个体化的哮喘自我管理能改善药物治疗的依从性和哮喘控制指标
2009/06/24
背景：对抗炎症治疗的依从性和自我管理技能是哮喘治疗计划中获得哮喘控制改善和防止哮喘加重的基本组成部分。对患者的自我管理教育能否改善长期的药物治疗的依从性尚不清楚。
目的：开展一项为期24周的前瞻性、随机对照试验，研究自我管理教育对吸入糖皮质激素（ISC）治疗的长期依从性和哮喘控控制指标的影响。
方法：在导入阶段规律进行ISC药物治疗后，从大都市社区中纳入95名中-重度成人哮喘患者，84例随机进行个体化自我管理教育，包括自我监测症状、最大呼吸流量或使用单独自我监测的常规护理。30分钟干预的主要组成内容为哮喘知识教育、评价和校正吸入方法、根据自我监测数据制定个体化行动方案、以及与过敏和刺激暴露相关的环境控制策略。以2周为1个周期，根据肺功能、皮肤过敏试验反应、吸入激素技术和强化措施对干预措施进行个体化调整。
结果：随机入自我管理干预组的患者对ICS始终保持较高的依从性，且在干预结束时，对处方剂量的依从性大于60%，较对照人群高9倍（P=0.02）；同时，研究结束时对处方剂量的依从性大于60%，较对照人群高3倍。与对照人群相比，干预人群对哮喘控制的认知度提升（P=0.006）、夜间觉醒减少（P=0.03），并且吸入b-受体激动剂使用减少（P=0.01）.
结论：我们的结果显示，进行个体化哮喘自我管理教育能减少患者对药物的依赖性和改善哮喘控制的临床指标。
（刘国梁 审校）
Janson SL,et al. J Allergy Clin Immunol. 2009 Apr;123(4):840-846.
Individualized asthma self-management improves medication adherence and markers of asthma control.
BACKGROUND: Adherence to inhaled anti-inflammatory therapy and self-management skills are essential parts of the asthma treatment plan to improve asthma control and prevent exacerbations. Whether self-management education improves long-term medication adherence is less clear.
OBJECTIVE: A 24-week prospective, randomized controlled trial was performed to study the effect of self-management education on long-term adherence to inhaled corticosteroid (ICS) therapy and markers of asthma control.
METHODS: After stabilization on ICS medication during a run-in phase, 95 adults with moderate-to-severe asthma were recruited from a large metropolitan community, and 84 were randomized to individualized self-management education, including self-monitoring of symptoms and peak flow or usual care with self-monitoring alone. The key components of the 30-minute intervention were asthma information, assessment, and correction of inhaler technique; an individualized action plan based on self-monitoring data; and environmental control strategies for relevant allergen and irritant exposures. The intervention was personalized based on pulmonary function, allergen skin test reactivity, and inhaler technique and reinforced at 2-week intervals.
RESULTS: Participants randomized to the self-management intervention maintained consistently higher ICS adherence levels and showed a 9-fold greater odds of more than 60% adherence to the prescribed dose compared with control subjects at the end of the intervention (P = .02) and maintained a 3-fold greater odds of higher than 60% adherence at the end of the study. Perceived control of asthma improved (P = .006), nighttime awakenings decreased (P = .03), and inhaled beta-agonist use decreased (P = .01) in intervention participants compared with control subjects.
CONCLUSION: Our results show that individualized asthma self-management education attenuates the usual decrease in medication adherence and improves clinical markers of asthma control.
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住院成人患者的哮喘管理医疗记录不足
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控制哮喘的自我管理计划及患者对其依从性的预测因子
