Disease severity and comorbidities of outpatients with asthma from urban area in China_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WANG Wenqiao ¹ ,  LIN Jiangtao ¹ , LIU Chuntao ² , ZHOU Xin ³ , WANG Changzheng ⁴ , HUANG Mao ⁵ , CAI Shaoxi ⁶ , CHEN Ping ⁷ , LIN Qichang ⁸ , ZHOU Jianying ⁹ , GU Yuhai ¹⁰ , YUAN Yadong ¹¹ , SUN Dejun ¹² , YANG Xiaohong ¹³ , YANG Lan ¹⁴ , HUO Jianmin ¹⁵ , CHEN Zhuochang ¹⁶ , JIANG Ping ¹⁷ , ZHANG Jie ¹⁸ , YE Xianwei ¹⁹ , LIU Huiguo ²⁰ , TANG Huaping ²¹ , LIU Rongyu ²² , ZHANG Wei ²³ , HU Chengping ²⁴ , CHEN Yiqiang ²⁵ , LIU Xiaoju ²⁶ , DAI Luming ²⁷ , ZHOU Wei ²⁸ , HUANG Yijiang ²⁹ , XU Jianying ³⁰

1. Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, P. R. China;
2. Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Department of Respiratory Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, P. R. China;
4. Department of Respiratory Medicine, Xinqiao Hospital, Army Medical University, Chongqing 410037, P. R. China;
5. Department of Respiratory and Critical Care Medicine, Jiangsu Province Hospital, Nanjing, Jiangsu 210029, P. R. China;
6. Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P. R. China;
7. Department of Respiratory Medicine, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, P. R. China;
8. Department of Respiratory Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P. R. China;
9. Department of Respiratory Medicine, First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, Zhejiang 310003, P. R. China;
10. Department of Respiratory Medicine, Qinghai Provincial People’s Hospital, Xining, Qinghai 810007, P. R. China;
11. Department of Respiratory Medicine, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P. R. China;
12. Department of Respiratory and Critical Care Medicine, Inner Mongolia People’s Hospital, Huhhot, Inner Mongolia 010017, P. R. China;
13. Department of Respiratory Medicine, People’s Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang 830001, P. R. China;
14. Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi 710061, P. R. China;
15. Department of Respiratory Medicine, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P. R. China;
16. Department of Respiratory Medicine, Henan Provincial People’s Hospital, Zhengzhou, Henan 450003, P. R. China;
17. Department of Respiratory Medicine, Tianjin First Central Hospital, Tianjin 300192, P. R. China;
18. Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Jilin University, Changchun, Jilin 130022, P. R. China;
19. Department of Respiratory and Critical Care Medicine, Guizhou Provincial People’s Hospital, Guiyang, Guizhou 550002, P. R. China;
20. Department of Respiratory Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P. R. China;
21. Department of Respiratory Medicine, Qingdao Municipal Hospital, Qingdao, Shandong 266071, P. R. China;
22. Department of Respiratory Medicine, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P. R. China;
23. Department of Respiratory Medicine, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P. R. China;
24. Department of Respiratory Medicine, Xiangya Hospital of Centre-south University, Changsha, Hunan 410013, P. R. China;
25. Department of Respiratory Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P. R. China;
26. Department of Respiratory Medicine, First Hospital of Lanzhou University, Lanzhou, Gansu 730000, P. R. China;
27. Department of Respiratory Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P. R. China;
28. Department of Respiratory and Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, P. R. China;
29. Department of Respiratory Medicine, Hainan Provincial People’s Hospital, Haikou, Hainan 570031, P. R. China;
30. Department of Respiratory Medicine, Shanxi Dayi Hospital, Taiyuan, Shanxi 030032, P. R. China;

Corresponding?author：

LIN Jiangtao, Email: jiangtao_l@263.net

Keywords：

Asthma; Cross-sectional studies; Questionnaire-based survey; Comorbidities; Disease severity

