The Application Value Of Dynamic Lung Function Monitoring In The Diagnosis And Treatment Of Asthma

Objective:To realize dynamic lung function monitoring by using a handheld lung function meter,and to explore the application value of dynamic lung function monitoring in asthma diagnosis,asthma efficacy assessment and predicting the risk of acute exacerbation of asthma.Methods:（1）Eighty patients who were diagnosed with asthma according to their medical history from March 2018 to February 2019 in the Outpatient Department of Respiratory and Critical Care Medicine,Tianjin First Central Hospital.Complete FeNO measurement and pulmonary function tests,if the patient’s pulmonary function test results indicate that there is airflow limitation and meets the bronchodilation test requirements,the bronchodilation test is given,otherwise the dynamic pulmonary function monitoring is performed for 2 weeks.The PEF mutation rate of patients was collected and the average daily mutation rate of PEF was more than 10%as the basis for diagnosis of asthma.Finally,the patients were divided into asthma group and non-asthma group according to the results of the examination.（2）Forty patients with asthma who had been diagnosed and well-adhered were randomly divided into 20 cases in the traditional observation group and the dynamic observation group,collecteding the ACT scores and lung function information of the two groups before enrollment.According to the condition,the patients were given corresponding treatment（Budesonide Formoterol powder inhaler,montelukast sodium tablets）,and both guide the correct use of the drug and asthma education.Telling the patients in the traditional observation group to review every month,and they were treated according to self-symptoms at any time;patients in the dynamic observation group were monitored daily for pulmonary function,and the patient’s lung function was monitored by WeChat software.If the PEF mutation rate was more than 10%,the patient was reminded to see the doctor promptly.After 3 months,collected the ACT score and lung function information of the two groups again.By comparing the ACT scores and changes in lung function between the two groups before and after enrollment,it was clarified whether dynamic lung function monitoring would affect the treatment of asthma.Patients in the dynamic observation group continued to monitor lung function,collected lung function information every2 weeks（FVC%,FEV₁%,FEV₁/FVC%,PEF%,PEF mutation rate,FEF25-75%and MMEF25%-75%）,and performed ACT score every 4 weeks.Linear regression analysis was used to compare changes in lung function indicators during asthma treatment,and Pearson correlation analysis was used to compare the correlation between lung function indicators and ACT scores.（3）Ten months of dynamic lung function monitoring was performed on 10asthmatic patients with allergens of autumn flowers（Artemisia argyi,common ragweed,daisy,dandelion）and grade 3 and above,observed in autumn（July to October）Whether there were acute asthma attacks and the number of seizures,observe the changes of various lung function indexes before acute exacerbation of asthma,and explore the time window of acute asthma attacks.Results:1.Of the 80 patients with suspected asthma,57 patients were diagnosed with asthma,including 11 patients with positive bronchodilation test,46 patients with positive PEF mean daily mutation rate,and 23 patients with non-asthmatic patients.2.The ACT scores and the improvement of FVC%,FEV₁%and PEF%in the dynamic observation group were higher than those in the traditional observation group,and the difference was statistically significant（P<0.05）.3.The change of PEF mutation rate of asthmatic patients was the most obvious after treatment;the correlation between PEF%and ACT score was the most significant（correlation coefficient r=0.991,P=0.009）;4.Allergic asthma patients may induce acute asthma attacks after exposure to allergens or infections.The lung function has changed significantly 2 days before the acute exacerbation of asthma symptoms,showing a restricted airflow state,and the change in PEF mutation rate is most obvious.Conclusion:Dynamic lung function monitoring can improve the diagnostic accuracy of asthma,and can be used as a practical method to monitor the condition,assess asthma control and predict the risk of acute exacerbation of asthma.