Williams L Keoki, Pladevall Manel, Xi Hugo, Peterson Edward L, Joseph Christine, Lafata Jennifer Elston, Ownby Dennis R, Johnson Christine C
Department of Internal Medicine, Henry Ford Health System, Detoit, MI 48202, USA.
J Allergy Clin Immunol. 2004 Dec;114(6):1288-93. doi: 10.1016/j.jaci.2004.09.028.
Regular use of inhaled corticosteroids (ICSs) can improve asthma symptoms and prevent exacerbations. However, overall adherence is poor among patients with asthma. Objective To estimate the proportion of poor asthma-related outcomes attributable to ICS nonadherence.
We retrospectively identified 405 adults age 18 to 50 years who had asthma and were members of a large health maintenance organization in southeast Michigan between January 1, 1999, and December 31, 2001. Adherence indices were calculated by using medical records and pharmacy claims. The main outcomes were the number of asthma-related outpatient visits, emergency department visits, and hospitalizations, as well as the frequency of oral steroid use.
Overall adherence to ICS was approximately 50%. Adherence to ICS was significantly and negatively correlated with the number of emergency department visits (correlation coefficient [ R ] = -0.159), the number of fills of an oral steroid ( R = -0.179), and the total days' supply of oral steroid ( R = -0.154). After adjusting for potential confounders, including the prescribed amount of ICS, each 25% increase in the proportion of time without ICS medication resulted in a doubling of the rate of asthma-related hospitalization (relative rate, 2.01; 95% CI, 1.06-3.79). During the study period, there were 80 asthma-related hospitalizations; an estimated 32 hospitalizations would have occurred were there no gaps in medication use (60% reduction).
Adherence to ICS is poor among adult patients with asthma and is correlated with several poor asthma-related outcomes. Less than perfect adherence to ICS appears to account for the majority of asthma-related hospitalizations.
定期使用吸入性糖皮质激素（ICS）可改善哮喘症状并预防病情加重。然而，哮喘患者的总体依从性较差。目的是评估因未坚持使用ICS而导致不良哮喘相关结局的比例。
我们回顾性纳入了405名年龄在18至50岁之间的成年哮喘患者，他们于1999年1月1日至2001年12月31日期间是密歇根州东南部一家大型健康维护组织的成员。通过病历和药房报销记录计算依从性指数。主要结局包括哮喘相关的门诊就诊次数、急诊就诊次数和住院次数，以及口服类固醇的使用频率。
ICS的总体依从率约为50%。ICS的依从性与急诊就诊次数（相关系数[R]=-0.159）、口服类固醇的配药次数（R=-0.179）以及口服类固醇的总供应天数（R=-0.154）呈显著负相关。在调整了包括ICS处方量在内的潜在混杂因素后，未使用ICS药物的时间比例每增加25%，哮喘相关住院率就会翻倍（相对率为2.01；95%CI为1.06-3.79）。在研究期间，有80例哮喘相关住院病例；如果用药无间断，估计会发生32例住院病例（减少60%）。
成年哮喘患者对ICS的依从性较差，且与多种不良哮喘相关结局相关。对ICS的不完全依从似乎是大多数哮喘相关住院病例的原因。