DOI：

10.7507/1671-6205.201807058

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Objective To investigate the disease severity and comorbidities in outpatient with asthma from urban area in China.Methods A face-to-face, questionnaire-based survey was carried out in outpatient department in 30 general hospitals from 30 provinces in China mainland except for Tibet during October 2015 to May 2016, and asthma patients who meet the including criteria were enrolled. Data of demographic characteristics, smoking status, disease severity, and comorbidities were collected.Results A total of 3 875 cases were included. According to GINA criteria, the proportion of diseases severity was as following: intermittent status 52.5% (2 033/3 875), mild persistent 24.5% (951/3 875), moderate persistent 16.9% (656/3 875), and severe persistent 6.1% (235/3 875). The overweight rate was 32.9% (1 274/3 875), the rate of obesity was 10.3% (401/3 875), and the smoking rate was 20.1% (777/3 875). Obesity and smoking were related to poor asthma control. 75.9% (2 941/3 875) of the patients had comorbidities: allergic rhinitis 43.4% (1682/3 875), hypertension 16.4% (634/3 875), nasosinusitis 8.7% (338/3 875), chronic obstructive pulmonary disease 7.3% (283/3 875), bronchiectasis 3.0% (118/3 875), and rhinopolypus 2.9% (114/3 875).Conclusions The majority of asthma patients from outpatient department are mild asthma patients. The proportion of allergic rhinitis and bronchiectasis in asthma patients is higher than mean level. Asthma patients with comorbidities of obesity and smoking is related to poor asthma control.

Citation： WANG Wenqiao, LIN Jiangtao, LIU Chuntao, ZHOU Xin, WANG Changzheng, HUANG Mao, CAI Shaoxi, CHEN Ping, LIN Qichang, ZHOU Jianying, GU Yuhai, YUAN Yadong, SUN Dejun, YANG Xiaohong, YANG Lan, HUO Jianmin, CHEN Zhuochang, JIANG Ping, ZHANG Jie, YE Xianwei, LIU Huiguo, TANG Huaping, LIU Rongyu, ZHANG Wei, HU Chengping, CHEN Yiqiang, LIU Xiaoju, DAI Luming, ZHOU Wei, HUANG Yijiang, XU Jianying. Disease severity and comorbidities of outpatients with asthma from urban area in China. Chinese Journal of Respiratory and Critical Care Medicine, 2019, 18(1): 51-56. doi: 10.7507/1671-6205.201807058 Copy

