿童父母相关知识知晓率高的比率为25.8%,儿童哮喘控制率与服药依从性之间存在相关性(P=0.029),哮喘儿童服药依从性与哮喘儿童父母相关知识知晓率之间存在相关性(P=0.035)。哮喘儿童的服药依从性受到儿童性别(OR=1.153,95%CI:1.04-1.96)、家族史(OR=1.402,95%CI:1.20-2.33)、知识知晓率(OR=1.828,95%CI:1.05-3.17)和病程(OR=0.758,95%CI:0.35-0.97)等因素的影响(P0.05)。结论:哮喘儿童的服药依从性受到儿童性别、家族史、知识知晓率和病程等因素的影响,要充分发挥儿童父母的作用,从医院内干预逐渐进入家庭干预,通过对父母或者监护人的认知或用药知识的提高,切实提高哮喘儿童的用药依从性和哮喘的控制率。  相似文献   

5.
刘剑梅  王自秀 《蛇志》2014,(2):175-176
目的了解哮喘患者吸入治疗正确操作流程写真对治疗依从性的影响。方法将108例支气管哮喘患者分为对照组和观察组。对照组制定规范化的治疗方案并进行哮喘防治知识教育、吸入技术指导;观察组在对照组的基础上,对患者实施吸入治疗正确技术操作流程写真,制作成系列相片,发给患者。比较两组患者的治疗依从性、ACT评分。结果两组患者的治疗依从性、ACT评分比较,经配对t检验,差异有统计学意义(P0.05)。结论哮喘患者吸入治疗正确操作流程写真的实施,有助于提高患者治疗依从性和哮喘病情控制,改善患者生活质量。  相似文献   

6.
摘要 目的:调查支气管哮喘患儿家长知信行情况,并分析支气管哮喘患儿病情控制的影响因素。方法:于2016年7月~2020年7月期间,选取我院收治的500例支气管哮喘患儿及其家长作为研究对象。患儿家长知信行情况采用《哮喘患儿家长知信行问卷》调查。患儿近4周的病情控制水平参照《诸福棠实用儿科学(第8版)》中的相关标准进行确定,病情控制水平包括良好控制、部分控制和未控制。将良好控制、部分控制的患儿纳为哮喘控制组,将未控制的患儿纳为哮喘未控制组。采用本院自制的调查量表调查患儿及其家长的信息,分析支气管哮喘患儿病情控制的影响因素。结果:支气管哮喘儿童家长知信行情况不容乐观。支气管哮喘患儿病情控制率为38.06%(187/491)。单因素分析结果表明,支气管哮喘患儿病情控制与家庭人均月收入、患儿个人过敏史、家长受教育程度、哮喘家族史、是否坚持长期用药、是否定期复诊有关(P<0.05)。多因素Logistic回归分析结果显示,家长受教育程度、家庭人均月收入、患儿个人过敏史、哮喘家族史、是否坚持长期用药、是否定期复诊均是支气管哮喘患儿病情控制的影响因素(P<0.05)。结论:本研究中支气管哮喘患儿病情控制水平一般,且支气管哮喘儿童家长知信行情况不容乐观,其中家长受教育程度、家庭人均月收入、患儿个人过敏史等均是支气管哮喘患儿病情控制的影响因素,临床中应结合相关因素进行针对性的干预或治疗,以期实现对支气管哮喘患儿病情的良好控制。  相似文献   

