RU2626688C1 - Method for prediction of bronchial asthma control after training by standard group asthma-school program - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: prior to training in an asthma school, the volume of forced expiration in 1 second (FEV₁) is determined in % of the required values, the indicators of motivational orientation (MOr) and the need for approval (Ap) are calculated based on tests. Then the bronchial asthma control is predicted after 4-5 weeks after training in asthma school using the classification function equations. During calculations, the result having the highest value indicates patient's belonging to one of the two groups predicted after training in the group asthma school: patients with controlled asthma and patients with uncontrolled asthma.

EFFECT: method allows to increase the effectiveness of teaching patients with bronchial asthma in the group asthma school by taking into account the volume of forced expiration in 1 second and conducting psychological tests.

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Description

The invention relates to medicine, namely to therapy and pulmonology, and can be used to predict the risk of developing an uncontrolled course of bronchial asthma after training according to the standard group asthma-school program.

Criteria for evaluating the effectiveness of the treatment of bronchial asthma are developed and reflected in the International Program "Global Strategy for the Treatment and Prevention of Asthma" (GINA) and include clinical monitoring of asthma symptoms and evaluation of lung function, reducing contact with allergens, and improving compliance [1]. Uncontrolled bronchial asthma is characterized by a more pronounced inflammation of the airways, leading to the progression and significantly more severe clinical course of the disease. A way to increase the control of bronchial asthma is to increase the patient's awareness of the laws of bronchial asthma, methods of prevention and treatment through training in an asthma school according to a standardized program. However, the degree of information assimilation and its further practical use are affected by the motivation features of patients with bronchial asthma.

A known method for predicting the unstable course of bronchial asthma, based on the determination by the radioaerosol method of the rate of bronchial mucociliary clearance (MCC) of the radiopharmaceutical in% for 1 hour and the solution of the discriminant equation: D = -0.6 × MCC, and with a value of D greater than -15.51 unstable course of bronchial asthma is predicted [2]. In addition to the lack of consideration of the motivational characteristics of patients with bronchial asthma, the main disadvantage of this method is the need to use radiopharmaceuticals.

There is a method for predicting the achievement of control of bronchial asthma in patients with a mild persistent or moderate persistent course during the off-peak period, based on the registration of a spirogram of calm breathing before therapy and after inhalation of a short-acting β ₂ -agonist. Next decide discriminant equation: D = 0,923 × AIJ _50% + 68,766 × CKO, where D - discriminant function, the boundary value is 77.0. If the value of D is equal to or greater than the boundary value, failure to control bronchial asthma is predicted after 6 months of standard therapy. When the value of D is less than the boundary value, the achievement of control of bronchial asthma is predicted [3]. The disadvantage of this method is the need to use a β ₂ short-acting agonist and its limited use only for predicting the uncontrolled course of mild and moderate persistent bronchial asthma. In addition, the method does not take into account the peculiarities of the motivational sphere of patients with bronchial asthma.

A known method for predicting the uncontrolled course of severe bronchial asthma, based on the determination of the parameters of the function of external respiration (PSV, FZHEL, MOS ₂₅ , MOS ₅₀ , MOS ₇₅ , FEV ₁ and FEV ₁ after the test with salbutamol), calculations ΔOPF ₁ , values of the AST test and indicators of gas concentration in exhaled air (СО, NO, NO ₂ ). As a result, the probability indicators for assigning an individual to a group with a high and low risk of developing an uncontrolled course of severe bronchial asthma are calculated according to the proposed mathematical formulas [4]. The disadvantages of this method include the limited use of it only for predicting the control of severe bronchial asthma, the need to use a β ₂ short-acting agonist, and high variability of the level of nitric oxide in exhaled air. In addition, the method does not take into account the motivational features of patients with bronchial asthma.

Closest to the claimed one is a method for predicting the uncontrolled course of bronchial asthma, based on obtaining spirometry, peak flowmetry, medical history, laboratory tests, followed by identifying risk factors for uncontrolled bronchial asthma (from low to very high) [5]. The disadvantage of this method is the lack of accuracy of the measured parameters (the presence and severity of comorbid pathology, the level of income in a changing social environment). In addition, the method also does not take into account the peculiarities of the motivational sphere of patients with bronchial asthma. None of the above methods allows predicting the level of control of the course of bronchial asthma after training according to the standard group asthma-school program.

The aim of the invention is to provide the ability to predict the achievement of control of bronchial asthma after training according to the program of a standard group asthma school, taking into account the motivational characteristics of the patient’s personality, which will allow timely selecting an individual form of patient management to stabilize the disease and achieve control, to exclude the use of large doses of inhaled glucocorticosteroids in patients with predicted achievement of control.

