哮喘联盟

   摘要
   在本篇文章中，我们旨在强调采用更全面和个体化的方法来应对哮喘患者普遍存在的依从性差的问题和进行个体化哮喘管理的必要性。虽然现有的几种方法能够评估哮喘患者的依从性程度，但是大部分方法没有纳入实际吸入、剂量和吸入技术等信息。此外，大多数现有的方法缺乏依从性差的个体化影响和当依从性差发生时应何时及怎样采取措施等详细信息。
   特别需要指出的是，依从性差存在多种形式（不稳定的依从性差、主观的依从性差和不知情的依从性差），每种依从性差都需要不同的方法。为了改善哮喘控制，需要更多的结合了依从性差评估、哮喘疾病控制和患者意愿的准确方法。将来源于最新吸入装置的信息和从手机监测及反馈系统得到的患者自诉结果的信息进行整合，被认为是一个有前途的手段，但是需要认真实施。在大范围实施之前，需要考虑的主要问题包括患者意愿、患者和疾病特征的巨大异质性、经济后果和新数字技术的长期持久性。
 

（杨冬 审校）
NPJ Prim Care Respir Med. 2015 Jul 16;25:15046. doi: 10.1038/npjpcrm.2015.46.

 

Towards tailored and targeted adherence assessment to optimise asthmamanagement.
 

van Boven JF1, Trappenburg JC2, van der Molen T3, Chavannes NH4.
 

Abstract
In this paper, we aim to emphasise the need for a more comprehensive and tailored approach to manage the broad nature of non-adherence, to personalise current asthma management. Although currently several methods are available to measure the extent of asthma patients' adherence, the vast majority do not incorporate confirmation of the actual inhalation, dose and inhalation technique. Moreover, most current measures lack detailed information on the individual consequences of non-adherence and on when and how to take action if non-adherence is identified.
Notably, one has to realise there are several forms of non-adherence (erratic non-adherence, intelligent non-adherence and unwitting non-adherence), each requiring a different approach. To improve asthma management, more accurate methods are needed that integrate measures of non-adherence, asthma disease control and patient preferences. Integrating information from the latest inhaler devices and patient-reported outcomes using mobile monitoring- and feedback systems ('mHealth') is considered a promising strategy, but requires careful implementation. Key issues to be considered before large-scale implementation include patient preferences, large heterogeneity in patient and disease characteristics, economic consequences, and long-term persistence with new digital technologies.

NPJ Prim Care Respir Med. 2015 Jul 16;25:15046. doi: 10.1038/npjpcrm.2015.46.