7.
目的:探讨哮喘专病门诊在哮喘规范化治疗和管理中的重要性。方法:随机选取于2013年7月至2013年12月新疆自治区人民医院哮喘专病门诊就诊的患者,其中初诊患者84例,复诊患者96例,合计180例。由经过培训的医师采用问卷调查的形式针对哮喘患者在疾病控制、管理和用药,以及对该病的认知程度等方面进行调查,比较初诊患者和复诊患者在哮喘的控制情况、管理情况、用药情况以及对哮喘的认知程度等方面的差异性,采用SPSS 11.5软件进行统计学分析。结果:1.哮喘控制方面,初诊和复诊患者在过去一年中的急诊就医比例(40.5%vs 21.9%)、住院比例(14.3%vs 10.4%)、需要使用急救药物比例(66.7%vs 29.2%),初诊患者均较复诊患者高,其中需要急诊就医和需要急救药物这两方面初诊与复诊相比有显著性差异(P0.01),但在住院比例两者间的差异无统计学意义(P0.05);初诊和复诊患者的哮喘控制测试评分分别为15.46±5.2,20.23±5.12(P0.01)。根据评分,初诊和复诊患者达到哮喘完全控制的比例为(5.4%vs 28.6%)、良好控制的比例为(14.3%vs 47.8%),未控制的比例为(80.3%vs 23.6%),复诊患者均明显高于初诊患者(P0.01)。2.哮喘管理方面,初诊和复诊患者在过去一年内测定过肺功能的比例为(20.2%vs 93.7%)、初诊患者无人使用峰流速仪,复诊患者的比例为17.8%,复诊患者均明显高于初诊患者,两者有明显的统计学差异(P0.01)。此外,复诊患者3月内至少一次随访的比例明显高于初诊患者,15.3%的初诊患者3月内前往呼吸科门诊至少就诊一次,而复诊患者则为64.2%(P0.05)。3.哮喘治疗方面,仅48.9%的初诊患者使用过吸入性糖皮质激素(inhaled corticosteroids,ICS),而复诊患者中使用的比例高达91.7%(P0.01)。4.哮喘认知方面,认为哮喘是气道炎症性疾病,初诊与复诊比例(19%vs91.7%),ICS是长期控制药物初诊与复诊比例(38.1%vs 92.7%),两者相比有着显著性差异(P0.0001),在对哮喘疾病的认知方面复诊患者明显优于初诊患者。结论:复诊患者无论在哮喘的控制、管理和用药方面,还是对疾病的认知方面均明显优于初诊患者,这提示哮喘专病门诊的设立有利于对哮喘患者的治疗和管理,有必要加强对呼吸科医师哮喘知识的再培训,推广哮喘专病门诊,同时有必要加强对哮喘患者的健康教育。  相似文献   

8.
了解门诊就诊的支气管哮喘患者的病情控制和对该病的认识。方法 :选择我院2011年3月~2013年3月来我院门诊就诊的支气管哮喘的患者83例进行分析。结果:83例患者的平均年龄在45±19岁,平均病程在9±5年。16%的患者在过去的两年内应病情加重而住院治疗,11%的患者应哮喘加重而就诊于急诊。完全控制率为15%,控制良好的患者为65%。结论 :由于哮喘教育管理工作的开展和哮喘规范化治疗的推广,哮喘病的总体控制水平及患者对疾病的认知得到了很大程度的提高。  相似文献   

9.
目的:探讨外周血单个核细胞(PBMC)TNF-α基因mRNA表达与哮喘严重程度、临床病理及相关影响因素的关系。方法:采用实时荧光定量PCR技术检测67例哮喘病人和25例健康对照PBMC中TNF-α mRNA表达水平,分析其与哮喘控制程度、血浆TNF-α浓度、嗜酸性粒细胞百分比(EOS%)、血浆总IgE浓度和哮喘相关影响因素的关系。结果:经方差分析和SNK-q检验,哮喘未控制组PBMC中TNF-α mRNA表达水平高于正常组(P<0.01)、控制组(P<0.01)和部分控制组(P<0.05)。相关分析显示哮喘病人TNF-α mRNA表达与血浆TNF-α浓度和EOS%呈正相关,相关系数分别为r=0.584(P<0.01)和r=0.29(P<0.05),有吸烟史的哮喘病人TNF-α mRNA表达水平高于非吸烟病人(P<0.05)。结论:哮喘病人PBMC中TNF-α mRNA表达水平与哮喘的控制程度呈负相关,与血浆TNF-α浓度呈正相关,PBMC中TNF-α mRNA表达水平与血浆TNF-α浓度可作为哮喘控制程度的参考指标。  相似文献   