1.	GINA Executive and Science Committee. Global Strategy for asthma management and prevention 2017[R/OL]. http://ginasthma.org/2017-gina-report-global-strategy-for-asthma-management-and-prevention/.
2.	林江濤, 王文巧, 周新, 等. 我國十城市支氣管哮喘控制和疾病管理及患者認知水平的變化. 中華結核和呼吸雜志, 2018, 41(3): 191-195.
3.	FitzGerald JM, Boulet LP, McIvor RA, et al. Asthma control in Canada remains suboptimal: the Reality of Asthma Control (TRAC) study. Can Respir J, 2006, 13(5): 253-259.
4.	Haselkorn T, Chen H, Miller DP, et al. Asthma control and activity limitations: insights from the Real-world Evaluation of Asthma Control and Treatment (REACT) study. Ann Allergy Asthma Immunol, 2010, 104(6): 471-477.
5.	中華醫學會呼吸病學分會哮喘學組, 中國哮喘聯盟. 重癥哮喘診斷與處理中國專家共識. 中華結核和呼吸雜志, 2017, 40(11): 813-829.
6.	GINA Executive and Science Committee. Global Strategy for asthma management and prevention 2015[R/OL]. http://ginasthma.org/wp-content/uploads/2016/01/GINA_Report_2015_Aug11-1.pdf.
7.	鄭潔, 張欣, 鄭靜, 等. 肥胖與支氣管哮喘控制水平及氣道炎癥表型的關系. 中國呼吸與危重監護雜志, 2015, 14(6): 546-552.
8.	Lin J, Wang W, Chen P, et al. Prevalence and risk factors of asthma in mainland China: The CARE study. Respir Med, 2018, 137: 48-54.
9.	Fitzpatrick S, Joks R, Silverberg JI. Obesity is associated with increased asthma severity and exacerbations, and increased serum immunoglobulin E in inner-city adults. Clin Exp Allergy, 2012, 42(5): 747-59.
10.	農英, 林江濤, 陳萍, 等. 我國 14 歲以上人群吸煙狀況及其與支氣管哮喘發病和控制的關系. 中華內科雜志, 2017, 56(7): 485-489.
11.	Sharifi A, Ansarin K. Effect of gastroesophageal relux disease on disease severity and characteristics of lung functional changes in patients with asthma. J Cardiovasc Thorac Res, 2014, 6(4): 223-228.
12.	Rameschandra S, Acharya V, Kunal, et al. Prevalence and spectrum of gastro esophageal reflux disease in bronchial asthma. J Clin Diagn Res, 2015, 9(10): OC11-OC14.
13.	Moore WC, Bleecker ER, Curran-Everett D, et al. Characterization of the severe asthma phenotype by the National Heart, Lung, and Blood Institute’s Severe Asthma Research Program. J Allergy Clin Immunol, 2007, 119(2): 405-413.
14.	Ten BA, Grootendorst DC, Schmidt JT, et al. Chronic sinusitis in severe asthma is related to sputum eosinophilia. J Allergy Clin Immunol, 2002, 109(4): 621-626.
15.	Bachert C, Zhang N. Chronic rhinosinusitis and asthma: novel understanding of the role of IgE ‘above atopy’. J Intern Med, 2012, 272(2): 133-143.
16.	Bousquet J, Khaltaev N, Cruz AA, et al. Allergic rhinitis and its impact on asthma (ARIA) 2008. Allergy, 2008, 63 Suppl 86: 8-160.
17.	Burks AW, Tang M, Sicherer S, et al. ICON: food allergy. J Allergy Clin Immunol, 2012, 129(4): 906-920.
18.	Price D, Kocevar VS, Zhang Q, et al. Effect of a concomitant diagnosis of allergic rhinitis on asthma-related health care use by adults. Clin Exp Allergy, 2005, 35(3): 282-287.
19.	Thomas M, Kocevar VS, Zhang Q, et al. Asthma-related health care resource use among asthmatic children with and without concomitant allergic rhinitis. Pediatrics, 2005, 115(1): 129-134.
20.	Bousquet J, Gaugris S, Kocevar VS, et al. Increased risk of asthma attacks and emergency visits among asthma patients with allergic rhinitis: a subgroup analysis of the improving asthma control trial. Clin Exp Allergy, 2005, 35(6): 723-727.
21.	López-Chacón M, Mullol J, Pujols L. Clinical and biological markers of difficult-to-treat severe chronic rhinosinusitis. Curr Allergy Asthma Rep, 2015, 15(5): 19.
22.	Lin JT, Gao J, Lai KF, et al. The characteristic of asthma control among nasal diseases population: results from a cross-sectional study. PLoS One, 2018, 13(2): e0191543.
23.	韓德民, 張羅, 黃丹, 等. 我國 11 個城市變應性鼻炎自報患病率調查. 中華耳鼻咽喉頭頸外科雜志, 2007, 42(5): 378-384.
24.	Zhang Y, Zhang L. Prevalence of allergic rhinitis in China. Allergy Asthma Immunol Res, 2014, 6(2): 105-113.
25.	Gaugris S, Sazonov-Kocevar V, Thomas M. Burden of concomitant allergic rhinitis in adults with asthma. J Asthma, 2006, 43(1): 1-7.
26.	Bachert C, Zhang L, Gevaert P. Current and future treatment options for adult chronic rhinosinusitis: focus on nasal polyposis. J Allergy Clin Immunol, 2015, 136(6): 1431-1440.
27.	Wang XD, Zheng M, Lou HF, et al. An increased prevalence of self-reported allergic rhinitis in major Chinese cities from 2005 to 2011. Allergy, 2016, 71(8): 1170-1180.
28.	Shi JB, Fu QL, Zhang H, et al. Epidemiology of chronic rhinosinusitis: results from a cross-sectional survey in seven Chinese cities. Allergy, 2015, 70(5): 533-539.
29.	Zhong NS, Wang C, Yao WZ, et al. Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey. Am J Respir Crit Care Med, 2007, 176(8): 753-760.
30.	Twiss J, Metcalfe R, Edwards E, et al. New Zealand national incidence of bronchiectasis " too high” for a developed country. Arch Dis Child, 2005, 90(7): 737-740.
31.	Singleton R, Morris A, Redding G, et al. Bronchiectasis in Alaska Native children: causes and clinical courses. Pediatr Pulmonol, 2000, 29(3): 182-187.
32.	王隴德. 中國居民營養與健康狀況調查報告之一 2002 綜合報告. 北京: 人民衛生出版社, 2005, 53-57.
33.	Wang L, Gao P, Zhang M, et al. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013. JAMA, 2017, 317(24): 2515-2523.
34.	國家心血管病中心. 中國心血管病報告 2016. 北京: 中國大百科全書出版社, 2017.

