个体自我管理教育对哮喘患者临床、生物学及依从性结局的影响。

Effects of individual self-management education on clinical, biological, and adherence outcomes in asthma.

作者信息

Janson Susan L, Fahy John V, Covington Jack K, Paul Steven M, Gold Warren M, Boushey Homer A

机构信息

Department of Community Health Systems, School of Nursing, University of California, San Francisco 94143-0608, USA.

出版信息

Am J Med. 2003 Dec 1;115(8):620-6. doi: 10.1016/j.amjmed.2003.07.008.

DOI:10.1016/j.amjmed.2003.07.008

PMID:14656614

Abstract

BACKGROUND

Asthma guidelines urge teaching patients the knowledge and skills required for self-management, based on the assumption that education will lead to improved skills and better asthma control.

METHODS

In a prospective, randomized controlled trial of 65 adults with mild-to-moderate asthma, we examined whether an educational self-management intervention would improve adherence to inhaled corticosteroid therapy, decrease markers of airway inflammation, and improve clinical control. Peak flow, symptoms, and adherence were monitored for 7 weeks. After a 1-week run-in, subjects were assigned randomly to either the educational intervention or control group. The 30-minute intervention was delivered and reinforced at biweekly intervals.

RESULTS

Compared with the control group, the intervention group had improvements in adherence to inhaled corticosteroid therapy (by 30% vs. -5%, P = 0.01), self-reported control of asthma (by 14% vs. 5%, P = 0.04), and perhaps quality of life (by 37% vs. 21%, P = 0.06). The direction of change for all other clinical outcomes was more favorable in the intervention group, but not significantly so. Markers of inflammation in sputum decreased more in the intervention group, with sputum eosinophils declining significantly (P = 0.02).

CONCLUSION

In asthmatic patients treated with inhaled corticosteroids, education and training in self-management improves adherence with inhaled therapy, perceived control of asthma, and sputum eosinophilia.

摘要

背景

哮喘指南敦促向患者传授自我管理所需的知识和技能，基于这样一种假设，即教育将提高技能并更好地控制哮喘。

方法

在一项针对65名轻度至中度哮喘成人的前瞻性随机对照试验中，我们研究了自我管理教育干预是否会提高吸入性糖皮质激素治疗的依从性、降低气道炎症标志物并改善临床控制。对峰值流量、症状和依从性进行了7周的监测。在为期1周的导入期后，受试者被随机分配到教育干预组或对照组。每两周进行一次30分钟的干预并强化。

结果

与对照组相比，干预组在吸入性糖皮质激素治疗的依从性方面有所改善（提高了30% 对比降低了5%，P = 0.01），自我报告的哮喘控制情况有所改善（提高了14% 对比提高了5%，P = 0.04），生活质量可能也有所改善（提高了37% 对比提高了21%，P = 0.06）。干预组所有其他临床结局的变化方向更有利，但差异无统计学意义。干预组痰液中的炎症标志物下降更多，痰液嗜酸性粒细胞显著下降（P = 0.02）。