10.
目的分析支气管扩张合并支气管哮喘患者的病原菌及危险因素。方法选取湖州市中心医院115例支气管扩张合并支气管哮喘患者作为观察组,另选取同期110例健康体检者作为对照组。分析患者病原菌的组成、耐药性及发病危险因素。结果观察组患者送检痰样本经痰培养,阳性检出者68例,阳性率为59.13%(68/115)。全部样本共分离出104株病原菌,其中革兰阴性菌92株(以铜绿假单胞菌最多,占54.81%),革兰阳性菌8株,真菌4株。药敏试验结果表明革兰阴性菌对复方新诺明、头孢曲松、左旋左氧氟沙星和阿莫西林/克拉维酸等药物的耐药性均较高,对妥布霉素、亚胺培南、头孢哌酮/舒巴坦和哌拉西林的耐药性较低。Logistic回归分析显示,吸烟史、药物过敏史、食物过敏史、过敏性鼻炎、哮喘、过敏性肺炎、慢性支气管炎及慢性阻塞性肺疾病均是支气管扩张伴支气管哮喘发生的危险因素。结论支气管扩张合并支气管哮喘患者其病原菌以革兰阴性菌为主,吸烟史、药物过敏史、食物过敏史、过敏性鼻炎等是支气管扩张伴支气管哮喘发生的危险因素。  相似文献   

11.

Background

Though insurance claims data are useful for researching asthma, they have important limitations, such as a diagnostic inaccuracy and a lack of clinical information. To overcome these drawbacks, we used the novel method by merging the clinical data from our asthma cohort with the National Health Insurance (NHI) claims data.

Methods and Results

Longitudinal analysis of asthma-related healthcare use from the NHI claims database, merged with data of 736 patients registered in a Korean asthma cohort, was conducted for three consecutive years from registration of the cohort. Asthma-related asthma healthcare referred to outpatient and emergency department visits, hospitalizations, and the use of systemic corticosteroids. Univariate and multivariate logistic regression analysis was used to evaluate risk factors for asthma-related healthcare. Over three years after enrollment, many patients changed from tertiary to primary/secondary hospitals with a lack of maintenance of inhaled corticosteroid-based controllers. An independent risk factor for emergency visits was a previous history of asthma exacerbation. In hospitalizations, old age and Asthma Control Test (ACT) score variability were independent risk factors. An independent risk factor for per person cumulative duration of systemic corticosteroids was the FEV1 (Forced expiratory volume in one second)%. The use of systemic corticosteroids was independently associated with being female, the FEV1%, and ACT score variability.

Conclusion

We found that old age, being female, long-standing asthma, a low FEV1%, asthma brittleness, asthma drug compliance, and a history of asthma exacerbation were independent risk factors for increased asthma-related healthcare use in Korea.  相似文献   

12.

Background

This study examined the attitudes and actions of 3415 physician-recruited adults aged ≥ 16 years with asthma in eleven countries who were prescribed regular maintenance therapy with inhaled corticosteroids or inhaled corticosteroids plus long-acting β2-agonists.

Methods

Structured interviews were conducted to assess medication use, asthma control, and patients' ability to recognise and self-manage worsening asthma.

Results

Despite being prescribed regular maintenance therapy, 74% of patients used short-acting β2-agonists daily and 51% were classified by the Asthma Control Questionnaire as having uncontrolled asthma. Even patients with well-controlled asthma reported an average of 6 worsenings/year. The mean period from the onset to the peak symptoms of a worsening was 5.1 days. Although most patients recognised the early signs of worsenings, the most common response was to increase short-acting β2-agonist use; inhaled corticosteroids were increased to a lesser extent at the peak of a worsening.

Conclusion

Previous studies of this nature have also reported considerable patient morbidity, but in those studies approximately three-quarters of patients were not receiving regular maintenance therapy and not all had a physician-confirmed diagnosis of asthma. This study shows that patients with asthma receiving regular maintenance therapy still have high levels of inadequately controlled asthma. The study also shows that patients recognise deteriorating asthma control and adjust their medication during episodes of worsening. However, they often adjust treatment in an inappropriate manner, which represents a window of missed opportunity.  相似文献   

13.

