我国中心城市支气管哮喘患者急性发作征兆及其自我管理水平的调查分析

Warning symptoms of asthma attack and asthma self-management： a national asthma control survey from China

目的 调查分析我国中心城市支气管哮喘（简称哮喘）患者急性发作的征兆及其自我管理水平.方法 采用多中心横断面研究,对2015年10月至2016年5月我国内地（除西藏外）30个省、自治区、直辖市的30家三级甲等医院的门诊哮喘患者进行面对面问卷调查,内容包括哮喘发作的频率及征兆、从征兆出现到哮喘发作的时间、哮喘发作对患者工作生活的影响及哮喘自我管理.结果共纳入3 875例门诊哮喘患者.调查结果显示,78.1%（3 026/3 875）的哮喘患者症状恶化时会限制或停止运动和日常活动,82.5%（3 160/3 829）的哮喘患者在上次经历哮喘发作时有明确的征兆,主要征兆为咳嗽、胸闷、气促.从征兆出现到哮喘发作的中位时间为2 h,平均时间为90 h.哮喘症状恶化时,非常有信心自己控制哮喘的患者仅占4.4%（167/3 829）.哮喘症状加重或妨碍日常生活时使用平喘药物的哮喘患者占76.7%（2 937/3 828）.药物使用选择情况：含福莫特罗的复合糖皮质激素吸入剂45.8%（1 776/3 875）,短效β2激动剂吸入剂23.9%（927/3 875）.结论 我国中心城市哮喘患者哮喘发作时大多具有咳嗽、胸闷、气促等明确征兆或症状;能够实施自我管理的患者比例较低.

Objective To investigate warning symptoms of asthma attack and evaluate asthma self-management status of asthma patients in urban China.Methods A multi-center, cross-sectional, questionnaire-based survey was carried out from 30 general hospitals dispersed in 30 provinces of China's Mainland （except for Tibet） during Oct 2015 to May 2016. Information of frequency and warning symptoms of asthma attack, the time from warning symptoms to asthma attack, the impact of asthma attack and asthma self-management were collected from asthma patients of outpatient department.Results Altogether 3 875 asthmatic outpatients were recruited. 78.1% （3 026/3 875） of the patients reported restriction of exercise and daily activities during asthma exacerbation. 82.5% （3 160/3 829） of the patients had warning symptoms before asthma attack, the most common warning symptoms were cough, chest tightness and shortness of breath. The median time from warning symptoms to asthma attack was 2 h, the mean time was 90 h. Only 4.4% （167/3 829） of the patients had definite confidence to control asthma when symptoms deteriorated. 76.7% （2 937/3 828） of the patients used medications to control asthma when asthma symptoms deteriorated. Medication choice： inhaled corticosteroid （ICS） ＋formoterol 45.8% （1 776/3 875）, short-acting beta-agonist （SABA） 23.9% （927/3 875）.Conclusions Most asthma patients have warning symptoms before asthma attack, the most common symptoms are cough, chest tightness and shortness of breath. The proportion of patients conducting effective asthma self-management remains low.