儿童和青少年哮喘控制器依从性评价
2020/07/13
摘要
背景：哮喘控制器依从性低会增加疾病控制不佳和不良健康事件风险。我们的目的是研究影响儿童和青少年哮喘患者长期使用缓解性药物依从性的危险因素。
方法：在三级儿科哮喘病门诊，根据医生处方和药房数据，使用覆盖天数百分比（PDC）这一指标对155例哮喘患儿2年内的依从性进行评估。危险因素分析包括年龄、性别、种族、BMI、特应性共患病、肺活量百分比和呼出一氧化氮（FeNO）分数。
结果：95名儿童，50名（53%）男性，平均年龄16.3岁（SD，2.36），在研究期间至少接受了一种哮喘控制药物处方。52名（54%）儿童被归类为不依从性，PDC截止值为80%。依从性与年龄呈负相关：依从率（AR）0.84（95%CI，0.73-0.95），p=0.008；1秒用力呼气量（FEV1）：AR/L 0.6（0.91-1.0），p=0.03；吸入β2激动剂：AR 0.45（0.23-0.89），p=0.02；FeNO：AR/ppb 0.98（0.97-0.99），p=0.03，多因素分析中年龄和FeNO具有显著性。哮喘控制器的类型和数量与依从性无关。
结论：本研究显示半数哮喘儿童对缓解性药物的依从性较低，与年龄的增长和FeNO水平有关。因此，对于青少年从儿童医学过渡到成人医学时，需对吸入激素治疗后FeNO仍升高的患者进行额外关注，以增加他们对哮喘控制器的依从性。
Assessment of Adherence to Asthmacontrollers in Children and Adolescents
M Marckmann, M N Hermansen, K S Hansen, B L Chawes
Abstract
Background: Low adherence to asthma controllers is known to increase the risk of uncontrolled disease and poor health outcomes. We aimed to study risk factors of long-term adherence to preventive medications in children and adolescents with asthma.
Methods: Adherence was assessed during atwo-year period in 155 children with asthma followed in a tertiary pediatric asthma outpatient clinic using percentage of days covered (PDC) based on physician prescriptions and pharmacy claims data. The risk factor analysis included age, sex, ethnicity, BMI, atopic comorbidity, spirometryincentives and fractional exhaled nitric oxide (FeNO).
Results: Ninety-five children, 50 (53%) males, mean age 16.3years (SD, 2.36), received at least one prescription for asthma controllers in the study period. Fifty-two (54%) children were classified as non-adherent with a PDC cut-off at 80%. Adherence was negatively associated with age: adherence ratio (AR) 0.84 (95% CI, 0.73-0.95), p=0.008; forced expiratory volume in 1st s (FEV1): AR per L 0.6 (0.91-1.0), p=0.03; unfilled inhaled beta-2-agonist prescription: AR 0.45 (0.23-0.89), p=0.02; and FeNO level: AR per ppb 0.98 (0.97-0.99), p=0.03, where age and FeNO retained significance in multivariate analysis. Type and number of asthma controllers were not associated with adherence.
Conclusions: This study shows low adherence to preventive medication among half of children with asthma, which is associated with increasing age and FeNO level. Therefore, an extra effort should be directed towards teenagers transitioning from pediatric to adult medicine and towards inhaled corticosteroid-treated patients with elevated FeNO to increase their adherence to asthma controllers.
背景：哮喘控制器依从性低会增加疾病控制不佳和不良健康事件风险。我们的目的是研究影响儿童和青少年哮喘患者长期使用缓解性药物依从性的危险因素。
方法：在三级儿科哮喘病门诊，根据医生处方和药房数据，使用覆盖天数百分比（PDC）这一指标对155例哮喘患儿2年内的依从性进行评估。危险因素分析包括年龄、性别、种族、BMI、特应性共患病、肺活量百分比和呼出一氧化氮（FeNO）分数。
结果：95名儿童，50名（53%）男性，平均年龄16.3岁（SD，2.36），在研究期间至少接受了一种哮喘控制药物处方。52名（54%）儿童被归类为不依从性，PDC截止值为80%。依从性与年龄呈负相关：依从率（AR）0.84（95%CI，0.73-0.95），p=0.008；1秒用力呼气量（FEV1）：AR/L 0.6（0.91-1.0），p=0.03；吸入β2激动剂：AR 0.45（0.23-0.89），p=0.02；FeNO：AR/ppb 0.98（0.97-0.99），p=0.03，多因素分析中年龄和FeNO具有显著性。哮喘控制器的类型和数量与依从性无关。
结论：本研究显示半数哮喘儿童对缓解性药物的依从性较低，与年龄的增长和FeNO水平有关。因此，对于青少年从儿童医学过渡到成人医学时，需对吸入激素治疗后FeNO仍升高的患者进行额外关注，以增加他们对哮喘控制器的依从性。
(中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校)
(Pediatr Allergy Immunol. 2020 Jun 23. doi: 10.1111/pai.13312.)
(Pediatr Allergy Immunol. 2020 Jun 23. doi: 10.1111/pai.13312.)
Assessment of Adherence to Asthmacontrollers in Children and Adolescents
M Marckmann, M N Hermansen, K S Hansen, B L Chawes
Abstract
Background: Low adherence to asthma controllers is known to increase the risk of uncontrolled disease and poor health outcomes. We aimed to study risk factors of long-term adherence to preventive medications in children and adolescents with asthma.
Methods: Adherence was assessed during atwo-year period in 155 children with asthma followed in a tertiary pediatric asthma outpatient clinic using percentage of days covered (PDC) based on physician prescriptions and pharmacy claims data. The risk factor analysis included age, sex, ethnicity, BMI, atopic comorbidity, spirometryincentives and fractional exhaled nitric oxide (FeNO).
Results: Ninety-five children, 50 (53%) males, mean age 16.3years (SD, 2.36), received at least one prescription for asthma controllers in the study period. Fifty-two (54%) children were classified as non-adherent with a PDC cut-off at 80%. Adherence was negatively associated with age: adherence ratio (AR) 0.84 (95% CI, 0.73-0.95), p=0.008; forced expiratory volume in 1st s (FEV1): AR per L 0.6 (0.91-1.0), p=0.03; unfilled inhaled beta-2-agonist prescription: AR 0.45 (0.23-0.89), p=0.02; and FeNO level: AR per ppb 0.98 (0.97-0.99), p=0.03, where age and FeNO retained significance in multivariate analysis. Type and number of asthma controllers were not associated with adherence.
Conclusions: This study shows low adherence to preventive medication among half of children with asthma, which is associated with increasing age and FeNO level. Therefore, an extra effort should be directed towards teenagers transitioning from pediatric to adult medicine and towards inhaled corticosteroid-treated patients with elevated FeNO to increase their adherence to asthma controllers.
上一篇：
难治性哮喘的新观点；基于性别和年龄的哮喘发病表型
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INITIAL研究中初始治疗和控制状态的事后分析：一项新诊断哮喘患者的观察性研究