Background

The avoidance of inhaled allergens or tobacco smoke has been known to have favorable effects on asthma control. However, it remains unclear whether other lifestyle-related factors are also related to asthma control. Therefore, a comprehensive study to examine the associations between various lifestyle factors and asthma control was conducted in Japanese asthmatic patients.

Methods

The study subjects included 437 stable asthmatic patients recruited from our outpatient clinic over a one-year period. A written, informed consent was obtained from each participant. Asthma control was assessed using the asthma control test (ACT), and a structured questionnaire was administered to obtain information regarding lifestyle factors, including tobacco smoking, alcohol drinking, physical exercise, and diet. Both bivariate and multivariate analyses were conducted.

Results

The proportions of total control (ACT = 25), well controlled (ACT = 20-24), and poorly controlled (ACT < 20) were 27.5%, 48.1%, and 24.5%, respectively. The proportions of patients in the asthma treatment steps as measured by Global Initiative for Asthma 2007 in step 1, step 2, step 3, step 4, and step 5 were 5.5%, 17.4%, 7.6%, 60.2%, and 9.4%, respectively. Body mass index, direct tobacco smoking status and alcohol drinking were not associated with asthma control. On the other hand, younger age (< 65 years old), passive smoking, periodical exercise (> 3 metabolic equivalents-h/week), and raw vegetable intake (> 5 units/week) were significantly associated with good asthma control by bivariate analysis. Younger age, periodical exercise, and raw vegetable intake were significantly associated with good asthma control by multiple linear regression analysis.

Conclusions

Periodical exercise and raw vegetable intake are associated with good asthma control in Japanese patients.  相似文献   

14.
目的:研究维生素D联合异丙托溴铵治疗支气管哮喘患者的临床疗效。方法:选择2015年1月~2017年12月在我院进行诊治的81例支气管哮喘患者并将其随机分为两组。对照组雾化吸入异丙托溴铵,观察组在对照组的基础上联合口服维生素D。比较两组的喘憋症状消失时间、咳嗽缓解时间、肺部哮鸣音消失时间和肺部湿啰音消失时间,治疗前后的最大呼气峰流速(peak expiratory flow rate,PEF)变异率和哮喘控制测试(asthma control test,ACT)评分值。结果:观察组治疗有效率为90.00%(36/40),较对照组[78.05%(32/41)]显著升高(P0.05);观察组的喘憋症状消失时间、咳嗽缓解时间、肺部哮鸣音消失时间和肺部湿啰音消失时间均明显短于对照组(P0.05)。治疗前,两组PEF变异率和ACT评分值比较差异无统计学意义(P0.05);治疗后,两组PEF变异率均较治疗前显著降低(P0.05),ACT评分值均较治疗前显著升高(P0.05),且观察组PEF变异率显著低于对照组(P0.05),而ACT评分值明显高于对照组(P0.05)。结论:与单用雾化吸入异丙托溴铵相比,维生素D联合雾化吸入异丙托溴铵治疗支气管哮喘的临床疗效更优,且可以有效缩短患者的症状消失时间。  相似文献   

