通过自然语言处理提取的哮喘症状及其与轻度哮喘患者急性哮喘加重的关联
2025/06/27
摘要
背景：轻度哮喘患者占需要急诊咨询的哮喘加重病例的30%-40%，且近30%的患者在过去4周内的哮喘症状控制不佳或非常差。
目的：我们旨在估计轻度哮喘患者中各种哮喘症状的患病率，并评估这些症状与未来急性哮喘加重（AAE）的关联。
方法（回顾性队列研究）：利用行政数据，我们识别出2013年至2018年间18-85岁的198,873名符合轻度哮喘标准的成年人。通过自然语言处理从临床记录和患者/提供者沟通中提取患者在基线访视（t₀）前12个月内的咳嗽、喘息、气促和胸闷症状。采用稳健标准误的泊松回归模型评估症状与t₀后12个月内的AAE的关联，同时控制潜在混杂因素。
结果：咳嗽、喘息、气促和胸闷的患病率分别为67.0%、47.7%、41.3%和13.2%。在t₀后12个月内，6.5%的患者经历了AAE。在未调整分析中，所有四种症状均与AAE风险增加相关。在调整其他患者特征后，只有喘息（调整后相对风险[99%置信区间]：1.13，1.07-1.20）和气促（1.17，1.12-1.23）与未来AAE风险增加相关。症状记录的频率越高，风险越大。
结论：表现出气促和喘息症状（尤其是多次出现）的轻度哮喘患者未来发生AAE的风险增加，可能从治疗干预和/或触发因素避免教育中受益。
Symptoms of asthma extracted through natural language processing and their associations with acute asthma exacerbation in adults with mild asthma
Wansu Chen, Eric J Puttock, Fagen Xie, William Crawford, Michael Schatz, William M Vollmer, Stanley Xu, Robert S Zeiger
Abstract
Background: Individuals with mild asthma account for 30-40% of asthma exacerbations requiring emergency consultation, and nearly 30% had not well controlled or very poorly controlled asthma symptoms over the previous 4 weeks.
Objective: We sought to estimate the prevalence of various asthma symptoms and assess their association with future acute asthma exacerbation (AAE) in patients with mild asthma.
Mehods (retrospective cohort study): Using administrative data, we identified 198,873 adults 18-85 years of age who met criteria for mild asthma between 2013 and 2018. Presence of cough, wheezing, dyspnea and chest tightness in the 12 months prior to their index visit (t0) was extracted from clinical notes and patient/provider communications through natural language processing. Poisson regression models with robust standard errors were utilized to assess the associations between symptoms and AAE in the 12 months after t0, controlling for potential confounders.
Results: The prevalence of cough, wheezing, dyspnea, and chest tightness were 67.0%, 47.7%, 41.3%, and 13.2%, respectively. 6.5% of patients experienced an AAE in the 12 months after t0. All four symptoms were associated with increased AAE risk in the unadjusted analysis. After adjusting for other patient characteristics, only wheezing (adjusted relative risk [99% CI]: 1.13, 1.07-1.20) and dyspnea (1.17, 1.12-1.23) were associated with increased risk of future AAE. The risk increased with the frequency of the documented symptoms.
Conclusion: Patients with mild asthma who exhibit symptoms of dyspnea and wheezing (especially on multiple occasions) are at increased risk for future AAEs and may benefit from therapeutic intervention and/or trigger-avoidance education.
背景：轻度哮喘患者占需要急诊咨询的哮喘加重病例的30%-40%，且近30%的患者在过去4周内的哮喘症状控制不佳或非常差。
目的：我们旨在估计轻度哮喘患者中各种哮喘症状的患病率，并评估这些症状与未来急性哮喘加重（AAE）的关联。
方法（回顾性队列研究）：利用行政数据，我们识别出2013年至2018年间18-85岁的198,873名符合轻度哮喘标准的成年人。通过自然语言处理从临床记录和患者/提供者沟通中提取患者在基线访视（t₀）前12个月内的咳嗽、喘息、气促和胸闷症状。采用稳健标准误的泊松回归模型评估症状与t₀后12个月内的AAE的关联，同时控制潜在混杂因素。
结果：咳嗽、喘息、气促和胸闷的患病率分别为67.0%、47.7%、41.3%和13.2%。在t₀后12个月内，6.5%的患者经历了AAE。在未调整分析中，所有四种症状均与AAE风险增加相关。在调整其他患者特征后，只有喘息（调整后相对风险[99%置信区间]：1.13，1.07-1.20）和气促（1.17，1.12-1.23）与未来AAE风险增加相关。症状记录的频率越高，风险越大。
结论：表现出气促和喘息症状（尤其是多次出现）的轻度哮喘患者未来发生AAE的风险增加，可能从治疗干预和/或触发因素避免教育中受益。
（中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校）
（J Allergy Clin Immunol Pract. 2025 Apr 26:S2213-2198(25)00389-7. doi: 10.1016/j.jaip.2025.04.031.）
Symptoms of asthma extracted through natural language processing and their associations with acute asthma exacerbation in adults with mild asthma
Wansu Chen, Eric J Puttock, Fagen Xie, William Crawford, Michael Schatz, William M Vollmer, Stanley Xu, Robert S Zeiger
Abstract
Background: Individuals with mild asthma account for 30-40% of asthma exacerbations requiring emergency consultation, and nearly 30% had not well controlled or very poorly controlled asthma symptoms over the previous 4 weeks.
Objective: We sought to estimate the prevalence of various asthma symptoms and assess their association with future acute asthma exacerbation (AAE) in patients with mild asthma.
Mehods (retrospective cohort study): Using administrative data, we identified 198,873 adults 18-85 years of age who met criteria for mild asthma between 2013 and 2018. Presence of cough, wheezing, dyspnea and chest tightness in the 12 months prior to their index visit (t0) was extracted from clinical notes and patient/provider communications through natural language processing. Poisson regression models with robust standard errors were utilized to assess the associations between symptoms and AAE in the 12 months after t0, controlling for potential confounders.
Results: The prevalence of cough, wheezing, dyspnea, and chest tightness were 67.0%, 47.7%, 41.3%, and 13.2%, respectively. 6.5% of patients experienced an AAE in the 12 months after t0. All four symptoms were associated with increased AAE risk in the unadjusted analysis. After adjusting for other patient characteristics, only wheezing (adjusted relative risk [99% CI]: 1.13, 1.07-1.20) and dyspnea (1.17, 1.12-1.23) were associated with increased risk of future AAE. The risk increased with the frequency of the documented symptoms.
Conclusion: Patients with mild asthma who exhibit symptoms of dyspnea and wheezing (especially on multiple occasions) are at increased risk for future AAEs and may benefit from therapeutic intervention and/or trigger-avoidance education.
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替泽帕鲁单抗的临床与生物学缓解：真实世界中重症未控制哮喘的治疗应答
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探索在重度哮喘中远程监测的FeNO抑制试验的长期效用
