儿童和青少年哮喘的心理干预
2024/01/26
摘要
背景：儿童和青少年哮喘的发病率较高，患有哮喘的年轻人通常报告比没有哮喘的人更差的健康结果。哮喘患有一系列可能导致心理困扰的挑战，这又加剧了在此生命阶段所有人都经历的社会、心理和发展挑战。心理干预（如行为疗法或认知疗法）有潜力减少心理困扰，从而改善自我效能和药物依从性等行为结果。反过来，这可能会减少医疗接触和哮喘发作。
目标：与常规治疗、无心理成分的治疗或无治疗相比，确定心理干预对改变哮喘儿童的健康和行为结果的功效。
搜索方法：我们检索了Cochrane Airways Group专门注册数据库（包括CENTRAL、CRS、MEDLINE、Embase、PsycINFO、CINAHL EBSCO、AMED EBSCO），主要呼吸研究大会的会议记录，已纳入研究的参考文献以及在线临床数据库。最近一次检索是在2022年8月22日进行的。
选择标准：我们纳入了与儿童和青少年（5至18岁）哮喘有关的男性和女性的任何持续时间的心理干预与常规护理、积极对照或等待名单对照的随机对照试验（RCTs）。
数据收集和分析：我们使用标准的Cochrane方法。我们的主要结果是1.焦虑和抑郁症状，2.医疗接触，3.哮喘发作。我们的次要结果包括1.自报告哮喘症状，2.药物使用，3.生活质量，4.不良事件/副作用。
主要结果：我们纳入了24项研究（1639名参与者），时间跨度从1978年到2021年。其中，11项研究在美国进行，5项在中国，2项在瑞典，3项在伊朗，分别有1项在荷兰、英国和德国。参与者的哮喘严重程度从轻度到重度不等。三项研究包括小学阶段的参与者（5至12岁），两项包括中学阶段的参与者（13至18岁），而有18项同时包括两个年龄组，有一项研究对年龄范围不明确。干预的持续时间从三天到八个月不等。有一项干预是在线进行的，其余均为面对面进行。由于临床异质性（干预、人群、结果工具和定义、以及随访时间的长度）的存在，无法进行荟萃分析。我们以结果的方向、幅度和效果的确定性为参考，叙述性地制表和总结了这些结果。所有结果的证据确定性非常低。由于用于测量焦虑、抑郁、哮喘症状、药物使用和生活质量的量表度量标准和最小临床重要差异的信息不足，很难判断临床意义。主要结果方面，有四项研究（327名参与者）报告了心理干预与对照组相比对焦虑症状产生了积极或混合的影响，而一项研究（104名参与者）发现两组之间几乎没有差异。两项评估抑郁症状的研究（166名参与者）均报告了心理干预与对照组相比的益处。三项小型研究（92名参与者）报告了医疗接触的减少，但两项较大的研究（544名参与者）发现两组在这一结果上几乎没有差异。两项研究（107名参与者）发现干预对哮喘发作次数有显著积极影响，而一项小型研究（22名参与者）发现该干预对这一结果几乎没有影响。次要结果方面，有11项研究（720名参与者）评估了哮喘症状；其中有4项研究（322名参与者）报告了干预与对照组相比的益处，5项研究（257名参与者）报告了混合或不明朗的结果，而有2项研究（131名参与者）发现两组之间几乎没有差异。有8项研究（822名参与者）报告了各种药物使用指标；其中有6项研究（670名参与者）发现干预与对照组相比有积极效果，而另外两项研究（152名参与者）发现两组之间几乎没有差异。在报道生活质量指标的6项研究中（653名参与者），其中最大的3项研究（522名参与者）发现两组之间几乎没有差异。在发现为积极或混合的情况下，存在选择性报告的证据（2项研究，131名参与者）。没有研究提供与不良反应相关的数据。
作者的结论：大多数报告焦虑症状、抑郁症状、哮喘发作、哮喘症状和药物使用的研究发现，在至少一项指标上，心理干预与对照组相比有积极效果。然而，一些结果是混合的，难以判断临床重要性，并且由于临床异质性、样本量小、报告不完整和偏倚风险，所有结果的证据都非常不确定。有限的证据表明，心理干预可能减少医疗接触的需求或改善生活质量，但没有研究报告不良事件。由于存在实质性的异质性，无法确定有效干预的组成部分并将其与没有证据效果的干预区分开来。未来的基于证据的心理技术的研究应考虑标准化结果，以支持跨研究比较，并更好地为患者和决策者提供信息。
Psychological interventions for asthma in children and adolescents
Kelsey J Sharrad, Olatokunbo Sanwo, Sofia Cuevas-Asturias, Kayleigh M Kew, Kristin V Carson-Chahhoud, Katharine C Pike
Abstract
Background: Rates of asthma are high in children and adolescents, and young people with asthma generally report poorer health outcomes than those without asthma. Young people with asthma experience a range of challenges that may contribute to psychological distress. This is compounded by the social, psychological, and developmental challenges experienced by all people during this life stage. Psychological interventions (such as behavioural therapies or cognitive therapies) have the potential to reduce psychological distress and thus improve behavioural outcomes such as self-efficacy and medication adherence. In turn, this may reduce medical contacts and asthma attacks.