15.
High mobility group protein B1 (HMGB1) has been implicated as an important mediator in the pathogenesis of asthma and chronic obstructive pulmonary disease (COPD). However, the expression of HMGB1 in plasma and sputum of patients with asthma and COPD across disease severity needs to be defined. The objective of the study was to examine the induced sputum and plasma concentrations of HMGB1 in COPD and asthmatic patients to determine differences in HMGB1 levels between these diseases and their relationship with airway obstruction and inflammatory patterns. A total of 147 participants were enrolled in this study. The participants included 34 control subjects, 61 patients with persistent asthma (according to the Global Initiative for Asthma [GINA] guidelines) and 47 patients with stable COPD (stratified by Global Initiative for Chronic Obstructive Lung Disease [GOLD] status). Spirometry was performed before sputum induction. HMGB1 levels in induced sputum and plasma were determined by enzyme-linked immunosorbent assay. Sputum and plasma concentrations of HMGB1 in patients with asthma and COPD were significantly higher than concentrations in control subjects and were significantly negatively correlated with forced expiratory volume in 1 s (FEV(1)), FEV(1) (% predicted) in all 147 participants. The levels of HMGB1 in induced sputum of COPD patients were significantly higher than those of asthma patients and healthy controls (P < 0.001). This difference was present even after adjusting for sex, age, smoking status, daily dose of inhaled corticosteroids and disease severity. There were no significant differences in HMGB1 levels between patients with eosinophilic and noneosinophilic asthma. HMGB1 levels in asthmatic and COPD patients were positively correlated with neutrophil counts and percentage of neutrophils. In multivariate analysis, the two diseases (asthma and COPD) and disease severity were independent predictors of sputum HMGB1, but not smoking, age or use of inhaled corticosteroids. In conclusion, these data support a potential role for HMGB1 as a biomarker and diagnostic tool for the differential diagnosis of asthma and COPD. The importance of this observation on asthma and COPD mechanisms and outcomes should be further investigated in large prospective studies.  相似文献   

16.
Although asthma is classically defined as reversible airflow obstruction and often remits in younger subjects with milder disease, a proportion of asthmatics experience chronic symptoms, episodic exacerbations and persistent airway obstruction, despite the continuous use of beta 2-agonists, associated with high doses of inhaled/oral corticosteroids. These patients contribute to the majority of asthma costs through hospitalization, emergency visits, absence from work or school and use of medication. Although the mechanisms behind irreversible airflow obstruction in asthma are unclear, a prominent role has been attributed to persistent structural changes of the bronchial wall, defined as airway remodeling. Studies conducted on endobronchial biopsy samples have led to the histopathological characterization of these tissue alterations, which include chronic mucosal inflammation, extensive epithelial damage, collagen deposition, subepithelial fibrosis, increased mucous glands and airway smooth muscle hypertrophy and/or hyperplasia. Several factors, such as polypeptide growth factors and their receptors, matrix metalloproteases, intracellular molecules controlling cell death and survival, adhesion molecules and their ligands, as well a large variety of cytotoxic pro-inflammatory mediators are likely to contribute to the onset and maintenance of these tissue abnormalities. However, to date, the cellular and molecular events driving specifically these phenomena and allowing asthmatics with persistent airflow limitation to be distinguished from patients who normalize their bronchial obstruction upon adequate therapeutic management have not been identified yet. Accordingly, airway remodeling represents a major research challenge, particularly in view of the development of new therapeutic strategies specifically addressed at alleviating persistent bronchial obstruction in these otherwise intractable patients.  相似文献   

17.
It is well documented that the psychiatric disorders are common in Asthma patients in China while the studies on the relationship between asthma control and psychological disorder are comparatively rare. We therefore performed a cross-sectional study on asthmatic outpatients in one Chinese tertiary center to investigate the correlation among asthma, anxiety and depression. Demographic data, anxiety and depression scores, the level of asthma control were collected in 261 patients. All patients were evaluated with Asthma Control Test (ACT), Self-Rating Anxiety Scale (SAS) and Self-rating depression scale (SDS) questionnaires. A multivariate analysis was performed to investigate the relationship between asthma control and psychological disorder. The result showed that 31 asthma patients had anxiety symptom while thirty-five asthma patients had depression. One hundred and ninety-two asthma patients were well controlled and 69 patients were not. The study found a negative correlation between ACT and SAS(r = −0.231, p<0.001) as well as ACT and SDS(r = −0.23, p<0.001) and depression (OR: 12.295, 95%CI: [5.374–28.128], p<0.001) were both independently associated with poor asthma control. We concluded that Asthma control is greatly affected by psychological disorder in Chinese patients.  相似文献   

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