哮喘流行病學(xué)研究

EpidemiologyofbronchialasthmaandasthmacontrolassessmentACTinHenanprovince,WenZhang1,XianlianChen2,LijunMa,JizhenWU,HongyanKuang,TaiboHuang,JianjianCheng,LuoxianZhang,YongQi,BeibeiSun,HongyanNiu1.DepartmentofRespiratoryandcriticalcaremedicine,People’sHospitalofHenanProvince,ZhengzhouUniversity,Zhengzhou,Henanprovince,2.Correspondenceto::[Objective]StudyontheprevalenceofbronchialasthmainHenanprovincewhileassessingasthmatreatment,andthecontrollevelofasthmapatients.[Methods]Bymulti-stagestratifiedclusterrandomsamplingmethod,werandomlyselected10amongthetotal109citiesandcountiesinourprovince,then500householdsfromeachcityandcounty.Atotalnumberof5000householdsweresampled,thesamplingofindividualabout20000people.Thesampledhouseholdmembersreceived mendedbyasthmaAlliance.Forpatientswithasthma,weconductedadetailedquestionnaireusingACTtoassessdiseasecontrol.[Results]Prevalenceofashtmawas0.73%,andprevalenceratioofmale(0.76%)andfemale(0.69%)was1.3:1.Asthmaprevalenceofcityresidentswas1.1%(88/7924),ruralresidentswas0.48%(57/11792).33.8%(52)oftheasthmapatientsreceivedregularmedicationsforasthma.25%(13)patientsoftheregulartreatmentgroupusedoralglucocorticoids,71.1%(37)oraltheophylline,9.6%(5)oralleukotriene3.8%(2)oralshort-actingβ2receptoragonist,5.8%(3)orallong-actingβ2agonist,17.3%(9)glucocorticoidinhalation,7.7%(4)long-actingβ2inhalation,7.7%(4)short-actingβ2receptoragonistinhalation,1.9%(1)intravenouscorticosteroids,1.9%(1)intravenousglucocorticoid.PatientsassessedaccordingtoACTwas:controlled33.1%,partlycontrolled49.7%,uncontrolled17.2%[Conclusion]ThisstudyrevealsthatasthmaprevalenceinHenanProvince,was0.73%.Treatmentforasthmawasinsufficient,whichleadtothesuboptimalresultsofasthmacontrol.ItisurgenttoimprovethediagnosisandtreatmentforasthmaBronchialasthmaisoneofthe monchronicdiseaseofrespiratorysystem,affectinganestimated300millionpeopleintheworldwide[1].CurrentGlobalInitiativeforAsthma(GINA)guidelinespointedoutthattheprevalenceofasthmaisestimatedtobe1-18%[2].Therehavebeenrecentreportsthatitsprevalencemaynowbechanging[345].Buttherewerenoconclusionwhetherthetrendisincreasingordecliningeveninthesamecountryduringacertainperiod[67]In,therearenoepidemiologicaldataforasthmaprevalenceofthewholenation.ThemostwidelyinvestigationwasconductedbytheNationalPreventionandTreatmentofChildrenAsthmaGroupin2003,which430,000childrenin43citieswereincludedandtheincidenceofasthmain0-15yearsoldchildrenlivinginthecitywas1.97%[8].Itisestimatedthattheincidenceofasthmawas1.05%inHenanprovince,whichwasinvestigatedin2000[9].Acessmentoftimetrendsandreginalvariationsinasthmaprevalencewasdifficultinduetoinsufficientdata[10].InrecentyearstheGINAguidelineswereusedasthemainreferencesourceforthenationalasthmaguidelines.ItisnecessarytoobtainasthmaprevalenceofresidentsinHenanProvincein2010,toinvestigatethetreatmentofpatientswithasthmaandasthmacontrolevaluationatme.Astudywasthereforeundertakentoassessingthediseaseburdenofasthma,asthmatreatment,andthecontrollevel.Henanprovinceislocatedintheeasternpartof,inthenorthlatitude31°23'-36°22',betweeneastlongitude110°21'-116°39'.Thereare19citiesinHenanprovince,thepopulationisabout104,890,000by2012[11].Itisadeveloprovinceinthecountry.Thiswasacross-sectionalstudyrecruitingpeoplelivinginHenanprovinceduringJune2010toJanuary2011.SamplesweredrawnrandomlyfromtheresidentsinHenanprovince(peoplewholivetogetherasafamily,orasinglelivingpeople,bothasasamplingunit).Samplesizewasestimatedasfollow:theoverallprevalence=0.05,theestimatedtotalsamplesizewas10000.Theactualcompletedsamplesizewas19878,including10275men(accountedfor51.7%)and（accountedforStratifiedmulti-stageclusterrandomsamplingmethodswereconductedinthestudy.Thereare109counties(countylevelcity)anddistrictsintheprovince.Counties(countylevelcity)weredividedinto3groupsbyeconomiclevel,therewerehigh,middle,andlowlevelgroups.Districtsweredividedinto2groupsbyeconomiclevel,therewerehighandlowgroups.Then,3counties(onecountyineachgroup)and2districts(onedistrictineachgroup)wereselected.Then,2townswereselectedineachcountyand2streetsineachdistricts.Inthenextstep,2administrativevillageswereselectedineachtownshipand2communitiesineachstreet.Atlast,500householdsresidentswererandomlyselectedineachadministrativevillageandcommunity.Atotalnumberof5000householdsweresampled,thesamplingofindividualabout20000people.Theinvestigationgroupwerecomposedofinvestigatorsandsurveyinstructors,investigatorsweretrainedfifthyearmedicalstudentsandresidents.Theysurveyedhouseholdmembersonebyonebyquestionnaire.Surveyinstructorswereassociatedchiefrespirationphysicianandabove,theywereresponsiblefortheinvestigationoftheorganization,guidance,inspectionandqualitycontrol.Weadoptedtheasthmaquestionnaire mendedbyasthmaAlliance.Thequestionnaireincludedgeneralcondition,asthmascreeningquestionnaireandquestionnaireforasthmapatients.Sceneinvestigationlastedfor6months.Inthestudywefolloweddiagnosticcriteria[12]:Asthmadiagnosiscanbeestablishedwhenmeetscriteria(1)(2)(3)(4)or(4)(5).(1)episodicwheezing,cough,breathlessness,orchesttightness.(2)wheezingonauscultationwhenthesymptomsattacks.(3)symptomsin(1)and(2)canbeimprovedbyappropriateasthmatreatmentrelievebyitselves.(4)otherdiseaseswhichcancausewheezing,cough,breathlessness,andchesttightnessshouldbeexcluded.(5)ifnopresenceofcharacteristicsymptoms,atleastoneofthetestsshouldbepositive:(a)bronchialprovocationtestorexercisechallengetestsispositive.(b)bronchialdilationtestispositive,FEV1increase≥12%and≥200ml.(c)PEFdiurnalvariation≥20%.DateDatawereinputusingunifiedprogramandSPSS17.0softwareforstatisticalPrevalenceofAsampleof19861peopleparticipatedinthisstudy,51.7%(10275)ofwhichweremenand48.3%(9603)ofwhichwerewomen.145peoplewerediagnosedsufferingfromasthma,including79malesand66females.Thetotalmorbidityratewas0.73%,andprevalenceratioofmale(0.76%)andfemale(0.69%)was1.3:1.TheprevalenceofeachsamplingareaofZhengzhouwas0.85%(34/4017),Kaifeng1.4%(54/3907),Zhongmu0.79%(33/4180),high-techzoneinPuyangcity(county)0.16%(6/3894),MengjinCountyinLuoyangCity0.49%(18/3718)(seeTable1).Table1-AsthmaprevalenceofeachsamplingSamplingareaNo.insamplecasesofasthmaprevalenceofasthma（‰）P zhongyuandistrictin （economiclevel-longtingdistrictin （economiclevel-Rural Zhongmucounty （economiclevel-high-techzoneinPuyang6(county)（economiclevelMengjin（economiclevel-*comparisonbetweenasthmaprevalenceofresidentsincityandruralareasofdifferenteconomiclevel,#comparisonoftheprevalenceofdifferentcityareas,^comparisonbetweenasthmaprevalenceofresidentsindifferentruralareasofdifferenteconomiclevel City,ZhongyuanDistrictofZhengzhou)was1.1%(88/7924).Asthmaprevalenceofruralresidents(high-techzoneinPuyang,MengjinCounty,Zhongmucounty)was0.48%(57/11792).Therewassignificantdifferencebetweenthem (Χ2=25.13P=0.00).Theprevalenceofcityresidentsintheareasofdifferenteconomicdevelopmentlevel different(Χ2=5.176P=0.023).Theprevalenceofruralareasofdifferenteconomicdevelopmentlevelhavedifferencetoo(Χ2=16.92P=0.00).AsthmaprevalenceofdifferentageThesurveyincluded2857children,ofwhich14childrenhadasthma.Children'sprevalenceratewas0.49%.Adultsovertheageof14were17004,andtherewere131adultasthmapatients.Adult’sprevalenceratewas0.77%.Therewasnosignificantdifferencecomparedwithdataofthechildren’s(P=0.10).Asthmaprevalenceofdifferentagegroupisshownintable2. Table2Asthmaprevalenceofdifferentage Agegroupsamplenumberasthmacasesprevalence（%）P0-*comparisonofasthmaprevalenceofchildrenandMedicationsusedfortreatingWithinthe154patientswithasthma,33.8%(52)ofthemreceivedregularmedicationsforasthma,theremainingpatientswithnoregulartreatment.25%(13)patientsoftheregulartreatmentgroupusedoralglucocorticoids,71.1%(37)oraltheophylline,9.6%(5)oralleukotrienemodifiers,3.8%(2)oralshort-actingβ2agonist,5.8%(3)orallong-actingβ2receptoragonist,17.3%(9)inhalation,7.7%(4)long-actingβ2agonistinhalation,7.7%(4)short-actingβreceptoragonistinhalation,1.9%(1)intravenouscorticosteroids,1.9%(1)intravenousglucocorticoid.32.7%(17)ofthe52peoplereceivedregulartreatmentusedacombinationof2ormorethan2kindsofmedicines.Themostcommoncombinationtherapywasoralcorticosteroidsandoraltheophylline(7cases).Therewere7casesinhaledcorticosteroids,andonly2casescombinedwithinhaledshort-actingβ2receptoragonistinhalation.ThelevelofasthmaAllofthe145asthmapatientsreceivedclinicalevaluationofasthmacontrolbyACT.48ofthemachievedcontrol,accountedfor33.1%.72patientsachievedpartlycontrol,accountedfor49.7%.25patientswereclassifieduncontrolled,accountedfor17.2%.Patientswithregulartreatmentaccountedfor38.5%(20)incontrolledgroup,for61.5%inpartlycontrolledanduncontrolledgroups.Inthepatientswithoutregulartreatment,28people(27.5%)wereasthmacontrolled,and72.5%werepartlycontrolledanduntrolled.Therewerenosignificantdifferenceinasthmacontrollingbetweenpatientswhoreceivedregularmedicinesornot(P=0.19).Thiscross-sectionalstudyshowedthatprevalencerateofasthmainProvince,was0.73%.ThedataGuobinWangetalreportedwas1.05%in2000.Asthmacomprisesarangeofheterogeneousphenotypesthatdifferinpresentation,etiologyandpathophysiology.Theriskfactorsforeachrecognizedphenotypeofasthmaarecomplicatedincludinggenetic,environmentalandhostfactors.Intermsofsocialenvironmentandlifestyle,itissuggestedthattheincreaseofasthmaprevalenceinsomewaytoberelatedtothewesternmodernwayoflife[1314].isgoingthroughatransitionfromamoretraditionaltoamoremodernlifestyleatamuchhigherspeedandduringashorterperiodthaninmanyothercountries[15].Comparedwiththedata1.05%obtained10yearsago,therewasnoincreasingtrendintheprevalenceofasthmainHenanProvince.ThereasonmayberelatedtotheunderdevelopedeconomicdevelopmentofHenanprovince,withruralpopulationaccountedfornearly60%[11],whichretainthetraditional