U-BIOPRED队列中重症哮喘患者口服皮质类固醇药物的依从性
2021/03/22
摘要
背景：虽然估计哮喘患者口服皮质类固醇的次优依从性在30%到50%之间，但还没有理想的测量方法；重症哮喘依从性差可能造成非常坏的影响。
研究问题：1.通过自我报告和直接测量发现的次优依从率是多少？2不理想的依从性与疾病活动有关吗？
研究设计和方法：数据来源于参加U-BIOPRED研究每天口服皮质类固醇的重症哮喘患者。参与者完成了MARS，一份五项问卷，用于在1到5的范围内对依从性进行分级，并提供了一份尿液样本，用于液相色谱-质谱法分析泼尼松龙及其代谢物。
结果：166名受试者的平均年龄为54.2岁（11.9岁），FEV1预测值为65.1%（20.5%），女性占58%。37%完成MARS试验的受试者报告其依从性不理想，43%的受试者尿中未检测到强的松或代谢物。两种方法的依从性均良好的受试者占35%，两种方法的依从性检测不匹配的占53%。自我报告的高依从性者有更好的哮喘控制和生活质量，而直接测量的高依从性者有较低的血嗜酸性粒细胞。
解释：无论是直接测量还是自我报告，重症哮喘患者的依从性低是一个常见问题。我们报告了两种方法之间的不一致性，这表明药物依从性的自我评估和定时口服皮质类固醇之间存在某种脱节，这表明每种方法都可能在临床实践中提供补充信息。
Medication adherence in patients with severe asthma prescribed oral corticosteroids in the U-BIOPRED cohort
Fahad H Alahmadi, Andrew J Simpson, Cristina Gomez, Magnus Ericsson, John-Olof Thörngren, Craig Wheelock, Dominic E Shaw, Louise J Fleming, Graham Roberts, John Riley, Stewart Bates, Ana R Sousa, Richard Knowles, Aruna T Bansal, Julie Corfield, Ioannis Pandis, Kai Sun, Per S Bakke, Massimo Caruso, Pascal Chanez, Barbro Dahlén, Ildiko Horvath, Norbert Krug, Paolo Montuschi, Florian Singer, Scott Wagers, Ian M Adcock, Ratko Djukanovic, Kian Fan Chung, Peter J Sterk, Sven-Erik Dahlen, Stephen J Fowler, U-BIOPRED Study Group
Abstract
Background: Whilst estimates of sub-optimal adherence to oral corticosteroids in asthma range from 30 to 50%, no ideal method for measurement exists; the impact of poor adherence in severe asthma is likely to be particularly high.
Research questions: 1. What is the prevalence of suboptimal adherence detected using self-reporting and direct measures? 2. Is suboptimal adherence associated with disease activity?
Study design and methods: Data were included from individuals with severe asthma taking part in the U-BIOPRED study prescribed daily oral corticosteroids. Participants completed the MARS, a five-item questionnaire used to grade adherence on a scale from 1 to 5, and provided a urine sample for analysis of prednisolone and metabolites by liquid-chromatography mass spectrometry.
Results: Data from 166 participants were included in this study, mean (SD) age 54.2 (11.9) years, FEV1 65.1 (20.5) % predicted, 58% female. 37% completing the MARS reported sub-optimal adherence, and 43% with urinary corticosteroid data did not have detectable prednisolone or metabolites in their urine. Good adherence by both methods was detected in 35% participants who had both performed; adherence detection did not match between methods in 53%. Self-reported high-adherers had better asthma control and quality of life, whereas directly-measured high-adherers had lower blood eosinophils.
Interpretation: Low adherence is a common problem in severe asthma, whether measured directly or self-reported. We report poor agreement between the two methods suggesting some disassociation between self-assessment of medication adherence and regular oral corticosteroid use, which suggests that each approach may provide complementary information in clinical practice.
