我国支气管哮喘问卷应用现状及对策

doi:10.16150/j.1671-2870.2023.06.004

摘要/Abstract

摘要：

我国的支气管哮喘（简称哮喘）哮喘患病率为4.2%，与全球其他国家相近，但我国哮喘的死亡率高达36.7/10万，为日本的4倍，美国的7倍。因此，我国需加强对哮喘进行有效管理、实现高效控制以及最大限度降低相关死亡风险。在哮喘管理中，筛查和症状控制评估是关键环节。简易筛查问卷主要用于基层医疗，以迅速识别需要深入评估的哮喘患者。数值型哮喘控制问卷，如哮喘控制测试（Asthma Control Test, ACT）和哮喘控制问卷（Asthma Control Questionnaire, ACQ），则是临床及临床研究中最为广泛使用的评估工具。分类型症状哮喘控制问卷则广泛应用于临床研究。如APGAR（活动、持续性、触发因素、哮喘药物、治疗反应）哮喘问卷不仅有助于评估哮喘，还能提高患者对治疗的依从性，从而提升哮喘控制率。目前，一些哮喘问卷在中国临床应用受限，尤其是在考虑社会文化背景、特殊年龄群体和异质性表型的方面存在一定局限性。哮喘问卷设计未来可以朝着更个体化、针对不同年龄和临床表型的方向发展，整合生物标志物和智能技术，以提高对哮喘患者的准确评估和精准管理。

关键词: 哮喘, 哮喘管理, 控制问卷, 患病率, 咳嗽变异型咳嗽

Abstract:

The prevalence of bronchial asthma in China is 4.2%, similar to other countries around the world, but the mortality rate of asthma in China is 36.7 /100 000, which is four times as high as that of Japan and seven times as that of the United States. Therefore, It is urgent for China to strengthen the effectiveness of asthma management and minimize the risk of related deaths. Pivotal aspects of asthma management involve screening and assessing symptom control. Simple screening tools expedite rapid identification of patients who require more detailed assessment in primary medical care. Numerical tools like ACT and ACQ are widely used in clinical practice and clinical research. Categorical symptom control tools are extensively used in clinical studies. For example,asthma APGAR (Activities, Persistence, Triggers, Asthma medications, Response to therapy) questionnaire not only assists in assessing asthma, but also in enhancing treatment adherence, improving asthma control. Currently, some asthma questionnaires face limitations in their application in China, particularly concerning sociocultural factors, specific age groups, and heterogeneous phenotypes. More attention should be paid to individualized factors (age diverse, clinical phenotypes), and use of biomarkers and intelligent technologies in questionnaire design for enhancing management of asthma.

Key words: Asthma, Asthma management, Control questionnaires, Prevalence, Cough variant asthma

中图分类号:

R562.25

包婺平, 林燕美, 张旻. 我国支气管哮喘问卷应用现状及对策[J]. 诊断学理论与实践, 2023, 22(06): 534-540.

BAO Wuping, LIN Yanmei, ZHANG Min. Current status and strategies of asthma questionnaire application in China[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(06): 534-540.

图/表 1

表1

常见哮喘控制问卷及比较

问卷	用途	内容	形式	应用场景	调查对象	优缺点
GINA症状控制问卷	控制评估	症状，夜间症状，缓解药物使用频次，活动限制	分类型	临床已普遍推广	患者自行填写	优点：简便，适用于患者；全面考虑症状及生活影响。缺点：基于患者自我报告，可能存在主观性。
PACS筛查问卷	筛查	症状，急性发作	分类型	基层医疗机构	患者自行填写	优点：用于快速初步筛查。缺点：内容相对简单，未全面考虑生活影响。
30秒哮喘测试问卷	控制评估	症状，缺勤/缺课时间	数值型	临床研究性应用	患者自行填写	优点：快速，考虑生活影响。缺点：主要关注症状，可能不够全面。
ACT问卷	控制评估	症状，急性发作，依从性	数值型	临床已普遍推广	患者自行填写	优点：综合考虑多个方面，易于使用。缺点：仍以患者自我评估为主。
ACQ问卷	控制评估	症状，用药，肺功能	数值型	临床研究性应用	患者自行填写	优点：全面考虑多个因素。缺点：相对较复杂，需要较多时间。
RCP3Q问卷	控制评估	睡眠障碍，日间症状，活动受限	分类型	临床已普遍推广	临床医生填写	优点：简便，关注多方面症状。缺点：基于医生观察和患者回答，主观性可能存在。
APGAR问卷	控制评估	活动情况，日夜间憋醒频率，触发因素，治疗药物，治疗反应	分类型	临床研究性应用	临床医生填写	优点：综合考虑多个方面。缺点：相对复杂，需要专业知识。
GETE问卷	控制评估	症状控制，肺功能，急性加重，缓解药物使用	数值型	临床研究性应用	临床医生填写	优点：考虑多个因素。缺点：专业人员填写，耗时相对较长。
CGI-C问卷PGI-C问卷	控制评估	总体印象变化	数值型	临床研究性应用	临床医生和患者填写	优点：包含患者和医生双方的评估。缺点：主观性较强，依赖于个体主观感受。
VAS问卷	咳嗽控制	咳嗽严重程度	数值型	临床研究性应用	患者自行填写	优点：灵敏，患者主观反映。缺点：主观性较强，仅关注咳嗽。
LCQ问卷	咳嗽控制	咳嗽对生活质量的影响	数值型	临床研究性应用	患者自行填写	优点：客观反映咳嗽对生活的影响。缺点：相对特定，不全面。
CET问卷	咳嗽控制	咳嗽对身体、社会和心理方面的影响	数值型	临床研究性应用	患者自行填写	优点：简便，全面考虑咳嗽影响。缺点：在临床研究中应用相对较少。

表1

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