The goal is achieved by determining the volume of forced expiration in 1 second (FEV ₁ ), indicators of motivational orientation and the level of need for approval before starting training in an asthma school.

The essence of the method is to calculate the developed classification functions taking into account the forced expiratory volume for 1 second (FEV ₁ ) in% of the required values, the type of motivational orientation and the level of the scale for assessing the need for approval before training in a group asthma school.

The method is as follows:

1. Prior to the start of training in a group asthma-school method of determining the value of spirometry in forced expiratory volume in 1 second (FEV ₁₎ in% of predicted values.

2. Using the test “Motivational orientation” (LV Bogovin, 2016) measure the type of motivational orientation in points (“MNap”, from 1 to 3) [6, P. 115].

The test “Motivational orientation” contains 44 questions about the orientation of personal motivation, each of which the patient answers “yes” (+) or “no” (-).

1. If I myself have chosen a task, then in case of failure or obstacles, its attractiveness for me increases even more.

2. I do not want to be the one who seeks power and position.

3. When you need to compete, I rather have interest and excitement than anxiety and anxiety.

4. When I work, it looks like I put everything on the card.

5. When a problem situation arises, I most often make one of the last decisions.

6. I, as a rule, do not refuse the goal, even in case of failure on the way to its achievement.

7. When working in conditions of limited time, the effectiveness of my activities usually improves, even if the task is quite difficult.

8. My success to some extent depends on my colleagues.

9. I work more effectively under someone else's leadership than when I bear personal responsibility for my work.

10. Reprimand stimulates me more than praise.

11. I prefer to set myself medium in difficulty or slightly overestimated, but achievable goals.

12. It's easier and easier for me to communicate with people who can work hard.

13. After a successful response to the exam, I would rather breathe a sigh of relief (“passed!”) Than be happy with a good grade.

14. Obstacles make my decisions harder.

15. When I have to make a decision, I try to do it as best as possible.

16. One must rely only on oneself.

17. When I undertake a difficult matter, I am more afraid that I can’t cope with it than I am sure that it will work out.

18. I always think before taking risks.

19. In doing the work, I do not count on the help of others.

20. If something didn’t work out for me, I would rather do my best to cope with it than go over to what I am doing well.

21. I often choose extremes: either very easy tasks, or completely impossible.

22. It is pointless to oppose the will of the leader.

23. When I have to undertake a difficult task, and time is short, I work much worse, slower.

24. Sometimes I put off what I had to do now.

25. As a rule, if the task cannot be completed, then I immediately lose interest in him.

26. I would rather learn entertaining games known to most people than rare games that require skill and are known to few.

27. Whenever I have to complete an important task, I don’t think about anything else.

28. I usually act actively.

29. I would prefer an important matter with a probability of failure in it equal to 50%, an important, but not difficult one.

30. I usually pay little attention to my achievements.

31. When performing responsible tasks, I try to find as much as possible any reasons to refuse.

32. The fruitfulness of an activity mainly depends on me, and not on someone else’s control.

33. I am usually persistent in achieving the goal.

34. I prefer to perform a difficult unfamiliar task than the one I am sure of the success.

35. I am less ambitious than many others.

36. I prefer to plan my future only in the near future.

37. I often tackle difficult tasks, even if I’m not sure that I can solve them, than for the lungs, of which I doubt the solution.

38. I usually plan my future not only for a few days, but also for a month or a year in advance.

39. After failure, I rather become more energetic than I lose all desire to continue the work.

40. I am usually not very persistent in achieving the goal, especially if no one controls me.

41. When I am disposed to work, I do it better and more professionally than others.

42. It is very important for me to do my job as best as possible, even if because of this I have friction with my comrades.

43. I tend to take the initiative.

44. When I encounter obstacles, as a rule, I do not retreat, but look for ways to overcome them.

Keys of the test: positive answers to questions 1, 3, 4, 6, 7, 12, 14, 15, 16, 19, 20, 27, 28, 32, 33, 34, 37, 38, 39, 41, 42, 43 , 44; negative answers to questions 2, 5, 8, 9, 10, 11, 13, 17, 18, 21, 22, 23, 24, 25, 26, 29, 30, 31, 35, 36, 40.

As a result of calculating the amount of responses, in accordance with the key, raw points are obtained, which are converted into standard sten. For stens, the mean (M), standard deviation (σ) are found, five intervals σ / 2 (half σ) are counted from the average on both sides.

The resulting data is estimated: 1-19 points - negative motivation, 20-24 points - intermediate (mixed) motivation, 25-44 points - positive motivation.

3. Using the scale of assessment of the need for approval (Yu.M. Orlov, 1978) measure the level of need for approval in points ("OMO", from 1 to 3) [7, P. 272].

