哮喘和 COPD 患者吸入药物的使用和吸入技术：一项随机对照试验数据
2020/01/02
摘要
背景：哮喘和COPD的患病人数众多，受影响的患者常因病情加重而住院治疗。在哮喘和COPD患者中疾病缺乏控制的原因有很多，多与不遵守医疗保健提供者的指导方针以及吸入技术差和/或患者不遵守规定的治疗计划有关。本研究旨在通过一项关于药物依从性的随机对照试验，介绍吸入器技术及其对典型慢性肺病患者生活质量（QoL）和症状控制的影响。
方法：在这项该横断面研究中，我们分析了165名哮喘和COPD患者，通过针对每种类型吸入器的预设检查表测试吸入装置使用是否正确，并通过COPD评估测试（CAT）和哮喘控制测试（ACT）研究QoL和症状控制。肺活量测定用于测量用力肺活量（FVC）和一秒钟用力呼气量（FEV1）。
结果：总体而言，在不同类型的吸入器中，不正确的吸入技术占0%-53％。与正确应用吸入装置的患者相比，未能正确应用吸入装置的COPD患者具有更高的CAT总分（P =0 .02）。此外，设备应用不正确的COPD患者更容易发作咳嗽（P= 0.03），并且在上坡或上楼梯时更加气喘（P = 0.02）。虽然在哮喘患者中未发现统计性差异，但在COPD患者中，能够正确使用吸入设备者在基线时FEV1％预计值显著优于不能正确使用相应设备者（P = 0.04）。
结论：正确吸入处方药与改善健康状况和肺功能密切相关。这些发现提醒卫生专业人员应提供正确的吸入技术说明，并定期评估患者的吸入技术。
Use and inhalation technique of inhaled medication in patients with asthma and
COPD: data from a randomized controlled trial.
Gregoriano C, et al. Respir Res. 2018 Dec 3.
Abstract
Background： The burden of asthma and COPD among patients is high and people affected are frequently hospitalized due to exacerbations. There are numerous reasons for the lack of disease control in asthma and COPD patients. It is associated with non-adherence to guidelines on the part of the health care provider and with poor inhalation technique and/or non-adherence to the prescribed treatment plan by the patient. This study aims to present data on inhaler technique and its impact on quality of life (QoL) and symptom control in a typical population of patients with chronic lung disease from a randomized controlled trial on medication adherence.
Methods ：For this cross-sectional analysis, 165 asthma and COPD patients were analyzed. Correct application of inhaler devices was tested using pre-defined checklists for each inhaler type. QoL and symptom control were investigated using COPD Assessment Test (CAT) and Asthma Control Test (ACT). Spirometry was used to measure forced vital capacity (FVC) and forced expiratory volume in one second (FEV1).
Results ：Overall, incorrect inhalation technique ranged from 0 to 53% depending on the type of inhaler. COPD patients with incorrect device application had a higher CAT sum score compared to those with a correct device application (P = .02). Moreover, COPD patients with incorrect device application were more likely to suffer from cough (P = .03) and were more breathless while walking uphill or a flight of stairs (P = .02). While there was no significance found in asthma patients, COPD patients who used their devices correctly had a significantly better mean FEV1% predicted at baseline compared to those who applied their devices incorrectly (P = .04).
Conclusions ：Correct inhalation of prescribed medication is associated with improved health status and lung function. These findings should encourage health professionals to provide instructions on correct inhalation technique and to regularly re-evaluate the patients’ inhalation technique.
背景：哮喘和COPD的患病人数众多，受影响的患者常因病情加重而住院治疗。在哮喘和COPD患者中疾病缺乏控制的原因有很多，多与不遵守医疗保健提供者的指导方针以及吸入技术差和/或患者不遵守规定的治疗计划有关。本研究旨在通过一项关于药物依从性的随机对照试验，介绍吸入器技术及其对典型慢性肺病患者生活质量（QoL）和症状控制的影响。
方法：在这项该横断面研究中，我们分析了165名哮喘和COPD患者，通过针对每种类型吸入器的预设检查表测试吸入装置使用是否正确，并通过COPD评估测试（CAT）和哮喘控制测试（ACT）研究QoL和症状控制。肺活量测定用于测量用力肺活量（FVC）和一秒钟用力呼气量（FEV1）。
结果：总体而言，在不同类型的吸入器中，不正确的吸入技术占0%-53％。与正确应用吸入装置的患者相比，未能正确应用吸入装置的COPD患者具有更高的CAT总分（P =0 .02）。此外，设备应用不正确的COPD患者更容易发作咳嗽（P= 0.03），并且在上坡或上楼梯时更加气喘（P = 0.02）。虽然在哮喘患者中未发现统计性差异，但在COPD患者中，能够正确使用吸入设备者在基线时FEV1％预计值显著优于不能正确使用相应设备者（P = 0.04）。
结论：正确吸入处方药与改善健康状况和肺功能密切相关。这些发现提醒卫生专业人员应提供正确的吸入技术说明，并定期评估患者的吸入技术。
(中国医科大学附属一院呼吸与危重症学科 李文扬 摘译 杨冬 审校)
(Gregoriano C, et al. Respir Res. 2018 Dec 3.)
(Gregoriano C, et al. Respir Res. 2018 Dec 3.)
Use and inhalation technique of inhaled medication in patients with asthma and
COPD: data from a randomized controlled trial.
Gregoriano C, et al. Respir Res. 2018 Dec 3.
Abstract
Background： The burden of asthma and COPD among patients is high and people affected are frequently hospitalized due to exacerbations. There are numerous reasons for the lack of disease control in asthma and COPD patients. It is associated with non-adherence to guidelines on the part of the health care provider and with poor inhalation technique and/or non-adherence to the prescribed treatment plan by the patient. This study aims to present data on inhaler technique and its impact on quality of life (QoL) and symptom control in a typical population of patients with chronic lung disease from a randomized controlled trial on medication adherence.
Methods ：For this cross-sectional analysis, 165 asthma and COPD patients were analyzed. Correct application of inhaler devices was tested using pre-defined checklists for each inhaler type. QoL and symptom control were investigated using COPD Assessment Test (CAT) and Asthma Control Test (ACT). Spirometry was used to measure forced vital capacity (FVC) and forced expiratory volume in one second (FEV1).
Results ：Overall, incorrect inhalation technique ranged from 0 to 53% depending on the type of inhaler. COPD patients with incorrect device application had a higher CAT sum score compared to those with a correct device application (P = .02). Moreover, COPD patients with incorrect device application were more likely to suffer from cough (P = .03) and were more breathless while walking uphill or a flight of stairs (P = .02). While there was no significance found in asthma patients, COPD patients who used their devices correctly had a significantly better mean FEV1% predicted at baseline compared to those who applied their devices incorrectly (P = .04).
Conclusions ：Correct inhalation of prescribed medication is associated with improved health status and lung function. These findings should encourage health professionals to provide instructions on correct inhalation technique and to regularly re-evaluate the patients’ inhalation technique.
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使用植物花粉片剂进行免疫治疗可减少过敏性鼻炎和哮喘的药物使用：一项来自法国的回顾性数据库研究
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