Goodman D C, Lozano P, Stukel T A, Chang Ch, Hecht J
Center for the Evaluative Clinical Sciences, Department of Community and Family Medicine, University of Washington, Seattle, USA.
Pediatrics. 1999 Aug;104(2 Pt 1):187-94. doi: 10.1542/peds.104.2.187.
Despite national initiatives to improve asthma medical treatment, the appropriateness of physician prescribing for children with asthma remains unknown. This study measures trends and recent patterns in the pediatric use of medications approved for reversible obstructive airway disease (asthma medications).
Population-based longitudinal and cross-sectional analyses. Setting. A nonprofit staff model health maintenance organization located in the Puget Sound area of Washington state.
Children 0 to 17 years of age enrolled continuously during any one of the years from 1984 to 1993 (N = 83 232 in 1993). PRIMARY OUTCOME MEASURES. Percent of enrollees filling prescriptions for asthma medications and fill rates by medication class and estimated duration of inhaled antiinflammatory medication use.
Between 1984 and 1993, the frequency of asthma medication use increased: the percent of children filling any asthma medication prescription increased from 4. 0% to 8.1%, whereas the percent filling an inhaled antiinflammatory inhaler rose from 0.4% to 2.4%. In contrast, the intensity of inhaled antiinflammatory use decreased among users; 37% of users filled more than two inhalers during the year in 1984, and 29% in 1993. In high beta-agonist users (filling more than two beta-agonist inhalers each quarter per year), the estimated duration of inhaled antiinflammatory use increased slightly from a mean of 4.1 months per year in 1984-1986 to 5.0 months in 1991-1993; estimated duration of use in adolescents 10 to 17 years of age was approximately half that of children 5 to 9 years of age.
The proportion of children using asthma medications increased substantially during the study period, but the use of inhaled antiinflammatory medication per patient remained low even for those using large amounts of inhaled beta-agonists. These findings suggest that most asthma medications were used by children with mild lower airway symptoms and that inhaled antiinflammatory medication use in children with more severe disease fell short of national guidelines.
尽管国家采取了多项举措来改善哮喘的药物治疗，但医生为哮喘儿童开处方的合理性仍不明确。本研究旨在衡量儿科使用批准用于可逆性阻塞性气道疾病的药物（哮喘药物）的趋势和近期模式。
基于人群的纵向和横断面分析。地点：位于华盛顿州普吉特海湾地区的一个非营利性员工模式健康维护组织。
1984年至1993年期间任何一年持续登记的0至17岁儿童（1993年为N = 83232）。主要结局指标：填写哮喘药物处方的参保者百分比、按药物类别划分的填充率以及吸入性抗炎药物的估计使用时长。
1984年至1993年期间，哮喘药物的使用频率有所增加：填写任何哮喘药物处方的儿童百分比从4.0%增至8.1%，而填写吸入性抗炎吸入器处方的儿童百分比从0.4%升至2.4%。相比之下，使用者中吸入性抗炎药物的使用强度有所下降；1984年，37%的使用者一年填充超过两个吸入器，1993年这一比例为29%。在高剂量β受体激动剂使用者（每年每季度填充超过两个β受体激动剂吸入器）中，吸入性抗炎药物的估计使用时长略有增加，从1984 - 1986年的平均每年使用4.1个月增至1991 - 1993年的5.0个月；10至17岁青少年的估计使用时长约为5至9岁儿童的一半。
在研究期间，使用哮喘药物的儿童比例大幅增加，但即使是那些大量使用吸入性β受体激动剂的患者，每人吸入性抗炎药物的使用量仍然较低。这些发现表明，大多数哮喘药物是由下呼吸道症状较轻的儿童使用的，而病情较严重儿童的吸入性抗炎药物使用未达到国家指南的要求。
