Gillissen A
St. George Medical Center, Robert-Koch-Hospital, Leipzig, Germany.
Int J Clin Pract. 2004 Jun;58(6):592-603. doi: 10.1111/j.1368-5031.2004.00182.x.
Asthma treatment is suboptimal in many patients, with impacts on morbidity and mortality, healthcare resource utilisation and patients' quality of life. The reasons for this include the inherent variability of asthma and the unpredictability of exacerbations, which can range from mild to fatal. In addition, asthma can be difficult to diagnose, particularly in the very young and old. Although treatment guidelines are widely available and well publicised, surveys have identified a significant gap between treatment aims and current levels of asthma control. Patient adherence to inhaled corticosteroids is poor, and many patients rely on short-acting beta2-agonists. The reasons for this are complex but are believed to include poor perception by patients of their asthma severity, concerns about the safety and efficacy of medication and low treatment expectations. Patients appear to be unaware of the extent to which airway inflammation can be controlled and are therefore satisfied with poor asthma control, accepting a high level of symptoms. Increasing patient understanding of asthma and its treatment, allowing patients greater involvement in treatment decisions, increasing the role of asthma nurses and improved communication between physicians and patients may improve outcomes in patients with asthma.
许多哮喘患者的治疗并不理想，这对发病率和死亡率、医疗资源利用以及患者的生活质量都产生了影响。造成这种情况的原因包括哮喘固有的变异性和发作的不可预测性，发作程度可从轻微到致命。此外，哮喘可能难以诊断，尤其是在婴幼儿和老年人中。尽管治疗指南广泛可得且宣传力度大，但调查发现治疗目标与当前哮喘控制水平之间存在显著差距。患者对吸入性糖皮质激素的依从性较差，许多患者依赖短效β2受体激动剂。其原因很复杂，但据信包括患者对自身哮喘严重程度认识不足、对药物安全性和有效性的担忧以及治疗期望较低。患者似乎并未意识到气道炎症能够得到控制的程度，因此对哮喘控制不佳感到满意，接受了高水平的症状。提高患者对哮喘及其治疗的认识，让患者更多地参与治疗决策，增加哮喘护士的作用，以及改善医生与患者之间的沟通，可能会改善哮喘患者的治疗效果。
