哮喘联盟

   摘要
   简介：吸入药物是哮喘治疗的重要手段，患者可以通过定量雾化吸入（MDI）给药。哮喘患者自我控制的效果取决于对这些药物的依从性和正确的MDI技术。
   目的：旨在评估正确使用MDI技术的预测因素，及MDI技术作为鉴别吸入药物依从性低者的方法。
   方法：对来自纽约和新不伦瑞克省门诊的哮喘患者进行前瞻性队列研究，采用标准化量表对MDI技术进行评估。采用药物治疗依从性报告量表评估吸入型哮喘控制药物的依从性。采用回归分析评估MDI技术的影响因素。比较依从性和非依从性哮喘患者中MDI技术步骤缺失人数的分布规律。
   结果：共326例患者被纳入该研究（55%西班牙裔，27%黑种人）。在校正分析中，年龄<55岁与MDI技术显著相关（P=0.03）。总体来说，分别有12%， 34%， 40%的哮喘患者未完成MDI 的5-6步, 3-4步或1-2步；16%的患者获得MDI技术评分的满分。在MDI技术量表中，存在5-6步, 3-4步, 1-2步或无一步MDI缺失的患者依从率分别为20%，39%， 48%和62%（P<0.001)。
   结论：在市区哮喘患者中，MDI技术使用不当现象普遍存在，且与控制哮喘药物的低依从性相关。老年哮喘患者MDI技术使用不当的风险更高。MDI技术的评估可能是鉴别控制哮喘药物低依从性的一种简便的临床方法。

（苏楠 审校）
Clin Respir J. 2013 Dec 6. doi: 10.1111/crj.12084. [Epub ahead of print]
 

Metered Dose Inhaler Technique Among Inner-City Asthmatics and its Association with Asthma Medication Adherence.

Lurslurchachai L, Krauskopf K, Roy A, Halm EA, Leventhal H, Wisnivesky JP.

ABSTRACT
INTRODUCTION: Inhaled medications, critical for asthma treatment, are self-administered through metered dose inhalers (MDI). Asthma self-management hinges on adherence to these medications and to proper MDI technique.
OBJECTIVE: To assess predictors of proper MDI technique, and MDI technique as a tool to identify patients with low adherence to inhaled medications.
METHODS: Prospective cohort of asthmatics from clinics in New York, NY and New Brunswick, NJ. MDI technique was assessed using a standardized checklist. Adherence to inhaled asthma controller medication was evaluated with the Medication Adherence Report Scale. Predictors of MDI technique were evaluated using regression analyses. The distribution of number of MDI technique steps missed was compared in adherent vs. non-adherent asthmatics.
RESULTS: Overall, 326 patients were included (55% Hispanic, 27% Black). In adjusted analyses, age <55 years was significantly associated with MDI technique (p=0.03). Overall, 12%, 34%, 40% of asthmatics missed 5-6, 3-4, or 1-2 MDI steps; 16% received a perfect MDI technique score. Adherence rates were 20%, 39%, 48%, and 62% among those who missed 5-6, 3-4, 1-2, or none of the steps in the MDI technique checklist (p<0.001).
CONCLUSION: Poor MDI technique is common among inner-city patients with asthma and is associated with poor adherence to controller medications. Older patients with asthma are at higher risk of improper MDI technique. Assessment of MDI technique may be a simple clinical aid to identify patients with low adherence to controller medications.
 

Clin Respir J. 2013 Dec 6. doi: 10.1111/crj.12084. [Epub ahead of print]