提高城市青少年哮喘防治水平的初步研究
2011/10/13
摘要
背景：在少数低收入人群中青少年罹患哮喘的比例非常高，而且防治的依从性也较差。
目的：评估以学校为基础的提高12～15岁持续性哮喘患者防治水平的新型哮喘项目的可行性和早期效果。我们假定该项干预措施（1）具有可行性，而且能被该人群所接受，（2）能降低哮喘患病率。
设计与方法：
参与者与参与机构：纽约罗切斯特地区正在接受药物治疗的持续性哮喘少年。
设计：2009年至2010年单组治疗前后对照初步研究。
干预措施：在学期开始时，少年患儿持续6～8周每日至学校护士处接受预防性哮喘治疗的直接督查治疗（DOT），DOT后2~4周，接受采用动机访谈（MI）的三次咨询（1次在家，2次通过电话），研究患儿对哮喘管理的态度，建立药物治疗依从性动机，帮助患儿过渡至独立预防性治疗。主要研究终点：每2周内的无症状天数（SFD），转归数据在基线状态后的2个月和学期结束后收集。
结果: 入选30名十几岁患儿，28名参与干预。所有少年患儿接受以学校为基础的DOT。所有在家接受MI咨询均成功完成。89%的患者完成两者随访。与基线状态相比，这些患儿症状在2个月后和学期结束后总体显著下降（分别为8.71 vs. 10.79 vs. 12.89，p = .046和p = .004）。这些患儿主诉有症状天数下降、活动受限下降以及急救用药降低（所有p < .05）。呼出气一氧化氮水平下降（p = .012），表明气道炎症缓解。第二次评估时，这些患儿主诉更有动力每天采用预防性用药(p = .043)。研究结束，79%的患儿主诉其自身在哮喘管理上能力提升，93%的患儿主诉希望再次参与类似的项目。
结论：该项初步试验为基于学校的提高城市少年哮喘患儿哮喘独立管理能力、改善哮喘转归的新干预计划提供了初步的可行性和效果证据。
（刘国梁 审校）
J Asthma. 2011 Jun;48(5):523-30.
A pilot study to enhance preventive asthma care among urban adolescents with asthma.
Halterman JS, Riekert K, Bayer A, Fagnano M, Tremblay P, Blaakman S, Borrelli B.
Source
Department of Pediatrics, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY 14642, USA. jill_halterman@urmc.rochester.edu
Abstract
BACKGROUND: Low-income, minority teens have disproportionately high rates of asthma morbidity and are at high risk for nonadherence to preventive medications.
OBJECTIVE: To assess the feasibility and preliminary effectiveness of an innovative school-based asthma program to enhance the delivery of preventive care for 12-15 year olds with persistent asthma. We hypothesized that this intervention would (1) be feasible and acceptable among this population and (2) yield reduced asthma morbidity.
DESIGN/METHODS:
SUBJECTS/SETTING: Teens with persistent asthma and a current preventive medication prescription in Rochester, NY.
DESIGN: Single group pre-post pilot study during the 2009-2010 school year.
INTERVENTION: Teens visited the school nurse daily for 6-8 weeks at the start of the school year to receive directly observed therapy (DOT) of preventive asthma medications; 2-4 weeks following DOT initiation, they received three counseling sessions (one in-home and two via telephone) using motivational interviewing (MI) to explore attitudes about asthma management, build motivation for medication adherence, and support transition to independent preventive medication use. PRIMARY OUTCOME: Number of symptom-free days (SFDs)/2 weeks; outcome data were collected 2 months after baseline and at the end of school year.
RESULTS: We enrolled 30 teens; 28 participated in the intervention. All teens initiated a trial of school-based DOT. All in-home MI visits were completed successfully, and 89% completed both follow-up sessions. Teens experienced an overall reduction of symptoms with more SFDs/2 weeks from baseline to 2-month and final (end of school year) assessments (8.71 vs. 10.79 vs. 12.89, respectively, p = .046 and p = .004). Teens also reported fewer days with symptoms, less activity limitation, and less rescue medication use (all p < .05). Exhaled nitric oxide levels decreased (p = .012), suggesting less airway inflammation. At the final assessment, teens reported significantly higher motivation to take their preventive medication every day (p = .043). At the end of the study, 79% of teens stated that they were better at managing asthma on their own, and 93% said they would participate in a similar program again.
CONCLUSIONS: This pilot study provides preliminary evidence of the feasibility and effectiveness of a novel school-based intervention to promote independence in asthma management and improve asthma outcomes in urban teens.
J Asthma. 2011 Jun;48(5):523-30.