4. Two equations of the classification function are solved:

F1 = FEV ₁ % × 0.12 + MNap × 11.78 + OMOD × 5.55-25.29 and

F2 = FEV ₁ % × 0.15 + Mnap × 10.47 + OMOD × 4.23-24.59,

where Mnap = 1 - negative motivational orientation, Mnap = 2 - intermediate motivational orientation, Mnap = 3 - positive motivational orientation; OMOD = 1 - low approval motivation, OMOD = 2 - average approval motivation, OMOD = 3 - high approval motivation.

In the calculations, the result that is of the greatest importance indicates the predicted affiliation of the patient to one of two groups after training in a standard group asthma school: F1 - patients with controlled bronchial asthma; F2 - patients with uncontrolled bronchial asthma. This prognostic model allows for the correct static classification of observations in 85% of cases.

The method provides an increase in the efficiency of training patients with bronchial asthma in a standard stationary asthma school (group F1) and differentially select patients for additional (educational and motivational) programs in order to achieve control of bronchial asthma.

The classification functions were tested by evaluating posterior probabilities. Incorrect classifications were found in 23 cases (11.9%). This means that in 88.1% of cases, patients fell into the group predicted by the equations.

These classification functions allow at the initial stage of management of patients with bronchial asthma to predict the level of disease control and discriminate them against a group of “susceptible” to teaching people for a standard asthma school (five-day program) and a group of “immune” to standard training.

The possibility of using the proposed method for predicting the uncontrolled course of bronchial asthma after training according to the program of the standard group asthma school is confirmed by the analysis conducted on a sample of 93 patients with bronchial asthma of the Caucasian race living in the Amur Region. The average age of the examined was 44.2 ± 11.5 years. Persistent bronchial asthma of mild, moderate and moderate degree was diagnosed in 22%, 63% and 15% of cases, respectively. Based on the results of calculations of the equations of the classification function, the following results were obtained: 36 patients were predicted to achieve control of bronchial asthma, 57 patients had an uncontrolled course of the disease. After 4-5 weeks after graduating from a group asthma school according to the standard program, the observed patients in 32 cases demonstrated achievement of control of bronchial asthma. The remaining 61 patients did not achieve disease control. There were 31 reliably positive forecast results, 56 reliably negative, 5 false, 5 and 1 false.

Based on the observation of this category of patients by the method of evidence-based medicine [8, 9], the sensitivity, specificity and accuracy of predicting the achievement of control of bronchial asthma using the proposed method were calculated.

Sensitivity (in%) was defined as the ratio of reliably positive forecast results (31 observations) to the sum of reliably positive results (31 observations) and false negative (1 observations). This indicator amounted to 96.8%.

The specificity (in%), calculated as the ratio of reliably negative forecast results (56 observations) to the sum of reliably negative results (56 observations) and false positive (5 observations), was 91.8%.

Overall accuracy (in%), calculated as the ratio of all the correct forecast results, i.e. the sum of reliably positive (31 observations) and reliably negative (56 observations) forecast results to the total number of forecasts made (i.e., the sum of reliably positive, reliably negative, false positive and false negative forecast results) was 93.5%.

The effectiveness of the clinical practice of the proposed method is illustrated by the following examples.

Example 1

Patient T., 44 years old. Diagnosis: Persistent bronchial asthma of moderate severity, uncontrolled course. She has asthma for 11 years. By the time of treatment, shortness of breath attacks occurred daily, including up to 2-3 times a week at night. The need to take short-acting inhaled β ₂ -agonists was daily and ranged from 2 to 4 times.

When assessing the state of the ventilation function of the lungs, it was found that the volume of forced expiration in the first second (FEV ₁ ) is 73.2% of the proper values, and its variability during the day is 36.7%.

According to the test "Motivational orientation" Mnap = 3.

According to the assessment scale of the need for approval OMOD = 2.

Using the equations of the classification function, the following results were obtained:

F1 = FEV ₁ % × 0.12 + Mnap × 11.78 + OMOD × 5.55-25.29 = 29.93,

F2 = FEV ₁ % × 0.15 + Mnap × 10.47 + OMOD × 4.23-24.59 = 26.26.

The result, which is of the greatest importance, indicates the predicted belonging of the patient to the F1 group (patients with controlled bronchial asthma).

The patient was trained according to the standard five-day group asthma-school program and basic treatment for bronchial asthma was prescribed [1]. 4 weeks after graduation, the patient registered asthma control, there were no day or night symptoms of the disease, the need for short-acting inhaled β ₂ -agonists arose less often than once a week; FEV ₁ increased to 92.2% of the expected values, and its variability during the day was 14%.

