重症哮喘生物制剂及热成形术时代的不依从性
2018/06/04
摘要
吸入性药物的依从性差会影响哮喘的控制。电子监控设备（EMD）可以客观地检测依从性，但在采用新疗法（即生物制剂和支气管热成形术）的难治性哮喘患者中的作用尚未阐明。我们对连续的难治性哮喘患者是否适合新型治疗进行了评估，并对进行新型治疗的患者进行连续8周的观察，比较其应用EMD评估的与标准化临床医生评估的依从性结果，其中药物治疗依从性定义为服用75％及以上的处方剂量。在69例难治性哮喘患者中，13例患者由于器械不兼容或功能障碍无法最终分析其依从性，余下45例患者中，20例患者（44.4％）依从性差。依从性差的临床评估结果不敏感（医师评估结果为15％，护士评估结果为28％）。依从性差的患者的血清嗜酸性粒细胞较高。若包含11名可能依从性差的患者（设备被拒绝或未返回），依从性差的比率将增加至55％（31/56）。69名患者中，59人符合重症哮喘标准，47名适用于新型治疗，EMD检测发现50%（16/32）患者依从性差，若包括7名可能依从性差的患者，那么依从性差的比率将提高至59％（23/39）。至少一半的符合新药疗法的患者对维持治疗方案依从性差。临床评估通也常无法检测到依从性差。 重症哮喘在采用新型治疗前，必须客观确认控制药物的依从性。
Non-adherence in the era of severe asthma biologics and thermoplasty.
Abstract
Non-adherence to inhaled preventers impairs asthma control. Electronic monitoring devices (EMD) can objectively measure adherence. Their use has not been reported in difficult asthma patients potentially suitable for novel therapies, i.e. biologics and bronchial thermoplasty. Consecutive patients with difficult asthma were assessed for eligibility for novel therapies. Medication adherence, defined as taking 75% or more of prescribed doses, was assessed by EMD and compared to standardised clinician assessment over an eight week period. Among 69 difficult asthma patients, adherence could not be analysed in 13, due to device incompatibility or malfunction. Non-adherence was confirmed in 20/45 (44.4%). Clinical assessment of non-adherence was insensitive (physician 15%, nurse 28%). Serum eosinophils were higher in non- adherent patients. Including 11 patients with possible non-adherence (device refused or not returned), increased the non-adherence rate to 31/56 (55%). Severe asthma criteria were fulfilled by 59/69 patients. Forty-seven were eligible for novel therapies, with confirmed non-adherence in 16/32 (50%) with EMD data; including seven patients with possible non-adherence increased the non-adherence rate to 23/39 (59%).At least half the patients eligible for novel therapies were non-adherent to preventers. Non-adherence was often undetectable by clinical assessments. Preventer adherence must be confirmed objectively before employing novel severe asthma therapies.
吸入性药物的依从性差会影响哮喘的控制。电子监控设备（EMD）可以客观地检测依从性，但在采用新疗法（即生物制剂和支气管热成形术）的难治性哮喘患者中的作用尚未阐明。我们对连续的难治性哮喘患者是否适合新型治疗进行了评估，并对进行新型治疗的患者进行连续8周的观察，比较其应用EMD评估的与标准化临床医生评估的依从性结果，其中药物治疗依从性定义为服用75％及以上的处方剂量。在69例难治性哮喘患者中，13例患者由于器械不兼容或功能障碍无法最终分析其依从性，余下45例患者中，20例患者（44.4％）依从性差。依从性差的临床评估结果不敏感（医师评估结果为15％，护士评估结果为28％）。依从性差的患者的血清嗜酸性粒细胞较高。若包含11名可能依从性差的患者（设备被拒绝或未返回），依从性差的比率将增加至55％（31/56）。69名患者中，59人符合重症哮喘标准，47名适用于新型治疗，EMD检测发现50%（16/32）患者依从性差，若包括7名可能依从性差的患者，那么依从性差的比率将提高至59％（23/39）。至少一半的符合新药疗法的患者对维持治疗方案依从性差。临床评估通也常无法检测到依从性差。 重症哮喘在采用新型治疗前，必须客观确认控制药物的依从性。
(中国医科大学附属第一医院呼吸与危重症医学科 李文扬 摘译 杨冬 审校)
(Lee J, et al. Eur Respir J. 2018 Mar 8. )
(Lee J, et al. Eur Respir J. 2018 Mar 8. )
Non-adherence in the era of severe asthma biologics and thermoplasty.
Abstract
Non-adherence to inhaled preventers impairs asthma control. Electronic monitoring devices (EMD) can objectively measure adherence. Their use has not been reported in difficult asthma patients potentially suitable for novel therapies, i.e. biologics and bronchial thermoplasty. Consecutive patients with difficult asthma were assessed for eligibility for novel therapies. Medication adherence, defined as taking 75% or more of prescribed doses, was assessed by EMD and compared to standardised clinician assessment over an eight week period. Among 69 difficult asthma patients, adherence could not be analysed in 13, due to device incompatibility or malfunction. Non-adherence was confirmed in 20/45 (44.4%). Clinical assessment of non-adherence was insensitive (physician 15%, nurse 28%). Serum eosinophils were higher in non- adherent patients. Including 11 patients with possible non-adherence (device refused or not returned), increased the non-adherence rate to 31/56 (55%). Severe asthma criteria were fulfilled by 59/69 patients. Forty-seven were eligible for novel therapies, with confirmed non-adherence in 16/32 (50%) with EMD data; including seven patients with possible non-adherence increased the non-adherence rate to 23/39 (59%).At least half the patients eligible for novel therapies were non-adherent to preventers. Non-adherence was often undetectable by clinical assessments. Preventer adherence must be confirmed objectively before employing novel severe asthma therapies.
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