paredwithasthmaprevalencerateinotherareasin,itwas0.38%inQinghaiProvince[16],and0.94%inGungdongTheroleofoutdoorairpollutionincausingasthmaremainscontroversial[18].Theresearchshowsthatasthmaprevalencerateofcityresidentswas1.1%whichwassignificantlyhigherthanthatinruralareas0.48%.Outdoorenvironmentalpollutionmaybethemainreasonforthisphenomenon.Incites,thereisahigherconcentrationofharmfulgasandfineparticulatematter(PM2.5)inoutdoorair.PM2.5notonlyassociatedwithchildrenasthmainincreasingasthmaprevalence,relatedemergencyandhospitalization[19],andalsoadult-onsetasthma[20].Inthestudy,wefoundthatasthmaprevalenceinthecityofhigheconomicallevelwaslowerthanthatintheloweconomicallevel,onthecontrast,asthmaprevalenceintheruralareaofhigheconomicallevelwashigherthanthatintheloweconomicallevel.Previousresearcheshaveindicatedthattheasthmaprevalencewasassociatedwithsocioeconomicstatus,andinfamilieswithbettereconomicconditionasthmaincidencerateislower[2122].Buttherearealsoreportswithoppositeconclusion[2324].Becauseofthesocialeconomicstatuscontainsmanyfactorsincludinggeographicalenvironment,airpollution,healthhabits,itisdifficulttodeterminetherelationshipbetweensocioeconomicstatusandtheincidenceofasthma[2526].Whenitcomestoasthmatreatment,wefoundthatinourresearchpatientsreceivinglong-termtreatmentaccountedforonly33.8%,andthemostcommonlyuseddrugwereoralglucocorticoidsandtheophylline,only2in145patientstreatedbyinhaledcorticosteroidscombinedwithrapid-actingβ2receptoragonistdrugs.Thisphenomenonshowedthattreatmentsformostofthepatientswereinsufficient.WeshouldeducatethegeneralpractitionersandspecialistshowtotreatasthmaaccordingtotheguidelineinordertoimprovethediagnosisandtreatmentofasthmainourAsthmaControlTest(ACT)isasimpletoolforassessingthelevelofasthmacontrolinclinicalpractice,andithasbeenvalidatedincomparisonwithageneralclinicalassessmentofasthmacontrol,suitableforself-assessmentbypatients[27-30].Inourstudy,patientclassificationaccordingtoACTsorewas:controlled33.1%,partiallycontrolled49.7%,uncontrolled17.2%.Allpatientswereclassifiedintotwogroupsaccordingtoreceivinglongtermmedicationsornot,therewerenodifferenceincontrolbetweenthetwogroups,whichindicatethatmedicationstakenbyasthmapatientshavepooreffects.ThisstudyrevealsthatasthmaprevalenceinHenanProvince,was0.73%.Treatmentforasthmawasinsufficient,whichleadtothesuboptimalresultsofasthmacontrol.Itisurgenttoimprovethediagnosisandtreatmentforasthmapresently.【1】MasoliM,FabianDHoltSBeasleyRTheglobalburdenofasthmaexecutivesummaryoftheGINADisseminationCommitteereport.Allergy2004;59:469-478.【2】Global prevention.Revised2012.http://w 【3】EderWEgeMJvonMutiusE.TheasthmaepidemicNEnglJMed2006;355:2226-【4】AnandanC,NurmatovU,vanSchayckOCP,SheikhA.Istheprevalenceofasthmadeclining?Systemicreviewofepidemiologicalstudies.Allergy2010;65:152-167.【5】VtialSigns:AsthmaPrevalence,DiseaseCharacteristics,andSelf-ManagementEduction–UnitedStates,2001-2009.MMWR2011;60(17)：547-552.【6】AndersonHRGuptaRStrachanDLimbE.50yearsofasthmaUKtrendsfrom1955to2004.Thorax2007;62:85-90. 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