哮喘联盟

   摘要
   哮喘和慢性阻塞性肺疾病（COPD）患者对药物治疗依从性不佳会对疾病控制和治疗花费产生负面影响。不依从的原因包括患者知识/教育程度、吸入装置的便捷性和治疗满意度、年龄、副作用和药物费用。年龄是其中一个特别值得注意的因素，因为年轻人哮喘发病逐渐增多，而且相比儿童和成年人，青少年的不依从率有升高趋势。绝大多数对成年人、青少年和儿童的研究表明，哮喘和COPD患者对吸入性药物治疗的依从性与临床疗效呈正相关，可改善症状控制和肺功能。对吸入装置的满意度同样与依从性提高和临床结果以及费用减低呈正相关。依从性良好时医疗费用持续降低；但是，这种降低与一般医疗服务和生产力损失相关费用的补偿仅见于依从性良好的严重病例，在哮喘和COPD患者中则不明显。不依从者的医疗占用和费用增加，健康相关的生命质量下降，并且存在个人、社会与经济方面的问题。进一步建立提高依从性的措施有必要全面理解这些问题。

 

(林江涛 审校)
Respir Med. 2013 May 2. pii: S0954-6111(13)00134-0. doi: 10.1016/j.rmed.2013.04.005. [Epub ahead of print]

 

Adherence to inhaled therapies, health outcomes and costs in patients with asthma and COPD.

Mäkelä MJ, Backer V, Hedegaard M, Larsson K.

Abstract
Suboptimal adherence to pharmacological treatment of asthma and chronic obstructive pulmonary disease (COPD) has adverse effects on disease control and treatment costs. 哮喘The reasons behind non-adherence revolve around patient knowledge/education, inhaler device convenience and satisfaction, age, adverse effects and medication costs. Age is of particular concern given the increasing prevalence of asthma in the young and increased rates of non-adherence in adolescents compared with children and adults. The correlation between adherence to inhaled pharmacological therapies for asthma and COPD and clinical efficacy is positive, with improved symptom control and lung function shown in most studies of adults, adolescents and children. Satisfaction with inhaler devices is also positively correlated with improved adherence and clinical outcomes, and reduced costs. Reductions in healthcare utilisation are consistently observed with good adherence; however, costs associated with general healthcare and lost productivity tend to be offset only in more adherent patients with severe disease, versus those with milder forms of asthma or COPD. Non-adherence is associated with higher healthcare utilisation and costs, and reductions in health-related quality of life, and remains problematic on an individual, societal and economic level. Further development of measures to improve adherence is needed to fully address these issues.

Respir Med. 2013 May 2. pii: S0954-6111(13)00134-0. doi: 10.1016/j.rmed.2013.04.005. [Epub ahead of print]