1. GINA Executive and Science Committee. Global Strategy for asthma management and prevention 2017[R/OL]. http://ginasthma.org/2017-gina-report-global-strategy-for-asthma-management-and-prevention/.
2. 林江濤, 王文巧, 周新, 等. 我國十城市支氣管哮喘控制和疾病管理及患者認知水平的變化. 中華結核和呼吸雜志, 2018, 41(3): 191-195.
3. FitzGerald JM, Boulet LP, McIvor RA, et al. Asthma control in Canada remains suboptimal: the Reality of Asthma Control (TRAC) study. Can Respir J, 2006, 13(5): 253-259.
4. Haselkorn T, Chen H, Miller DP, et al. Asthma control and activity limitations: insights from the Real-world Evaluation of Asthma Control and Treatment (REACT) study. Ann Allergy Asthma Immunol, 2010, 104(6): 471-477.
5. 中華醫學會呼吸病學分會哮喘學組, 中國哮喘聯盟. 重癥哮喘診斷與處理中國專家共識. 中華結核和呼吸雜志, 2017, 40(11): 813-829.
6. GINA Executive and Science Committee. Global Strategy for asthma management and prevention 2015[R/OL]. http://ginasthma.org/wp-content/uploads/2016/01/GINA_Report_2015_Aug11-1.pdf.
7. 鄭潔, 張欣, 鄭靜, 等. 肥胖與支氣管哮喘控制水平及氣道炎癥表型的關系. 中國呼吸與危重監護雜志, 2015, 14(6): 546-552.
8. Lin J, Wang W, Chen P, et al. Prevalence and risk factors of asthma in mainland China: The CARE study. Respir Med, 2018, 137: 48-54.
9. Fitzpatrick S, Joks R, Silverberg JI. Obesity is associated with increased asthma severity and exacerbations, and increased serum immunoglobulin E in inner-city adults. Clin Exp Allergy, 2012, 42(5): 747-59.
10. 農英, 林江濤, 陳萍, 等. 我國 14 歲以上人群吸煙狀況及其與支氣管哮喘發病和控制的關系. 中華內科雜志, 2017, 56(7): 485-489.
11. Sharifi A, Ansarin K. Effect of gastroesophageal relux disease on disease severity and characteristics of lung functional changes in patients with asthma. J Cardiovasc Thorac Res, 2014, 6(4): 223-228.
12. Rameschandra S, Acharya V, Kunal, et al. Prevalence and spectrum of gastro esophageal reflux disease in bronchial asthma. J Clin Diagn Res, 2015, 9(10): OC11-OC14.
13. Moore WC, Bleecker ER, Curran-Everett D, et al. Characterization of the severe asthma phenotype by the National Heart, Lung, and Blood Institute’s Severe Asthma Research Program. J Allergy Clin Immunol, 2007, 119(2): 405-413.
14. Ten BA, Grootendorst DC, Schmidt JT, et al. Chronic sinusitis in severe asthma is related to sputum eosinophilia. J Allergy Clin Immunol, 2002, 109(4): 621-626.
15. Bachert C, Zhang N. Chronic rhinosinusitis and asthma: novel understanding of the role of IgE ‘above atopy’. J Intern Med, 2012, 272(2): 133-143.
16. Bousquet J, Khaltaev N, Cruz AA, et al. Allergic rhinitis and its impact on asthma (ARIA) 2008. Allergy, 2008, 63 Suppl 86: 8-160.
17. Burks AW, Tang M, Sicherer S, et al. ICON: food allergy. J Allergy Clin Immunol, 2012, 129(4): 906-920.