背景：虽然估计哮喘患者口服皮质类固醇的次优依从性在30%到50%之间，但还没有理想的测量方法；重症哮喘依从性差可能造成非常坏的影响。
研究问题：1.通过自我报告和直接测量发现的次优依从率是多少？2不理想的依从性与疾病活动有关吗？
研究设计和方法：数据来源于参加U-BIOPRED研究每天口服皮质类固醇的重症哮喘患者。参与者完成了MARS，一份五项问卷，用于在1到5的范围内对依从性进行分级，并提供了一份尿液样本，用于液相色谱-质谱法分析泼尼松龙及其代谢物。
结果：166名受试者的平均年龄为54.2岁（11.9岁），FEV1预测值为65.1%（20.5%），女性占58%。37%完成MARS试验的受试者报告其依从性不理想，43%的受试者尿中未检测到强的松或代谢物。两种方法的依从性均良好的受试者占35%，两种方法的依从性检测不匹配的占53%。自我报告的高依从性者有更好的哮喘控制和生活质量，而直接测量的高依从性者有较低的血嗜酸性粒细胞。
解释：无论是直接测量还是自我报告，重症哮喘患者的依从性低是一个常见问题。我们报告了两种方法之间的不一致性，这表明药物依从性的自我评估和定时口服皮质类固醇之间存在某种脱节，这表明每种方法都可能在临床实践中提供补充信息。
(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)
(Chest. 2021 Feb 18;S0012-3692(21)00288-9. doi: 10.1016/j.chest.2021.02.023.)
(Chest. 2021 Feb 18;S0012-3692(21)00288-9. doi: 10.1016/j.chest.2021.02.023.)
Medication adherence in patients with severe asthma prescribed oral corticosteroids in the U-BIOPRED cohort
Fahad H Alahmadi, Andrew J Simpson, Cristina Gomez, Magnus Ericsson, John-Olof Thörngren, Craig Wheelock, Dominic E Shaw, Louise J Fleming, Graham Roberts, John Riley, Stewart Bates, Ana R Sousa, Richard Knowles, Aruna T Bansal, Julie Corfield, Ioannis Pandis, Kai Sun, Per S Bakke, Massimo Caruso, Pascal Chanez, Barbro Dahlén, Ildiko Horvath, Norbert Krug, Paolo Montuschi, Florian Singer, Scott Wagers, Ian M Adcock, Ratko Djukanovic, Kian Fan Chung, Peter J Sterk, Sven-Erik Dahlen, Stephen J Fowler, U-BIOPRED Study Group
Abstract
Background: Whilst estimates of sub-optimal adherence to oral corticosteroids in asthma range from 30 to 50%, no ideal method for measurement exists; the impact of poor adherence in severe asthma is likely to be particularly high.
Research questions: 1. What is the prevalence of suboptimal adherence detected using self-reporting and direct measures? 2. Is suboptimal adherence associated with disease activity?
Study design and methods: Data were included from individuals with severe asthma taking part in the U-BIOPRED study prescribed daily oral corticosteroids. Participants completed the MARS, a five-item questionnaire used to grade adherence on a scale from 1 to 5, and provided a urine sample for analysis of prednisolone and metabolites by liquid-chromatography mass spectrometry.
Results: Data from 166 participants were included in this study, mean (SD) age 54.2 (11.9) years, FEV1 65.1 (20.5) % predicted, 58% female. 37% completing the MARS reported sub-optimal adherence, and 43% with urinary corticosteroid data did not have detectable prednisolone or metabolites in their urine. Good adherence by both methods was detected in 35% participants who had both performed; adherence detection did not match between methods in 53%. Self-reported high-adherers had better asthma control and quality of life, whereas directly-measured high-adherers had lower blood eosinophils.
Interpretation: Low adherence is a common problem in severe asthma, whether measured directly or self-reported. We report poor agreement between the two methods suggesting some disassociation between self-assessment of medication adherence and regular oral corticosteroid use, which suggests that each approach may provide complementary information in clinical practice.
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