哮喘联盟

   摘要
   研究目的：本研究旨在发现城市成人对哮喘病情控制阻碍因素与助力因素的认识，包括自我护理、药物、环境治疗以及初级保健等方面。
   研究方法：研究采用半结构化开放式定性采访。通过NVivo10.0（澳大利亚，维多利亚，唐卡斯特，QSR国际有限公司）逐字录入采访电话录音，结合人口及哮喘控制数据对录音进行分析。采用一种经修正的基础理论进行数据分析。
   研究结果：35名来自费城西部5个哮喘最高发地区的持续性哮喘成年患者（黑人94%，女性71%，哮喘病情未控制者71%）参加本项研究。总体而言，尽管局部吸入糖皮质激素（ICS）可导致全身性副作用，但所有参与者均了解吸入ICS及短效β-2受体激动剂（SABA）在哮喘自我护理中的作用。数据显示，与哮喘病情得到控制的患者相比，病情未得到控制者存在以下情况：SABA过度使用、ICS使用不足、拒绝医疗并导致补救治疗、对初级护理人员存在负面经验，倾向于使用非经典疗法以预防和控制哮喘症状。
   结论：对疾病控制的认识可影响患者对药物及环境干预的依从性，并可导致哮喘病情未控制率增加。临床医生应了解这些认识能否被转变及转变程度。转变观念可能需要新的健康护理模式（如以患者为中心、共同制定决策的方式）以及新的合作人员（如社区健康工作人员）。这些都是对易感人群进行哮喘病情控制的第一步，也是重要的一步。
 

（刘国梁 审校）
J Asthma. 2014 Aug 7:1-7. [Epub ahead of print]

 

Urban adults' perceptions of factors influencing asthma control.
 

George M1, Keddem S, Barg FK, Green S, Glanz K.
 

ABSTRACT
OBJECTIVE: To identify urban adults' perceptions of facilitators and barriers to asthma control, including the role of self-care, medications, environmental trigger remediation, and primary care.
METHODS: Semi-structured open-ended qualitative interviews were conducted. Audio recordings were transcribed verbatim and entered into NVivo 10.0 (QSR International Pty Ltd, Doncaster, Victoria, Australia) for coding, analysis, and integration with demographic and asthma control data. Results were analyzed by the level of asthma control. A modified grounded theory approach was used in the analysis.
RESULTS: Thirty-five adults with persistent asthma (94% Black; 71% female; 71% with uncontrolled asthma) from the five West Philadelphia zip codes with the highest asthma burden participated. Generally, all participants understood the roles of inhaled corticosteroid (ICS) and short-acting β-2 agonist (SABA) therapies in asthma self-care although they attributed systemic side effects to topical ICS administration. Compared with participants with controlled asthma, uncontrolled participants reported overusing SABAs, underusing ICS, rejecting medical and trigger remediation advice, having more negative experiences with primary care providers, and preferring more unconventional strategies to prevent or manage asthma symptoms.
CONCLUSIONS: Personal health beliefs about control can undermine adherence to medical and environmental remediation advice and likely contributes to high rates of uncontrolled asthma in this population. Clinicians need to know whether, and to what degree, these health beliefs can be modified. It is likely that new models of care, such as patient-centered shared decision-making approaches, and new partners, such as community health workers, may be required to modify these beliefs. This would be an important first step to enhance asthma control in vulnerable populations.
 

J Asthma. 2014 Aug 7:1-7. [Epub ahead of print]