Example 2

Patient D., 36 years old. Diagnosis: Persistent bronchial asthma of mild severity, uncontrolled course. He has asthma for 5 years. By the time of treatment, shortness of breath attacks occurred almost daily, including up to 2 times a month at night. The need for taking inhaled β ₂ -agonists of short action was up to 1-2 times a week.

When assessing the state of the ventilation function of the lungs, it was found that FEV ₁ is 80.7% of the proper values, and its variability during the day is 16.2%.

According to the test "Motivational orientation" Mnap = 1.

According to the assessment scale for the need for approval OMOD = 1.

Using the equations of the classification function, the following results were obtained:

F1 = FEV ₁ % × 0.12 + Mnap × 78 + OMOD × 5.55-25.29 = 1.84,

F2 = FEV ₁ % × 0.15 + Mnap × 10.47 + OMOD × 4.23-24.59 = 2.36.

The result, which is of the greatest importance, indicates the predicted belonging of the patient to the F2 group (patients with uncontrolled bronchial asthma).

The patient was trained according to the standard five-day group asthma-school program, he was prescribed basic treatment for bronchial asthma [1]. 5 weeks after the end of training in a patient, control of bronchial asthma was not achieved. The patient retained attacks of labored breathing 2-3 times a week, including up to 1-2 times a week at night. FEV ₁ was 81.4% of the expected values, and its variability during the day was 15.3%.

Thus, the application of the proposed method based on the use of non-invasive criteria allows us to predict with sufficient accuracy the development of an uncontrolled course of bronchial asthma, which makes it promising for implementation in wide clinical practice. The method allows at an early stage to determine the likelihood of a response to educational activities, which allows the attending physician to develop an optimal management plan for each individual patient with bronchial asthma. In General, the result of the application of the method will be expressed in increasing the effectiveness of asthma treatment and reducing direct and indirect costs of health resources.

Information sources

1. GINA Report, Global Strategy for Asthma Management and Prevention. 2015. URL: http://www.ginasthma.org/local/uploads/files/GINA_Report_2015_May19.pdf

2. Patent RU 2004107936/14. A method for predicting the unstable course of bronchial asthma. Lutsenko M.T., Pirogov A.B., Optur L.Yu., Kolosov V.P.

3. Patent RU 2506045. A method for predicting the achievement of control of bronchial asthma. Nakhamchen L.G., Kolosov V.P., Nakhamchen D.L., Perelman Yu.M.

4. Patent RU 2470582. A method for predicting the uncontrolled course of severe bronchial asthma. Ogorodova L.M., Fokin V.A., Kistenev Yu.V., Krasnobaeva L.A., Kulikov E.S., Starovoitova E.A., Selivanova P.A.

5. Patent RU 2559905. A method for predicting the risk of developing uncontrolled bronchial asthma. Baturin V.A., Baida A.P., Pozdnyakova O.Yu.

6. Bogovin L.V., Kolosov V.P., Perelman Yu.M. Nonpharmacological methods for achieving control of bronchial asthma: a monograph. Vladivostok: Dalnauka, 2016.250 s.

7. Eliseev O.P. Workshop on personality psychology. St. Petersburg: Peter, 2003.560 s.

8. Karmazanovsky G.G. Assessment of the diagnostic significance of the method ("sensitivity", "specificity", "general accuracy") // Annals of surgical hepatology. 1997.T 2.P. 139-142.

9. SEVM - Center for evidence-based medicine. URL: http://www.cebm.net/likelihood-ratios/

Claims (4)

A method for predicting the control of bronchial asthma after training according to the program of a standard group asthma school, characterized in that before the start of training in an asthma school, the volume of forced expiration for 1 second (FEV ₁ ) is determined in% of the proper values, the motivational orientation indicators are calculated by tests ( Mnap) and the level of need for approval (OMOD), and then predict the control of bronchial asthma after 4-5 weeks after studying at an asthma school, solving two equations of the classification function: F1 = FEV ₁ % × 0.12 + MHap × 11.78 + OMOD × 5.55-25.29 and F2 = FEV ₁ % × 0.15 + MHap × 10.47 + OMOD × 4.23-24.59, where Mnap = 1 - negative motivational orientation, Mnap = 2 - intermediate motivational orientation, Mnap = 3 - positive motivational orientation; OMOD = 1 - low approval motivation, OMOD = 2 - average approval motivation, OMOD = 3 - high approval motivation; the result, which is of the greatest importance, indicates the predicted affiliation of the patient to one of two groups after training in a standard group asthma school: F1 - patients with controlled bronchial asthma; F2 - patients with uncontrolled bronchial asthma.