ICS治疗依从性电子化监测：一项识别儿童重症哮喘的重要工具
2018/01/05
摘要
国际性指南建议重症哮喘应在甄别相关诱发因素后做出，后者包括治疗依从性，但在临床实践中难以准确评价治疗依从性。我们假设通过电子监测可以帮助评价儿童的较低依从性，从而诊断一小部分真实的重症哮喘患者。接受ICS治疗的哮喘儿童前瞻性的纳入研究，通过电子监测设备评价用药持续依从性。肺功能、气道炎症以及哮喘控制在基线期以及监测后期进行测定。共计92名儿童（62名男孩，平均年龄12.4岁），平均研究时间为92天，依从性评价为74%(21-99%)。受试儿童分为4个组别：1）依从性好治疗改善占24%（可能既往依从性差）；2）依从性好治疗效果差占18%（考虑重症哮喘且治疗无效）；3）依从性差控制良好占26%（可能过度治疗）；以及4）依从性差未控制占32%。无相关临床参数较依从性数据更适合鉴别这些组别。电子监测对于需要升阶梯治疗的儿童十分必要。不同的治疗选择对于依从性存在差异的症状稳定儿童需要个体化考虑。电子监测对于儿童重症哮喘诊治十分重要。
Electronic monitoring of adherence to inhaled corticosteroids: an essential tool in identifying severe asthma in children.
Eur Respir J.2017Dec 21;50(6). pii: 1700910. doi: 10.1183/13993003.00910-2017. Print 2017 Dec.
Jochmann A, Artusio L, Jamalzadeh A, Nagakumar P, Delgado-Eckert E2, Saglani S, Bush A, Frey U, Fleming LJ.
Abstract
International guidelines recommend that severe asthma can only be diagnosed after contributory factors, including adherence, have been addressed. Accurate assessment of adherence is difficult in clinical practice. We hypothesised that electronic monitoring in children would identify nonadherence, thus delineating the small number with true severe asthma.Asthmatic children already prescribed inhaled corticosteroids were prospectively recruited and persistence of adherence assessed using electronic monitoring devices. Spirometry, airway inflammation and asthma control were measured at the start and end of the monitoring period.93 children (62 male; median age 12.4 years) were monitored for a median of 92 days. Median (range) monitored adherence was 74% (21-99%). We identified four groups: 1) good adherence during monitoring with improved control, 24% (likely previous poor adherence); 2) good adherence with poor control, 18% (severe therapy-resistant asthma); 3) poor adherence with good control, 26% (likely overtreated); and 4) poor adherence with poor control, 32%. No clinical parameter prior to monitoring distinguished these groups.Electronic monitoring is a useful tool for identifying children in whom a step up in treatment is indicated. Different approaches are needed in those who are controlled when adherent or who are nonadherent. Electronic monitoring is essential in a paediatric severe asthma clinic.
国际性指南建议重症哮喘应在甄别相关诱发因素后做出，后者包括治疗依从性，但在临床实践中难以准确评价治疗依从性。我们假设通过电子监测可以帮助评价儿童的较低依从性，从而诊断一小部分真实的重症哮喘患者。接受ICS治疗的哮喘儿童前瞻性的纳入研究，通过电子监测设备评价用药持续依从性。肺功能、气道炎症以及哮喘控制在基线期以及监测后期进行测定。共计92名儿童（62名男孩，平均年龄12.4岁），平均研究时间为92天，依从性评价为74%(21-99%)。受试儿童分为4个组别：1）依从性好治疗改善占24%（可能既往依从性差）；2）依从性好治疗效果差占18%（考虑重症哮喘且治疗无效）；3）依从性差控制良好占26%（可能过度治疗）；以及4）依从性差未控制占32%。无相关临床参数较依从性数据更适合鉴别这些组别。电子监测对于需要升阶梯治疗的儿童十分必要。不同的治疗选择对于依从性存在差异的症状稳定儿童需要个体化考虑。电子监测对于儿童重症哮喘诊治十分重要。
（上海交通大学医学院附属瑞金医院呼吸与危重症医学科 周剑平 万欢英 摘译）
（Eur Respir J.2017Dec 21;50(6). pii: 1700910. doi: 10.1183/13993003.00910-2017. Print 2017 Dec.）
（Eur Respir J.2017Dec 21;50(6). pii: 1700910. doi: 10.1183/13993003.00910-2017. Print 2017 Dec.）
Electronic monitoring of adherence to inhaled corticosteroids: an essential tool in identifying severe asthma in children.
Eur Respir J.2017Dec 21;50(6). pii: 1700910. doi: 10.1183/13993003.00910-2017. Print 2017 Dec.
Jochmann A, Artusio L, Jamalzadeh A, Nagakumar P, Delgado-Eckert E2, Saglani S, Bush A, Frey U, Fleming LJ.
Abstract
International guidelines recommend that severe asthma can only be diagnosed after contributory factors, including adherence, have been addressed. Accurate assessment of adherence is difficult in clinical practice. We hypothesised that electronic monitoring in children would identify nonadherence, thus delineating the small number with true severe asthma.Asthmatic children already prescribed inhaled corticosteroids were prospectively recruited and persistence of adherence assessed using electronic monitoring devices. Spirometry, airway inflammation and asthma control were measured at the start and end of the monitoring period.93 children (62 male; median age 12.4 years) were monitored for a median of 92 days. Median (range) monitored adherence was 74% (21-99%). We identified four groups: 1) good adherence during monitoring with improved control, 24% (likely previous poor adherence); 2) good adherence with poor control, 18% (severe therapy-resistant asthma); 3) poor adherence with good control, 26% (likely overtreated); and 4) poor adherence with poor control, 32%. No clinical parameter prior to monitoring distinguished these groups.Electronic monitoring is a useful tool for identifying children in whom a step up in treatment is indicated. Different approaches are needed in those who are controlled when adherent or who are nonadherent. Electronic monitoring is essential in a paediatric severe asthma clinic.
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