家中口服糖皮质激素，能预防哮喘急诊就诊和住院：我们是否遵循国家指南
2010/11/04
摘要
背景：自1991年开始，NIH/NHLBI指南就将口服糖皮质激素（OCS）作为哮喘恶化的家庭处理手段。作为书面行动计划的一个常规组成，家庭OCS治疗与急诊就医（ED）和住院率下降及死亡率降低相关。
方法：通过检索PubMed, EMBASE和SCOPUS 数据库中1991～2009年间的英文文献，来评价对国家指南中哮喘恶化家庭处理的依从性。
结果：检索结果显示，一些研究发现，少部分（<3-26%）患者在急诊就诊前，采用OCS进行哮喘恶化的家庭处理。其他研究显示，采用书面行动计划的比率较低，表明采用OCS进行哮喘恶化家庭处理的比率很低。
结论：尽管有证据显示急诊就医和住院率呈现下降，而且国家和国际指南推荐采用OCS进行哮喘恶化的家庭治疗，但有关该治疗的使用率很低。需要采用新的方法，促进采用OCS进行哮喘恶化的家庭治疗，并将其作为书面行动计划一部分，预防急诊就医和住院。
（苏楠 审校）
J Asthma. 2010 Sep 13. [Epub ahead of print]
Preventing emergency department visits and hospitalizations for asthma by use of oral corticosteroids at home: Are we adhering to national guidelines?
Self TH, Chrisman CR, Jacobs AR, Vo NH, Winton JC.
University of Tennessee Health Science Center and Methodist University Hospital, Memphis, TN, USA.
Abstract
Background: Oral corticosteroids (OCS) in the home management of asthma exacerbations have been recommended in the NIH/NHLBI guidelines since 1991. As a routine component of written action plans, OCS treatment at home is associated with reduced emergency department (ED) visits and hospitalizations as well as decreased mortality.
Methods: A literature search of English language journals from 1991 to 2009 was performed using several databases, including PubMed, EMBASE, and SCOPUS. We assessed studies that evaluated adherence to national guidelines for home management of asthma exacerbations.
Results: Our review of the literature found that several studies reveal that a small percentage (<3-26%) of patients are receiving OCS at home to manage asthma exacerbations prior to an ED visit. Additional studies were found showing very low use of written action plans, strongly suggesting lack of OCS for home management of asthma exacerbations.
Conclusions: Despite evidence of reduced ED visits and hospitalizations and the recommendations of national and international guidelines, the home use of OCS in managing asthma exacerbations remains unacceptably low. New strategies are needed to ensure home use of OCS as part of written action plans to prevent ED visits and hospitalizations for asthma exacerbations.
J Asthma. 2010 Sep 13. [Epub ahead of print]
背景：自1991年开始，NIH/NHLBI指南就将口服糖皮质激素（OCS）作为哮喘恶化的家庭处理手段。作为书面行动计划的一个常规组成，家庭OCS治疗与急诊就医（ED）和住院率下降及死亡率降低相关。
方法：通过检索PubMed, EMBASE和SCOPUS 数据库中1991～2009年间的英文文献，来评价对国家指南中哮喘恶化家庭处理的依从性。
结果：检索结果显示，一些研究发现，少部分（<3-26%）患者在急诊就诊前，采用OCS进行哮喘恶化的家庭处理。其他研究显示，采用书面行动计划的比率较低，表明采用OCS进行哮喘恶化家庭处理的比率很低。
结论：尽管有证据显示急诊就医和住院率呈现下降，而且国家和国际指南推荐采用OCS进行哮喘恶化的家庭治疗，但有关该治疗的使用率很低。需要采用新的方法，促进采用OCS进行哮喘恶化的家庭治疗，并将其作为书面行动计划一部分，预防急诊就医和住院。
（苏楠 审校）
J Asthma. 2010 Sep 13. [Epub ahead of print]
Preventing emergency department visits and hospitalizations for asthma by use of oral corticosteroids at home: Are we adhering to national guidelines?
Self TH, Chrisman CR, Jacobs AR, Vo NH, Winton JC.
University of Tennessee Health Science Center and Methodist University Hospital, Memphis, TN, USA.
Abstract
Background: Oral corticosteroids (OCS) in the home management of asthma exacerbations have been recommended in the NIH/NHLBI guidelines since 1991. As a routine component of written action plans, OCS treatment at home is associated with reduced emergency department (ED) visits and hospitalizations as well as decreased mortality.
Methods: A literature search of English language journals from 1991 to 2009 was performed using several databases, including PubMed, EMBASE, and SCOPUS. We assessed studies that evaluated adherence to national guidelines for home management of asthma exacerbations.
Results: Our review of the literature found that several studies reveal that a small percentage (<3-26%) of patients are receiving OCS at home to manage asthma exacerbations prior to an ED visit. Additional studies were found showing very low use of written action plans, strongly suggesting lack of OCS for home management of asthma exacerbations.
Conclusions: Despite evidence of reduced ED visits and hospitalizations and the recommendations of national and international guidelines, the home use of OCS in managing asthma exacerbations remains unacceptably low. New strategies are needed to ensure home use of OCS as part of written action plans to prevent ED visits and hospitalizations for asthma exacerbations.
J Asthma. 2010 Sep 13. [Epub ahead of print]
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