哮喘联盟

   摘要
   背景：妊娠期未控制的哮喘与产妇和围产期风险有关。旨在改善产妇哮喘控制，由药剂师介导，纳入多学科治疗、健康教育与常规检测的干预已被建立与评估。
   方法：一项随机对照试验在澳大利亚两家主要的妇产科医院产科门诊展开。60例怀孕20周且1年前使用哮喘药物的产妇被纳入研究。受试者随机接受干预治疗或常规治疗，并在整个孕期接受前瞻性随访。主要的结果是哮喘控制调查问卷(ACQ)的评分。比较两组基线自3个月和6个月的ACQ平均值，以评估干预的效果。
   结果：干预组（n=29）ACQ评分3个月时平均（SD）减少0.46（1.05），6个月时减少0.89（0.98）。对照组（n=29）3个月时平均减少0.15（0.63），6个月时平均减少0.18（0.73）。校正基线后，两组间的差异3个月为-0.22 (95%C：-0.54～0.10)，6个月为-0.60 (-0.85～ -0.36)。6个月时的差异具有统计学意义（P=0.001）和临床意义（P=0.5）。试验期间没有使用口服糖皮质激素、入院治疗、急诊和节假日就诊等报告。
   结论：多学科哮喘管理模型涉及教育和常规监测，能帮助改善产妇结局且在临床实际中被广泛的应用。
 

（林江涛 审校）
Chest. 2014 Feb 13. doi: 10.1378/chest.13-2276. [Epub ahead of print]


 

Multidisciplinary Approach to Management of Maternal Asthma (MAMMA): A Randomized Controlled Trial.
 

Lim AS, Stewart K, Abramson MJ, Walker SP, Smith CL, George J.
 

Abstract
BACKGROUND：Uncontrolled asthma during pregnancy is associated with maternal and perinatal hazards. A pharmacist-led intervention directed at improving maternal asthma control, involving multidisciplinary care, education and regular monitoring to help reduce these risks, was developed and evaluated.
METHODS：A randomized controlled trial was carried out in the antenatal clinics of two major Australian maternity hospitals. Sixty pregnant women <20 weeks gestation who had used asthma medications in the previous year were recruited. Participants were randomized to either an intervention or usual care group and followed prospectively throughout pregnancy. The primary outcome was Asthma Control Questionnaire (ACQ) score. Mean changes in ACQ scores from baseline were compared between groups at 3 and 6 months to evaluate intervention efficacy.
RESULTS：The ACQ score in the intervention group (n = 29) decreased by a mean (SD) of 0.46 (1.05) at 3 months and 0.89 (0.98) at 6 months. The control group (n = 29) had a mean decrease of 0.15 (0.63) at 3 months and 0.18 (0.73) at 6 months. The difference between groups, adjusting for baseline, was -0.22 (95%CI: -0.54 to 0.10) at 3 months and -0.60 (-0.85 to -0.36) at 6 months. The difference at 6 months was statistically significant (p<0.001) and clinically significant (>0.5). No asthma-related oral corticosteroid use, hospital admissions, emergency visits or days off work were reported during the trial.
CONCLUSION：A multidisciplinary model of care for asthma management involving education and regular monitoring could potentially improve maternal asthma outcomes and be widely implemented in clinical practice.
 

Chest. 2014 Feb 13. doi: 10.1378/chest.13-2276. [Epub ahead of print]