哮喘患儿对吸入糖皮质激素的长期依从性：观察性研究
2015/10/30
摘要
简介：哮喘患儿对日常控制药物的依从性差，这强烈地取决于潜在的可改变因素，如父母对疾病的认识和用药理念。然而，通过解决依从性差的可改变性决定因素而能够改善的儿童依从性程度至今尚无研究。我们评估了参与了一个综合性哮喘护理项目（该项目会采用与患儿父母共同做出的决策）的哮喘患儿的长期依从性和其决定因素。
方法：该项观察性研究纳入了135例2~12岁的就诊于以医院为基础的门诊的哮喘患儿。用电子设备测量了吸入糖皮质激素的一年依从性。使用有效的问卷调查评估父母的疾病认知、用药理念和患儿的哮喘控制情况。
结果：依从性的中位数（四分间距）为84%（70-92%）。55例儿童（41%）没有达到良好依从性（≧80%）的预定义水平，这与较差的哮喘控制相关。父母认为服药是很必要的，BMQ必要性得分的中位数（四分间距）为17（16-20）。父母就该项目核心事项的五个关键问题的回复表明：他们的疾病认知和用药理念与哮喘的医疗模式及其治疗具有高度一致性。依从性好与依从性差的家庭在认知方面的差异很小且无显著性意义。
结论：尽管医疗团队和父母在疾病认知和用药理念具有高度的一致性，但是儿童的依从性仍可能会较差，即使不存在影响良好依从性的社会经济障碍。实现所有儿童的良好依从性是一项复杂的工作，需要现行儿童哮喘管理指南未涉及的干预措施。
（杨冬 审校）
Respir Med. 2015 Jul26.pii:S0954-6111(15)30031-7.doi:10.1016/j.rmed.2015.07.016. [Epub ahead of print]
Long-term adherence to inhaled corticosteroids in children with asthma: Observational study.
Klok T1, Kaptein AA2, Duiverman EJ3, Brand PL4.
Abstract
INTRODUCTION:Non-adherence to daily controller medication in childhood asthma is strongly dependent on potentially modifiable factors such as parental illness perceptions and medication beliefs. The extent to which adherence in children can be improved by addressing modifiable determinants of non-adherence has not been studied to date, however. We assessed long-term adherence and its determinants in children with asthma enrolled in a comprehensive asthma care program employing shared decision making with parents.
METHODS:Observational study in 135 children 2-12 years of age with asthma attending a hospital-based outpatient clinic. One-year adherence to inhaled corticosteroids was measured by electronic devices. Parental illness perceptions and medication beliefs, and asthma control were assessed by validated questionnaires.
RESULTS:Median (interquartile range) adherence was 84% (70-92%). 55 children (41%) did not achieve the pre-defined level of good adherence (≥80%) and this was associated with poorer asthma control. Parental perceived medication necessity was high, with a median (interquartile range) BMQ necessity score of 17 (16-20). Parents' replies to the five key questions on the core issues of the program showed high concordance of their illness perceptions and medication beliefs with the medical model of asthma and its treatment. Differences in these perceptions between adherent and non-adherent families were small and non-significant.
CONCLUSIONS:Poor adherence may persist in children despite a high level of concordance between medical team and parents on illness perceptions and medication beliefs, even in the absence of socio-economic barriers to good adherence. Achieving good adherence in all children is a complex task, requiring interventions not covered in current guidelines of managing asthma in children.
Respir Med. 2015 Jul26.pii:S0954-6111(15)30031-7.doi:10.1016/j.rmed.2015.07.016. [Epub ahead of print]
