初级医疗保健机构中避免接触过敏原和触发因素的建议对哮喘控制的影响：随机对照试验
2009/12/15
背景：过敏反应能明显促使哮喘恶化，然而，在初级医疗保健机构中少有详细阐述避免接触触发因素，特别是过敏原，在常规哮喘控制中的作用。
目的：本试验旨在研究作为初级医疗保健机构哮喘控制的一部分，避免接触过敏原和触发因素的结构化、个性化建议是否能够改善肺功能和哮喘控制。
方法：在此项随机对照试验中，6个普通初级医疗保健机构的214名成人哮喘患者入选。根据标准程式，患者由经过培训的护理人员给予初级医疗保健机构具备的常规护理或额外给予鉴别过敏原（基于皮肤点刺试验和结构化过敏反应评价）及避免接触过敏原和触发因素建议。主要检测结果包括肺功能、哮喘控制和哮喘自我效能。
结果：两组患者在基线状态下的人口统计学及哮喘相关变量未见显著差异。经过3～6个月的随访，与常规护理患者相比，接受避免过敏原和触发因素建议的患者的肺功能显著改善（由对本研究不知情的护理人员评价）。接受建议组第1秒用力呼气量≥15％的患者人数显著多于对照组。自我评价的哮喘控制方面两组未见显著差异。两组患者的哮喘特异性自我效能均有所改善，但两组无显著性差异。
结论：过敏原和触发因素鉴别及避免上述因素的建议，作为初级医疗保健机构中哮喘控制措施的一部分，能有效改善肺功能，但对自我报告的哮喘控制未见显著影响。
（林江涛 审校）
Clin Exp Allergy. 2009 Sep 28.
Effects of allergen and trigger factor avoidance advice in primary care on asthma control: a randomized-controlled trial.
Bobb C, Ritz T, Rowlands G, Griffiths C.
Summary Background Allergy contributes significantly to asthma exacerbation, yet avoidance of triggers, in particular allergens, is rarely addressed in detail in regular asthma review in primary care. Objective To determine whether structured, individually tailored allergen and trigger avoidance advice, given as part of a primary care asthma review, improves lung function and asthma control. Methods In a randomized-controlled trial 214 adults with asthma in six general practices were either offered usual care during a primary care asthma review or usual care with additional allergen and trigger identification (by skin prick testing and structured allergy assessment) and avoidance advice according to a standardized protocol by trained practice nurses. Main outcome measures were lung function, asthma control, asthma self-efficacy. Results Both intervention groups were equivalent in demographic and asthma-related variables at baseline. At 3-6-month follow-up, patients receiving the allergen and trigger avoidance review showed significant improvements in lung function (assessed by blinded research nurses) compared with those receiving usual care. Significantly more patients in the intervention group than in the control group showed improvements in forced expiratory volume in 1 s >/=15%. No significant differences were found in self-report measures of asthma control. Asthma-specific self-efficacy improved in both groups but did not differ between groups. Conclusions Allergen and trigger identification and avoidance advice, given as part of a structured asthma review delivered in primary care by nurses results in clinically important improvements in lung function but not self-report of asthma control
Bobb C, Ritz T, Rowlands G, et al. Clin Exp Allergy. 2009 Sep 28.
目的：本试验旨在研究作为初级医疗保健机构哮喘控制的一部分，避免接触过敏原和触发因素的结构化、个性化建议是否能够改善肺功能和哮喘控制。
方法：在此项随机对照试验中，6个普通初级医疗保健机构的214名成人哮喘患者入选。根据标准程式，患者由经过培训的护理人员给予初级医疗保健机构具备的常规护理或额外给予鉴别过敏原（基于皮肤点刺试验和结构化过敏反应评价）及避免接触过敏原和触发因素建议。主要检测结果包括肺功能、哮喘控制和哮喘自我效能。
结果：两组患者在基线状态下的人口统计学及哮喘相关变量未见显著差异。经过3～6个月的随访，与常规护理患者相比，接受避免过敏原和触发因素建议的患者的肺功能显著改善（由对本研究不知情的护理人员评价）。接受建议组第1秒用力呼气量≥15％的患者人数显著多于对照组。自我评价的哮喘控制方面两组未见显著差异。两组患者的哮喘特异性自我效能均有所改善，但两组无显著性差异。
结论：过敏原和触发因素鉴别及避免上述因素的建议，作为初级医疗保健机构中哮喘控制措施的一部分，能有效改善肺功能，但对自我报告的哮喘控制未见显著影响。
（林江涛 审校）
Clin Exp Allergy. 2009 Sep 28.
Effects of allergen and trigger factor avoidance advice in primary care on asthma control: a randomized-controlled trial.
Bobb C, Ritz T, Rowlands G, Griffiths C.
Summary Background Allergy contributes significantly to asthma exacerbation, yet avoidance of triggers, in particular allergens, is rarely addressed in detail in regular asthma review in primary care. Objective To determine whether structured, individually tailored allergen and trigger avoidance advice, given as part of a primary care asthma review, improves lung function and asthma control. Methods In a randomized-controlled trial 214 adults with asthma in six general practices were either offered usual care during a primary care asthma review or usual care with additional allergen and trigger identification (by skin prick testing and structured allergy assessment) and avoidance advice according to a standardized protocol by trained practice nurses. Main outcome measures were lung function, asthma control, asthma self-efficacy. Results Both intervention groups were equivalent in demographic and asthma-related variables at baseline. At 3-6-month follow-up, patients receiving the allergen and trigger avoidance review showed significant improvements in lung function (assessed by blinded research nurses) compared with those receiving usual care. Significantly more patients in the intervention group than in the control group showed improvements in forced expiratory volume in 1 s >/=15%. No significant differences were found in self-report measures of asthma control. Asthma-specific self-efficacy improved in both groups but did not differ between groups. Conclusions Allergen and trigger identification and avoidance advice, given as part of a structured asthma review delivered in primary care by nurses results in clinically important improvements in lung function but not self-report of asthma control
Bobb C, Ritz T, Rowlands G, et al. Clin Exp Allergy. 2009 Sep 28.
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非特应性哮喘及反流患儿支气管高反应性：抗反流治疗的作用
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腺甘酸受体作为哮喘和慢性阻塞性肺疾病干预治疗的靶点