18. Price D, Kocevar VS, Zhang Q, et al. Effect of a concomitant diagnosis of allergic rhinitis on asthma-related health care use by adults. Clin Exp Allergy, 2005, 35(3): 282-287.
19. Thomas M, Kocevar VS, Zhang Q, et al. Asthma-related health care resource use among asthmatic children with and without concomitant allergic rhinitis. Pediatrics, 2005, 115(1): 129-134.
20. Bousquet J, Gaugris S, Kocevar VS, et al. Increased risk of asthma attacks and emergency visits among asthma patients with allergic rhinitis: a subgroup analysis of the improving asthma control trial. Clin Exp Allergy, 2005, 35(6): 723-727.
21. López-Chacón M, Mullol J, Pujols L. Clinical and biological markers of difficult-to-treat severe chronic rhinosinusitis. Curr Allergy Asthma Rep, 2015, 15(5): 19.
22. Lin JT, Gao J, Lai KF, et al. The characteristic of asthma control among nasal diseases population: results from a cross-sectional study. PLoS One, 2018, 13(2): e0191543.
23. 韓德民, 張羅, 黃丹, 等. 我國 11 個城市變應性鼻炎自報患病率調查. 中華耳鼻咽喉頭頸外科雜志, 2007, 42(5): 378-384.
24. Zhang Y, Zhang L. Prevalence of allergic rhinitis in China. Allergy Asthma Immunol Res, 2014, 6(2): 105-113.
25. Gaugris S, Sazonov-Kocevar V, Thomas M. Burden of concomitant allergic rhinitis in adults with asthma. J Asthma, 2006, 43(1): 1-7.
26. Bachert C, Zhang L, Gevaert P. Current and future treatment options for adult chronic rhinosinusitis: focus on nasal polyposis. J Allergy Clin Immunol, 2015, 136(6): 1431-1440.
27. Wang XD, Zheng M, Lou HF, et al. An increased prevalence of self-reported allergic rhinitis in major Chinese cities from 2005 to 2011. Allergy, 2016, 71(8): 1170-1180.
28. Shi JB, Fu QL, Zhang H, et al. Epidemiology of chronic rhinosinusitis: results from a cross-sectional survey in seven Chinese cities. Allergy, 2015, 70(5): 533-539.
29. Zhong NS, Wang C, Yao WZ, et al. Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey. Am J Respir Crit Care Med, 2007, 176(8): 753-760.
30. Twiss J, Metcalfe R, Edwards E, et al. New Zealand national incidence of bronchiectasis " too high” for a developed country. Arch Dis Child, 2005, 90(7): 737-740.
31. Singleton R, Morris A, Redding G, et al. Bronchiectasis in Alaska Native children: causes and clinical courses. Pediatr Pulmonol, 2000, 29(3): 182-187.
32. 王隴德. 中國居民營養與健康狀況調查報告之一 2002 綜合報告. 北京: 人民衛生出版社, 2005, 53-57.
33. Wang L, Gao P, Zhang M, et al. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013. JAMA, 2017, 317(24): 2515-2523.
34. 國家心血管病中心. 中國心血管病報告 2016. 北京: 中國大百科全書出版社, 2017.

Chinese Journal of Respiratory and Critical Care Medicine

Disease severity and comorbidities of outpatients with asthma from urban area in China

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