呼气峰流速监测及哮喘日记对支气管哮喘患者病情控制分级的影响

Influence of peak expiratory flow monitoring and asthma diary on the grading of bronchial asthma

目的:观察呼气峰流速每天监测对慢性持续期的支气管哮喘患者病情控制分级的影响,从而为康复措施及时介入提供量化依据。方法:选择2002-01/2003-10在上海市杨浦区中心医院呼吸科门诊就诊的38例哮喘患者为研究对象。每4周以回忆方式让哮喘患者说明哮喘病情严重程度同时测定患者当时呼气峰流速,另外以哮喘患者4周呼气峰流速的每天监测记录及哮喘日记为依据对哮喘病情严重程度的判断,比较两种方法对哮喘病情控制分级的一致性。同时比较观察每天、每周、每个月呼气峰流速变化率对哮喘病情控制分级的影响。结果:32例门诊哮喘患者完成了12周呼气峰流速的监测,在12周的3次随访中,依据哮喘患者回忆方式结合当时测定的呼气峰流速判断哮喘患者控制分级为:缓解期为27例次(28%),发作期69例次,其中1级6例次(6%),2级11例次(12%),3级23例次(24%),4级29例次(30%);依据呼气峰流速监测结合哮喘日记评估分级,缓解期13例次(14%),发作期83例次,其中1级6例次(6%),2级7例次(7%),3级18例次(19%),4级52例次(54%),两种评估方法比较Kappa是0.3113(<0.4),说明对病情控制分级的一致性较差,通过呼气峰流速监测可以发现更多处于发作期的患者。另外通过呼气峰流速监测发现,如果以不同的时间段计算呼气峰流速变化率。

AIM:To observe the influence of daily monitoring of peak expiratory flow on the grading of severity in patients with persistent bronchial asthma,so as to provide quantitative evidence for the timely intervention of rehabilitative measures. METHODS:Thirty-eight patients with asthma,who were treated in the clinic of respiratory medicine of Yangpu District Central Hospital of Shanghai City from January 2002 to October 2003,were selected as the subjects.The patients were required to instruct their severity of disease by means of recollection every 4 weeks,and their peak expiratory flow was determined at that time,besides their severities of asthma were judged taking the records of daily monitoring of peak expiratory flow and the asthma diary as the evidences,and then the consistency of the two methods to the grading of asthma severity was compared. Meanwhile,the effects of daily,weekly and monthly changing rates of peak expiratory flow on the grading of asthma severity were compared and observed. RESULTS:All the 32 asthma outpatients completed the 12-week peak expiratory flow monitoring.In the 3 follow-ups during the 12 weeks,the patients were graded according to their recollection combining with peak expiratory flow at that time:27 cases(28%) were at remission,69 cases at exacerbation,including 6 cases(6%) of grade 1,11 cases(12%) of grade 2,23 cases(24%) of grade 3 and 29 cases(30%) of grade 4;According to the peak expiratory flow monitoring and asthma dairy,the patients were graded as 13 cases(14%) at remission and 83 cases at exacerbation,including 6 cases(6%) of grade 1,7 cases(7%) of grade 2,18 cases(19%) of grade 3 and 52 cases(54%) of grade 4.Kappa of the two evaluating methods was 0.311 3(< 0.4),which indicating that their consistency to the grading of asthma severity was worse,and peak expiratory flow monitoring could find more asthma patients at exacerbation.peak expiratory flow monitoring also found that peak expiratory flow changing rate calculated at different time could affect the grading of asthma severity. CONCLUSION:The asthma condition will be under-estimated if the patients are not applied peak expiratory flow monitoring,which can detect the early signs as asthma deterioration of the patients without clinical symptoms.