Mann M C, Eliasson O, Patel K, ZuWallack R L
Section of Pulmonary Diseases, Saint Francis Hospital and Medical Center, Hartford, Conn.
Chest. 1992 Nov;102(5):1342-6. doi: 10.1378/chest.102.5.1342.
Although the asthmatic subject's compliance with a regimen of inhaled corticosteroids is often poor, it has been suggested this may improve during periods of increased severity. To test this, we measured daily peak expiratory flow rates (PEFRs), asthma symptoms, and the use of an albuterol inhaler over nine weeks period in ten patients with moderately severe asthma. The effect of changes in these severity indices on compliance with a q.i.d. regimen of inhaled beclomethasone was evaluated. The PEFR was measured in the morning before bronchodilator administration, and symptoms were graded on a scale of 4 to 16, while albuterol and beclomethasone inhalations were electronically recorded. Three measures of compliance with the beclomethasone regimen were used: (1) mean daily compliance ([number of inhalations/number of prescribed inhalations] x 100); (2) underuse, ie, the percentage of days with less than the prescribed number of inhalations; and (3) overuse, ie, the percentage of days with greater than the prescribed number of inhalations. Mean daily compliance was 67 +/- 36 percent, while underuse was observed in 69 percent and overuse in 11 percent of the days. Despite clinical exacerbations in six of the ten patients and considerable variation in the severity indices, no significant relationship was found between the change in asthma severity and compliance with the beclomethasone regimen. These findings do not support the concept of severity-modulated compliance with inhaled corticosteroids.
尽管哮喘患者对吸入性糖皮质激素治疗方案的依从性通常较差，但有人提出在病情加重期间依从性可能会改善。为了验证这一点，我们在10名中度重度哮喘患者中，测量了9周期间的每日呼气峰值流速（PEFR）、哮喘症状以及沙丁胺醇吸入器的使用情况。评估了这些严重程度指标的变化对吸入倍氯米松每日4次治疗方案依从性的影响。在早晨给予支气管扩张剂之前测量PEFR，症状按4至16级进行分级，同时对沙丁胺醇和倍氯米松的吸入情况进行电子记录。使用了三种衡量倍氯米松治疗方案依从性的方法：（1）平均每日依从性（[吸入次数/规定吸入次数]×100）；（2）使用不足，即吸入次数少于规定次数的天数百分比；（3）使用过度，即吸入次数多于规定次数的天数百分比。平均每日依从性为67±36%，69%的天数出现使用不足，11%的天数出现使用过度。尽管10名患者中有6名出现临床病情加重，且严重程度指标存在相当大的差异，但未发现哮喘严重程度的变化与倍氯米松治疗方案的依从性之间存在显著关系。这些发现不支持吸入性糖皮质激素依从性随病情严重程度调节的概念。