背景：在少数低收入人群中青少年罹患哮喘的比例非常高，而且防治的依从性也较差。
目的：评估以学校为基础的提高12～15岁持续性哮喘患者防治水平的新型哮喘项目的可行性和早期效果。我们假定该项干预措施（1）具有可行性，而且能被该人群所接受，（2）能降低哮喘患病率。
设计与方法：
参与者与参与机构：纽约罗切斯特地区正在接受药物治疗的持续性哮喘少年。
设计：2009年至2010年单组治疗前后对照初步研究。
干预措施：在学期开始时，少年患儿持续6～8周每日至学校护士处接受预防性哮喘治疗的直接督查治疗（DOT），DOT后2~4周，接受采用动机访谈（MI）的三次咨询（1次在家，2次通过电话），研究患儿对哮喘管理的态度，建立药物治疗依从性动机，帮助患儿过渡至独立预防性治疗。主要研究终点：每2周内的无症状天数（SFD），转归数据在基线状态后的2个月和学期结束后收集。
结果: 入选30名十几岁患儿，28名参与干预。所有少年患儿接受以学校为基础的DOT。所有在家接受MI咨询均成功完成。89%的患者完成两者随访。与基线状态相比，这些患儿症状在2个月后和学期结束后总体显著下降（分别为8.71 vs. 10.79 vs. 12.89，p = .046和p = .004）。这些患儿主诉有症状天数下降、活动受限下降以及急救用药降低（所有p < .05）。呼出气一氧化氮水平下降（p = .012），表明气道炎症缓解。第二次评估时，这些患儿主诉更有动力每天采用预防性用药(p = .043)。研究结束，79%的患儿主诉其自身在哮喘管理上能力提升，93%的患儿主诉希望再次参与类似的项目。
结论：该项初步试验为基于学校的提高城市少年哮喘患儿哮喘独立管理能力、改善哮喘转归的新干预计划提供了初步的可行性和效果证据。
（刘国梁 审校）
J Asthma. 2011 Jun;48(5):523-30.
A pilot study to enhance preventive asthma care among urban adolescents with asthma.
Halterman JS, Riekert K, Bayer A, Fagnano M, Tremblay P, Blaakman S, Borrelli B.
Source
Department of Pediatrics, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY 14642, USA. jill_halterman@urmc.rochester.edu
Abstract
BACKGROUND: Low-income, minority teens have disproportionately high rates of asthma morbidity and are at high risk for nonadherence to preventive medications.
OBJECTIVE: To assess the feasibility and preliminary effectiveness of an innovative school-based asthma program to enhance the delivery of preventive care for 12-15 year olds with persistent asthma. We hypothesized that this intervention would (1) be feasible and acceptable among this population and (2) yield reduced asthma morbidity.
DESIGN/METHODS:
SUBJECTS/SETTING: Teens with persistent asthma and a current preventive medication prescription in Rochester, NY.
DESIGN: Single group pre-post pilot study during the 2009-2010 school year.
INTERVENTION: Teens visited the school nurse daily for 6-8 weeks at the start of the school year to receive directly observed therapy (DOT) of preventive asthma medications; 2-4 weeks following DOT initiation, they received three counseling sessions (one in-home and two via telephone) using motivational interviewing (MI) to explore attitudes about asthma management, build motivation for medication adherence, and support transition to independent preventive medication use. PRIMARY OUTCOME: Number of symptom-free days (SFDs)/2 weeks; outcome data were collected 2 months after baseline and at the end of school year.
RESULTS: We enrolled 30 teens; 28 participated in the intervention. All teens initiated a trial of school-based DOT. All in-home MI visits were completed successfully, and 89% completed both follow-up sessions. Teens experienced an overall reduction of symptoms with more SFDs/2 weeks from baseline to 2-month and final (end of school year) assessments (8.71 vs. 10.79 vs. 12.89, respectively, p = .046 and p = .004). Teens also reported fewer days with symptoms, less activity limitation, and less rescue medication use (all p < .05). Exhaled nitric oxide levels decreased (p = .012), suggesting less airway inflammation. At the final assessment, teens reported significantly higher motivation to take their preventive medication every day (p = .043). At the end of the study, 79% of teens stated that they were better at managing asthma on their own, and 93% said they would participate in a similar program again.
CONCLUSIONS: This pilot study provides preliminary evidence of the feasibility and effectiveness of a novel school-based intervention to promote independence in asthma management and improve asthma outcomes in urban teens.
J Asthma. 2011 Jun;48(5):523-30.
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低社会经济地位哮喘患儿的心理反弹：适应应激
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