Objectives: To determine the efficacy of psychological interventions for modifying health and behavioural outcomes in children with asthma, compared with usual treatment, treatment with no psychological component, or no treatment.
Search methods: We searched the Cochrane Airways Group Specialised Register (including CENTRAL, CRS, MEDLINE, Embase, PsycINFO, CINAHL EBSCO, AMED EBSCO), proceedings of major respiratory conferences, reference lists of included studies, and online clinical databases. The most recent search was conducted on 22 August 2022.
Selection criteria: We included randomised controlled trials (RCTs) comparing psychological interventions of any duration with usual care, active controls, or a waiting-list control in male and female children and adolescents (aged five to 18 years) with asthma.
Data collection and analysis: We used standard Cochrane methods. Our primary outcomes were 1. symptoms of anxiety and depression, 2. medical contacts, and 3. asthma attacks. Our secondary outcomes were 1. self-reported asthma symptoms, 2. medication use, 3. quality of life, and 4. adverse events/side effects.
Main results: We included 24 studies (1639 participants) published between 1978 and 2021. Eleven studies were set in the USA, five in China, two in Sweden, three in Iran, and one each in the Netherlands, UK, and Germany. Participants' asthma severity ranged from mild to severe. Three studies included primary school-aged participants (five to 12 years), two included secondary school-aged participants (13 to 18 years), and 18 included both age groups, while one study was unclear on the age ranges. Durations of interventions ranged from three days to eight months. One intervention was conducted online and the rest were face-to-face. Meta-analysis was not possible due to clinical heterogeneity (interventions, populations, outcome tools and definitions, and length of follow-up). We tabulated and summarised the results narratively with reference to direction, magnitude, and certainty of effects. The certainty of the evidence was very low for all outcomes. A lack of information about scale metrics and minimal clinically important differences for the scales used to measure anxiety, depression, asthma symptoms, medication use, and quality of life made it difficult to judge clinical significance. Primary outcomes Four studies (327 participants) reported beneficial or mixed effects of psychological interventions versus controls for symptoms of anxiety, and one found little to no difference between groups (104 participants). Two studies (166 participants) that evaluated symptoms of depression both reported benefits of psychological interventions compared to controls. Three small studies (92 participants) reported a reduction in medical contacts, but two larger studies (544 participants) found little or no difference between groups in this outcome. Two studies (107 participants) found that the intervention had an important beneficial effect on number of asthma attacks, and one small study (22 participants) found little or no effect of the intervention for this outcome. Secondary outcomes Eleven studies (720 participants) assessed asthma symptoms; four (322 participants) reported beneficial effects of the intervention compared to control, five (257 participants) reported mixed or unclear findings, and two (131 participants) found little or no difference between groups. Eight studies (822 participants) reported a variety of medication use measures; six of these studies (670 participants) found a positive effect of the intervention versus control, and the other two (152 participants) found little or no difference between the groups. Across six studies (653 participants) reporting measures of quality of life, the largest three (522 participants) found little or no difference between the groups. Where findings were positive or mixed, there was evidence of selective reporting (2 studies, 131 participants). No studies provided data related to adverse effects.
Authors' conclusions: Most studies that reported symptoms of anxiety, depression, asthma attacks, asthma symptoms, and medication use found a positive effect of psychological interventions versus control on at least one measure. However, some findings were mixed, it was difficult to judge clinical significance, and the evidence for all outcomes is very uncertain due to clinical heterogeneity, small sample sizes, incomplete reporting, and risk of bias. There is limited evidence to suggest that psychological interventions can reduce the need for medical contact or improve quality of life, and no studies reported adverse events. It was not possible to identify components of effective interventions and distinguish these from interventions showing no evidence of an effect due to substantial heterogeneity. Future investigations of evidence-based psychological techniques should consider standardising outcomes to support cross-comparison and better inform patient and policymaker decision-making.
