哮喘联盟

   摘要
   背景：老年哮喘患者对处方的吸入糖皮质激素（ICS）的依从性差。虽然以前的研究已经确定人口统计学和认知因素与老年哮喘患者对ICS的依从性相关，但对老年人实现每日使用他们的药物的方法知之甚少。当临床医生询问自己的患者对ICS的依从性时，确定这些方法可以帮助临床医生为患者提供有用的建议。
   目的：在老年患者中，识别与ICS保持良好依从性相关的药物使用方法
   研究对象：研究于纽约和芝加哥的初级保健和肺部保健部门招募讲英语和西班牙语的年龄≥60岁，并伴有中度或重度哮喘的患者，。排除慢性阻塞性肺疾病、其他慢性肺部疾病或吸烟史大于10包年的患者。
   主要方法：通过药物依从性量表（MARS）对服药的依从性进行评估。通过开放式的询问对药物的使用方法进行评估。“良好的依从性”定义为平均MARS得分为4.5分或更高。
   主要结果：对ICS良好的依从性患者比例为37％。我们确认了6类用于保持服药依从性的常用方法：保持药物放在经常的位置（44.2％），药物与日常活动的结合（32.6％），在特定的时间服用药物（21.7％），与其他药物一起服用（13.4％），仅在需要服药的时候服用（13.4％），以及使用其他提醒（11.9％）。在盥洗室使用ICS（调整后的比值配给[AOR]3.05，95％CI为1.03-9.02，P = 0.04）或将ICS的使用整合到日常生活中（AOR3.77，95％CI：1.62-8.77，P = 0.002）的患者的依从性更好。
   结论：在浴室使用ICS药物和将其纳入日常生活都是与保持对ICS良好的依从性相关的方法。
即使需要更多的研究来确定这些建议是否会提高依从性的行为，关注依从性的临床医生应该考虑为他们的老年哮喘患者推荐这些方法。
 

（苏楠 审校）
J Gen Intern Med. 2014 Aug 5. [Epub ahead of print]


 

Strategies Used by Older Adults with Asthma for Adherence to Inhaled Corticosteroids.
 

Brooks TL1, Leventhal H, Wolf MS, O'Conor R, Morillo J, Martynenko M, Wisnivesky JP, Federman AD.
 

ABSTRACT
BACKGROUND: Older adults with asthma have low levels of adherence to their prescribed inhaled corticosteroids (ICS). While prior research has identified demographic and cognitive factors associated with ICS adherence among elderly asthmatics, little is known about the strategies that older adults use to achieve daily use of their medications. Identifying such strategies could provide clinicians with useful advice for patients when counseling their patients about ICS adherence.
OBJECTIVE: To identify medication use strategies associated with good ICS adherence in older adults.
PARTICIPANTS: English-speaking and Spanish-speaking adults ages 60 years and older with moderate or severe asthma were recruited from primary care and pulmonary practices in New York City, NY, and Chicago, IL. Patients with chronic obstructive pulmonary disease, other chronic lung diseases or a smoking history of greater than 10 pack-years were excluded.
MAIN MEASURES: Medication adherence was assessed with the Medication Adherence Rating Scale (MARS). Medication use strategies were assessed via open-ended questioning. "Good adherence" was defined as a mean MARS score of 4.5 or greater.
KEY RESULTS: The rate of good adherence to ICS was 37 %. We identified six general categories of medication adherence strategies: keeping the medication in a usual location (44.2 %), integrating medication use with a daily routine (32.6 %), taking the medication at a specific time (21.7 %), taking the medication with other medications (13.4 %), using the medication only when needed (13.4 %), and using other reminders (11.9 %). The good adherence rate was greater among individuals who kept their ICS medication in the bathroom (adjusted odds ration [AOR] 3.05, 95 % CI 1.03-9.02, p = 0.04) or integrated its use into a daily routine (AOR 3.77, 95 % CI: 1.62-8.77, p = 0.002).
CONCLUSIONS: Keeping ICS medications in the bathroom and integrating them into daily routines are strategies associated with good ICS adherence. Clinicians concerned with adherence should consider recommending these strategies to their older asthmatic patients, although additional research is needed to determine whether such advice would improve adherence behaviors.
 

J Gen Intern Med. 2014 Aug 5. [Epub ahead of print]