Adams R J, Fuhlbrigge A, Finkelstein J A, Lozano P, Livingston J M, Weiss K B, Weiss S T
Channing Laboratory, Brigham and Women's Hospital, 181 Longwood Ave, Boston, MA 02115, USA.
Arch Pediatr Adolesc Med. 2001 Apr;155(4):501-7. doi: 10.1001/archpedi.155.4.501.
Many factors affect use of inhaled therapy in asthma. Relatively little is known about current patterns of use of anti-inflammatory medication in children with asthma and whether variations occur with age and use of bronchodilator medication.
To study the factors associated with dispensing of anti-inflammatory (controller) asthma medication to children in 3 managed care organizations (MCOs).
Using automated databases, a 1-year cross-sectional study of children with asthma aged 3 to 15 years cared for in 3 MCOs was used to evaluate the association of age and other factors with controller medication use.
A total of 13 352 children were studied. Significantly fewer children aged 3 to 5 years were dispensed any (> or =1) controller medication than older children (P<.001). Among children dispensed 6 or more beta-agonists, only 39% also received 5 or more controller dispensings, with adolescents significantly less likely than younger children to receive 5 or more controllers (33%; P<.001). Significant differences were seen among MCOs in proportions of patients dispensed controller medication. In a multiple logistic regression model, controlling for frequency of beta-agonist dispensing and MCO, significantly lower dispensing of any controller medication was seen for those aged 3 to 5 years (odds ratio [OR], 0.8; 95% confidence interval [CI], 0.7-0.9) and for girls (OR, 0.9; 95% CI, 0.8-0.96). In contrast, for repeated (> or =5) controller dispensing there were significantly fewer dispensings to adolescents (OR, 0.7; 95% CI, 0.6-0.9) and girls (OR, 0.8; 95% CI, 0.7-0.9).
There may be differences in the use of preventive asthma medication in children that are affected by age, sex, and health care organization. Few children with frequent symptoms are using controllers regularly, as is recommended by national guidelines.
许多因素影响哮喘吸入疗法的使用。对于哮喘儿童目前使用抗炎药物的模式以及这些模式是否随年龄和支气管扩张剂药物的使用而变化，我们了解得相对较少。
研究在3个管理式医疗组织（MCO）中，与向儿童配发抗炎（控制）哮喘药物相关的因素。
利用自动化数据库，对3个MCO中3至15岁的哮喘儿童进行了为期1年的横断面研究，以评估年龄和其他因素与控制药物使用之间的关联。
共研究了13352名儿童。3至5岁的儿童中，配发任何（≥1种）控制药物的人数明显少于年龄较大的儿童（P<0.001）。在配发6种或更多β受体激动剂的儿童中，只有39%的儿童同时接受了5种或更多次的控制药物配发，青少年接受5种或更多次控制药物的可能性明显低于年幼儿童（33%；P<0.001）。在配发控制药物的患者比例方面，各MCO之间存在显著差异。在多因素逻辑回归模型中，在控制β受体激动剂配发频率和MCO的情况下，3至5岁儿童（优势比[OR]，0.8；95%置信区间[CI]，0.7 - 0.9）和女孩（OR，0.9；95% CI，0.8 - 0.96）的任何控制药物配发量显著较低。相比之下，对于重复（≥5次）控制药物配发，青少年（OR，0.7；95% CI，0.6 - 0.9）和女孩（OR，0.8；95% CI，0.7 - 0.9）的配发量明显较少。
儿童哮喘预防性药物的使用可能因年龄、性别和医疗保健组织而存在差异。很少有症状频繁的儿童按照国家指南的建议规律使用控制药物。