背景：儿童和青少年哮喘的发病率较高，患有哮喘的年轻人通常报告比没有哮喘的人更差的健康结果。哮喘患有一系列可能导致心理困扰的挑战，这又加剧了在此生命阶段所有人都经历的社会、心理和发展挑战。心理干预（如行为疗法或认知疗法）有潜力减少心理困扰，从而改善自我效能和药物依从性等行为结果。反过来，这可能会减少医疗接触和哮喘发作。
目标：与常规治疗、无心理成分的治疗或无治疗相比，确定心理干预对改变哮喘儿童的健康和行为结果的功效。
搜索方法：我们检索了Cochrane Airways Group专门注册数据库（包括CENTRAL、CRS、MEDLINE、Embase、PsycINFO、CINAHL EBSCO、AMED EBSCO），主要呼吸研究大会的会议记录，已纳入研究的参考文献以及在线临床数据库。最近一次检索是在2022年8月22日进行的。
选择标准：我们纳入了与儿童和青少年（5至18岁）哮喘有关的男性和女性的任何持续时间的心理干预与常规护理、积极对照或等待名单对照的随机对照试验（RCTs）。
数据收集和分析：我们使用标准的Cochrane方法。我们的主要结果是1.焦虑和抑郁症状，2.医疗接触，3.哮喘发作。我们的次要结果包括1.自报告哮喘症状，2.药物使用，3.生活质量，4.不良事件/副作用。
主要结果：我们纳入了24项研究（1639名参与者），时间跨度从1978年到2021年。其中，11项研究在美国进行，5项在中国，2项在瑞典，3项在伊朗，分别有1项在荷兰、英国和德国。参与者的哮喘严重程度从轻度到重度不等。三项研究包括小学阶段的参与者（5至12岁），两项包括中学阶段的参与者（13至18岁），而有18项同时包括两个年龄组，有一项研究对年龄范围不明确。干预的持续时间从三天到八个月不等。有一项干预是在线进行的，其余均为面对面进行。由于临床异质性（干预、人群、结果工具和定义、以及随访时间的长度）的存在，无法进行荟萃分析。我们以结果的方向、幅度和效果的确定性为参考，叙述性地制表和总结了这些结果。所有结果的证据确定性非常低。由于用于测量焦虑、抑郁、哮喘症状、药物使用和生活质量的量表度量标准和最小临床重要差异的信息不足，很难判断临床意义。主要结果方面，有四项研究（327名参与者）报告了心理干预与对照组相比对焦虑症状产生了积极或混合的影响，而一项研究（104名参与者）发现两组之间几乎没有差异。两项评估抑郁症状的研究（166名参与者）均报告了心理干预与对照组相比的益处。三项小型研究（92名参与者）报告了医疗接触的减少，但两项较大的研究（544名参与者）发现两组在这一结果上几乎没有差异。两项研究（107名参与者）发现干预对哮喘发作次数有显著积极影响，而一项小型研究（22名参与者）发现该干预对这一结果几乎没有影响。次要结果方面，有11项研究（720名参与者）评估了哮喘症状；其中有4项研究（322名参与者）报告了干预与对照组相比的益处，5项研究（257名参与者）报告了混合或不明朗的结果，而有2项研究（131名参与者）发现两组之间几乎没有差异。有8项研究（822名参与者）报告了各种药物使用指标；其中有6项研究（670名参与者）发现干预与对照组相比有积极效果，而另外两项研究（152名参与者）发现两组之间几乎没有差异。在报道生活质量指标的6项研究中（653名参与者），其中最大的3项研究（522名参与者）发现两组之间几乎没有差异。在发现为积极或混合的情况下，存在选择性报告的证据（2项研究，131名参与者）。没有研究提供与不良反应相关的数据。
作者的结论：大多数报告焦虑症状、抑郁症状、哮喘发作、哮喘症状和药物使用的研究发现，在至少一项指标上，心理干预与对照组相比有积极效果。然而，一些结果是混合的，难以判断临床重要性，并且由于临床异质性、样本量小、报告不完整和偏倚风险，所有结果的证据都非常不确定。有限的证据表明，心理干预可能减少医疗接触的需求或改善生活质量，但没有研究报告不良事件。由于存在实质性的异质性，无法确定有效干预的组成部分并将其与没有证据效果的干预区分开来。未来的基于证据的心理技术的研究应考虑标准化结果，以支持跨研究比较，并更好地为患者和决策者提供信息。
(中日友好医院呼吸与危重症医学科 顾宪民 摘译 林江涛 审校)
(Cochrane Database Syst Rev. 2024 Jan 11;1(1):CD013420. doi: 10.1002/14651858.CD013420.pub2.)
(Cochrane Database Syst Rev. 2024 Jan 11;1(1):CD013420. doi: 10.1002/14651858.CD013420.pub2.)
