哮喘联盟

   摘要
   背景：哮喘临床指南提示书面的哮喘行动计划对提高自我管理和预后是必需的。
   目的：旨在评估亚专科医生提供的以书面的哮喘行动计划的形式制定的书面说明在门诊日常哮喘护理中的效果。
   方法：纳入来自4个城市医疗中心首次接收肺和过敏治疗的407例患有持续性哮喘的儿童和成人，随机接受内科医生的书面说明(n=204)或无任何书面说明（除处方药物外）(n=203)。
   测量及主要结果：使用书面哮喘行动计划作为工具进行自我管理在以下首要研究终点中未发现显著效果：从基线到随访12个月时的  1）哮喘症状发生的频率，2）急诊次数，或3） 哮喘生活质量。两组相似且都可显著降低哮喘症状发生频率（白天症状 (P < .0001)、夜间发作频率 (P < .0001)、β受体激动剂使用 (P < .0001)）。干预组(p<.0001)和对照组(p<.0006)患者的急诊就诊次数均显著降低。哮喘成人(P < .0001)和哮喘儿童护理者(P< .0001)的生活质量评分均显著提高。
   结论：研究结果表明，对于首次接受亚专科治疗的持续哮喘患者，使用书面哮喘行动计划作为哮喘管理的工具，不能比哮喘的基础医疗保健和教育取得更多的获益。

 

（杨冬 审校）
Am J Respir Crit Care Med. 2015 Apr 13. [Epub ahead of print]
 

Do Patients of Subspecialist Physicians Benefit from Written Asthma Action Plans?
 

Sheares BJ1, Mellins RB, Dimango E, Serebrisky D, Zhang Y, Bye MR, Dovey ME, Nachman S, Hutchinson V, Evans D.

Author information
 

Abstract
RATIONALE:Asthma clinical guidelines suggest written asthma action plans are essential for improving self-management and outcomes.
OBJECTIVE:To assess the efficacy of written instructions in the form of a written asthma action plan provided by subspecialist physicians as part of usual asthma care during office visits.
METHODS:A total of 407 children and adults with persistent asthma receiving first time care in pulmonary and allergy practices at 4 urban medical centers were randomized to either receive written instructions (n=204) or no written instructions other than prescriptions (n=203) from physicians.
MEASUREMENTS AND MAIN RESULTS:Using written asthma action plan forms as a vehicle for providing self-management instructions did not have a significant effect on any of the primary outcomes: 1) asthmasymptom frequency, 2) emergency visits, or 3) asthma quality of life from baseline to 12 month follow-up. Both groups showed similar and significant reductions in asthma symptom frequency (daytime symptoms (p < .0001), nocturnal symptoms (p < .0001), beta-agonist use (p < .0001)). There was also a significant reduction in emergency visits for the intervention (p<.0001) and control (p<.0006) groups. There was significant improvement in asthma quality of life scores for adults (p < .0001) and pediatric caregivers (p < .0001).
CONCLUSIONS:Our results suggest that using a written asthma action plan form as a vehicle for providingasthma management instructions to patients with persistent asthma who are receiving subspecialty care for the first time confers no added benefit beyond subspecialty-based medical care and education for asthma. Clinical trial registration available at www.clinicaltrials.gov, ID NCT00149461.
 

Am J Respir Crit Care Med. 2015 Apr 13. [Epub ahead of print]