The Clinical Evaluation Of Severity And Treatment For 12 Weeks Of Newly Diagnosed Patients With Asthma

Objective:Bronchial asthma(asthma)is a common chronic respiratory disease in the world.According to statistics,about 300 million people around the world suffer from asthma,and it is estimated there are about 30 million asthma patients in China.The prevalence and mortality rate of asthma is increasing year by year.Although asthma can not be cured at present,it was showed that nearly 80%of the asthma patients who were graded and given maintenance therapy in accordance with the GINA guidelines,during the one-year study period,could reach to good control in the Gaining Optimal Asthma Control(GOAL)study.However,the reality is not the case.A newly published study of asthma in the Asia Pacific region showed that the partial control rate and control rate of 402 of the Chinese asthma patients were 56%and 2%,respectively.It indicates that the control level of asthma in our country is very low.Many factors may affect the control level of asthma and the severity of asthma.In accordance with the GINA guidelines,the treatment plan is very important to achieve high level of asthma control and to enhance confidence in the control of asthma.However,there are very few related reports to evaluate the severity of the newly diagnosed patients with asthma,the corresponding prescription drugs and treatment effect in our country.In this study,we investigated the incidence and treatment status of 70 outpatient patients of newly diagnosed asthma in respiratory clinic and asthma clinic of our hospital.Our investigation aimed to find the risk factors and the severity of these patients,as well as the clinical curative efficacy of the standardized treatment according to GINA guideline for 12 weeks.Otherwise we made comparison with the non-standardized treatment of asthma patients in the investigation which was performed in our hospital in 2012.in order to provide more clinical evidences for better carrying out prevention and treatment of asthma in the future.Methods:70 newly diagnosed asthma patients who were selected from the Second Affiliated Hospital of Dalian Medical University between December 2014 and November 2015 were enrolled.1.Inclusion criteria:age?18 years;newly diagnosed asthma patients within 3 months without using of inhaled glucocorticoids:diagnosis of aforementioned patients was in accordance with the diagnostic standard of asthma of the GINA 2012 guidelines and 2008 China guidelines for the prevention and treatment of asthma.2.Exclusion criteria:patients enrolled in other clinical trials in the past 90 days;patients with chronic obstructive pulmonary disease;acute exacerbation of asthma.3.The gathering content when selected:(1)Basic information and risk factors:name,sex,age,degree of education,course of disease,smoking history,family history of asthma,whether or not with allergic rhinitis,and inducement,etc.;(2)Severity classification of asthma:evaluation criteria refer to severity grading standards of asthma of GINA 2006 guidelines;(3)The control level of asthma:evaluation criterion referenced to GINA 2012 guidelines for asthma and asthma control test(ACT)scores.4.Standardized treatment and evaluation of its efficacy:according to GINA guidelines for standardized treatment.The subjects were reviewed every 4 weeks,overall 3 times in 12 weeks.Collected content as reviewed:(1)Severe acute attack of asthma:In this study,severe acute attack of asthma was defined as acute attack of asthma was so serious that need for systemic application of glucocorticoid for no less than 3 days,or need for emergency treatment or hospitalization caused by asthma exacerbations;(2)Control level of asthma.5.Comparison of asthma control level between the new diagnostic group and the control group:The new diagnostic group of 56 asthma patients had completed standardized treatment of asthma for 12 weeks in this study.The control group of 79 patients in the investigation which was performed in our hospital in 2012 was not treated with standardized treatment.SPSS software(version 17.0)was adopted for statistical analysis,P<0.05 was considered statistically significant.Results:1.Basic information,risk factors and severity of asthma:Among 70 selected patients,30%of them had been smoking(17.1%of the subjects were still smoking and 12.9%had quit smoking)and 70%of them did not ever smoke.35.7%of the selected patients had a family history of asthma,55.7%of the subjects with allergic rhinitis.Asthmatic attacks of the patients commonly induced by respiratory tract infection(95.7%),smog(72.9%),temperature change(60%),movement(55.7%),dust mite allergy(38.6%),pollen allergy(14.3%).violent mood swings(10%).Assessment of the severity of asthma in patients when they were enrolled:mildly persistent(4.3%),moderately persistent(31.4%).severely persistent(64.3%).The patients of moderate to severe persistent asthma accounted for 95.7%.2.Compliance,severe acute asthma attack and asthma control:(1)In 70 patients,only 56 patients finished standardized treatment for 12 weeks,14 cases(20%)were lost to follow-up.Out of the patients who were lost to follow-up,4 cases with treatment for less than 4 weeks assumed that treatment program was invalid and dropped out of the study;8 patients with awareness of effective treatment,were unwilling to review again because of being busy;another case recognised treatment effective,but could not accept continued treatment due to economic reasons;the last case was credulous of folk prescriptions that others suggested to him,and withdrew from the study.(2)56 subjects that accomplished standardized treatment did not experience severe acute exacerbation of asthma during the investigation period.(3)The control proportion of asthma patients have being gradually increased with standardized treatment being performed much longer.When standardized treatment was finished 12 weeks later,asthma control proportion reached 78.6%according to clinical control standards of the GINA 2012 guidelines,and the ratio of both complete control and good control of asthma was 98.2%in accordance with good control and over the criterion of the ACT score standards(ACT?20 points).3.Comparison of asthma control level between the new diagnostic group and the control group:In accordance with clinical control standards of the GINA 2012 guidelines and ACT score(ACT?20 points)standard,asthma clinical control rate and good control above proportion of the new diagnostic group(78.6%and 98.2%)were significantly higher than the control group's(20.3%and 44.3%)(P<0.01).Conclusions:Most of the newly diagnosed patients with asthma were in serious condition.However,after accepting standardized treatment for 12 weeks,78.6%can achieve the clinical control of asthma.The probability of severe acute exacerbation in asthma patients who had achieved the clinical control is significantly reduced.