Psychological interventions for asthma in children and adolescents
Kelsey J Sharrad, Olatokunbo Sanwo, Sofia Cuevas-Asturias, Kayleigh M Kew, Kristin V Carson-Chahhoud, Katharine C Pike
Abstract
Background: Rates of asthma are high in children and adolescents, and young people with asthma generally report poorer health outcomes than those without asthma. Young people with asthma experience a range of challenges that may contribute to psychological distress. This is compounded by the social, psychological, and developmental challenges experienced by all people during this life stage. Psychological interventions (such as behavioural therapies or cognitive therapies) have the potential to reduce psychological distress and thus improve behavioural outcomes such as self-efficacy and medication adherence. In turn, this may reduce medical contacts and asthma attacks.
Objectives: To determine the efficacy of psychological interventions for modifying health and behavioural outcomes in children with asthma, compared with usual treatment, treatment with no psychological component, or no treatment.
Search methods: We searched the Cochrane Airways Group Specialised Register (including CENTRAL, CRS, MEDLINE, Embase, PsycINFO, CINAHL EBSCO, AMED EBSCO), proceedings of major respiratory conferences, reference lists of included studies, and online clinical databases. The most recent search was conducted on 22 August 2022.
Selection criteria: We included randomised controlled trials (RCTs) comparing psychological interventions of any duration with usual care, active controls, or a waiting-list control in male and female children and adolescents (aged five to 18 years) with asthma.
Data collection and analysis: We used standard Cochrane methods. Our primary outcomes were 1. symptoms of anxiety and depression, 2. medical contacts, and 3. asthma attacks. Our secondary outcomes were 1. self-reported asthma symptoms, 2. medication use, 3. quality of life, and 4. adverse events/side effects.
Main results: We included 24 studies (1639 participants) published between 1978 and 2021. Eleven studies were set in the USA, five in China, two in Sweden, three in Iran, and one each in the Netherlands, UK, and Germany. Participants' asthma severity ranged from mild to severe. Three studies included primary school-aged participants (five to 12 years), two included secondary school-aged participants (13 to 18 years), and 18 included both age groups, while one study was unclear on the age ranges. Durations of interventions ranged from three days to eight months. One intervention was conducted online and the rest were face-to-face. Meta-analysis was not possible due to clinical heterogeneity (interventions, populations, outcome tools and definitions, and length of follow-up). We tabulated and summarised the results narratively with reference to direction, magnitude, and certainty of effects. The certainty of the evidence was very low for all outcomes. A lack of information about scale metrics and minimal clinically important differences for the scales used to measure anxiety, depression, asthma symptoms, medication use, and quality of life made it difficult to judge clinical significance. Primary outcomes Four studies (327 participants) reported beneficial or mixed effects of psychological interventions versus controls for symptoms of anxiety, and one found little to no difference between groups (104 participants). Two studies (166 participants) that evaluated symptoms of depression both reported benefits of psychological interventions compared to controls. Three small studies (92 participants) reported a reduction in medical contacts, but two larger studies (544 participants) found little or no difference between groups in this outcome. Two studies (107 participants) found that the intervention had an important beneficial effect on number of asthma attacks, and one small study (22 participants) found little or no effect of the intervention for this outcome. Secondary outcomes Eleven studies (720 participants) assessed asthma symptoms; four (322 participants) reported beneficial effects of the intervention compared to control, five (257 participants) reported mixed or unclear findings, and two (131 participants) found little or no difference between groups. Eight studies (822 participants) reported a variety of medication use measures; six of these studies (670 participants) found a positive effect of the intervention versus control, and the other two (152 participants) found little or no difference between the groups. Across six studies (653 participants) reporting measures of quality of life, the largest three (522 participants) found little or no difference between the groups. Where findings were positive or mixed, there was evidence of selective reporting (2 studies, 131 participants). No studies provided data related to adverse effects.
Authors' conclusions: Most studies that reported symptoms of anxiety, depression, asthma attacks, asthma symptoms, and medication use found a positive effect of psychological interventions versus control on at least one measure. However, some findings were mixed, it was difficult to judge clinical significance, and the evidence for all outcomes is very uncertain due to clinical heterogeneity, small sample sizes, incomplete reporting, and risk of bias. There is limited evidence to suggest that psychological interventions can reduce the need for medical contact or improve quality of life, and no studies reported adverse events. It was not possible to identify components of effective interventions and distinguish these from interventions showing no evidence of an effect due to substantial heterogeneity. Future investigations of evidence-based psychological techniques should consider standardising outcomes to support cross-comparison and better inform patient and policymaker decision-making.
上一篇：
经皮递送耐受性纳米颗粒诱导哮喘治疗的有效免疫耐受
下一篇：
重症嗜酸性粒细胞性哮喘患者贝那利珠单抗治疗中每日维持吸入糖皮质激素减量研究：一项随机多中心开放标签4期临床试验
