客观的气道监测在感冒和流感季节改善哮喘控制：一项整群随机试验
2011/09/09
背景：哮喘治疗的目标是减少发病风险和损害，但是要达到这些目标需要患者和医生的合作。本研究旨在通过哮喘患者和基层监护医生的治疗性沟通而达到改善吸入皮质激素（inhaled corticosteroid,ICS）依从性和哮喘控制。
方法：通过一项前瞻性的随机对照优效性试验，评估向患者和其医生提供形象标准、可释的峰流速图（干预组）对ICS依从性和哮喘控制的影响。由于哮喘发作频次存在季节变异，对哮喘控制结果采用分季节分析。
结果：经过对数转换后，两试验组间的平均ICS依从性无明显差异，从长远来看，干预组存在持久的依从性趋势（P=0.16）。同对照组相比，干预组的口服激素疗程在冬季(9% vs 23%, P<0.001)和春季(3% vs 7%, P<0.001)均有减少。干预组患者在冬季出现症状加重(65% vs 89%, P<0.001)和急诊次数(10% vs 23%, P<0.001)亦明显减少。事后分析显示，干预组在冬季ICS依从性明显改善，这可解释使用强的松和症状的减少。整个研究过程中，干预组的日峰流速变异基本保持稳定，平均从基线的32%到最后测量的23%（P<0.001），表明随着时间的过去气道反应降低。
结论：我们的发现为哮喘患者在最易感的季节即感冒/流感季节，进行峰流量监测的价值提供了证据。峰流速信息明显提高ICS的依从性，并因此减少了强的松的紧急使用需求和较少症状加重的发生。
(王刚 四川大学华西医院中西医结合科呼吸组 610041 摘译)
(Chest; 2010; 138 (5); 1148-1155)
Objective airway monitoring improves asthma control in the cold and flu season: a cluster randomized trial
Janson SL, McGrath KW, Covington JK, Baron RB, Lazarus SC
Chest 2010; 138 (5); 1148-1155
Background: The goals of asthma care are reductions in risk and impairment, but achieving these goals requires collaborative work between patients and their clinicians. The purpose of this study was to improve inhaled corticosteroid (ICS) adherence and asthma control by cueing therapeutic communication between patients with asthma and their primary care clinicians.
Methods: We conducted a prospective, cluster-randomized, controlled effectiveness trial to assess the effect of providing visually standardized, interpreted peak flow graphs (CUE intervention) to patients and their clinicians on ICS adherence and asthma control. Asthma control outcomes were analyzed by season to account for seasonal variations in exacerbation frequency.
Results: Although mean log-transformed ICS adherence was not significantly different between the two groups, there was a trend toward preserved adherence in the intervention group over time (P=.16). Intervention patients required fewer courses of oral steroids during winter (9% vs 23%, P<.001) and spring (3% and 17%, P<.001) compared with control subjects. Intervention patients also had fewer periods of worsening symptoms (65% vs 89%, P<.001) and fewer urgent care visits (10% vs 23%, P<.001) during winter compared with control subjects. Post hoc analysis showed significant improvement in the intervention group with respect to ICS adherence during winter months (P<.05), the likely explanation for the reduction in prednisone use and symptoms. Day-to-day peak flow variability in the intervention group fell consistently throughout the study from an average of 32% at baseline to 23% at final measurement (P<.001), indicating less airway reactivity over time.
Conclusions: Our findings provide evidence of the value of peak flow monitoring for patients with asthma during seasons of greatest vulnerability, the cold/flu season. The peak flow information apparently led to improvements in ICS adherence resulting in less need for prednisone rescue and fewer episodes of worsening symptoms.
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哮喘患者日常生活中体力活动、肺功能及气短情况研究
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在城市中重度哮喘成人患者中，采用解决问题的方法来改善治疗依从性和哮喘转归：随机对照试验
