哮喘联盟

   摘要
   目的：旨在调查一项全面哮喘管理计划中少儿在定期随访前后吸入性激素依从性的变化。
   研究设计：在104例哮喘儿童（平均年龄4.8岁）中开展为期一年的前瞻性随访研究。使用电子设备（Smartinhaler®）评估吸入性皮质类固醇激素的依从性。评估门诊就诊前后依从性的变化。如果其依从性超出背景差异，即门诊就诊前三天依从性增加 > 10%，被认为可以反映临床相关的白大衣依从性(WCA)（变化的中位数〉0，且在门诊就诊后增加值大于依从性的变化）。
   结果：总体依从性较高（中位值85%）。其中在17例患者（22%）中已证明就诊前依从性增加〉10%，但在门诊就诊前后依从性中位值变化为0。在门诊就诊前后的天数间依从性变化没有显著差异（P > 0.2）。依从性的中位变异系数为9%，且在伴或不伴依从性就诊前增加的儿童间无显著差异（P = 0.12）。其中12例患者（15.4%）显示在门诊就诊月依从性增加；其总平均(SE)依从性略低于（73%，4.6%）不伴此增加的患者（80%，2.2%，P = 0.054）。
   结论：有全面哮喘管理计划而纳入本研究的哮喘儿童整体依从性高并且无WCA。这表明在儿科慢性疾病中WCA主要针对总体依从性低的群体而言。
 

（苏楠 审校）
Pediatr Pulmonol. 2014 Dec 2. doi: 10.1002/ppul.23138. [Epub ahead of print]


 

Long-term adherence to daily controller medication in children with asthma: The role of outpatient clinic visits.
 

Keemink YS1, Klok T, Brand PL.
 

ABSTRACT
OBJECTIVE: To investigate changes in inhaled corticosteroids adherence, both before and after a scheduled follow-up visit, in young children in a comprehensive asthma management program.
STUDY DESIGN: One-year prospective follow-up study in 104 asthmatic children (mean age 4.8 years). Adherence to inhaled corticosteroids was assessed using electronic (Smartinhaler®) devices. We assessed changes in adherence before and after clinic visits. A  > 10% increase in adherence in the 3 days preceding a clinic visit was considered to reflect clinically relevant white coat adherence (WCA) if it exceeded background variation in adherence (median change >0, and increase larger than adherence changes after a clinic visit).
RESULTS: Overall adherence was high (median 85%). A pre-visit increase in adherence of >10% was demonstrated in 17 patients (22%), but the median change in adherence around a clinic visit was 0. There were no significant differences in changes in adherence between the days before or after a visit (P > 0.2). The median coefficient of variation in adherence was 9%, and did not significantly differ between children with and without a pre-visit increase in adherence (P = 0.12). Twelve patients (15.4%) showed an increase of adherence in the month following a clinic visit; their overall mean (SE) adherence was slightly lower (73% (4.6%)) than those without such an increase (80% (2.2%), P = 0.054).
CONCLUSIONS: There was no WCA in children with asthma enrolled in a comprehensive asthma management program with high overall adherence. This suggests that WCA in pediatric chronic conditions primarily occurs against the background of low overall adherence.
 

Pediatr Pulmonol. 2014 Dec 2. doi: 10.1002/ppul.23138. [Epub ahead of print]