Foster Juliet M, Aucott Lorna, van der Werf Rik H W, van der Meijden Mariken J, Schraa Gysbert, Postma Dirkje S, van der Molen Thys
Department of General Practice and Primary Care, University of Aberdeen, Foresterhill AB25 2AY, Scotland.
Respir Med. 2006 Aug;100(8):1318-36. doi: 10.1016/j.rmed.2005.11.029. Epub 2006 Jan 25.
The range and extent of inhaled corticosteroid (ICS) side effects experienced by patients in the general community are likely to be underestimated.
To identify the side effects of ICS perceived by patients in the community and, through the use of a self-report questionnaire, measure their intensity, prevalence and relationship with daily medication dose.
Focus groups and in-depth interviews were conducted to identify side effects that patients associated with their use of ICS. In an international multicentre cross-sectional survey, 395 inhaler users from community pharmacy (mean age 50, 53% female), divided into 4 daily dosage groups (beta2-agonist without ICS n=66, beclometasone dipropionate (BDP) equivalent ICS low dose 400 microg, n=109; mid dose 401-800 microg, n=151; and high dose>800 microg, n=69) reported how much they were affected by these side effects on a 7-point Likert scale.
Focus groups and interviews revealed 57 side effects that were associated with ICS use. Cross-sectional survey results showed significant differences in side effect perception between the four dosage groups for 31 items (all P0.01) and a rising intensity with increasing ICS dose for total side effect score (P<0.001). For ICS users reporting the most bothersome side effects (scoring 3 on 0-6 scale) there was a rising prevalence as ICS dose increased for 34 items. A multivariate model confirmed that mid and high ICS dosages were statistically significantly associated with side effect perception after controlling for the other factors and covariates.
Higher daily ICS doses were associated with a higher intensity and a higher prevalence of many patient perceived side effects, lending support to the call for dose titration in clinical practice. Results indicate the usefulness of patient self-report scales for understanding the burden of side effects of ICS in the community.
普通人群中患者所经历的吸入性糖皮质激素（ICS）副作用的范围和程度可能被低估了。
确定社区患者所察觉到的ICS副作用，并通过使用自我报告问卷来测量其强度、患病率以及与每日药物剂量的关系。
进行焦点小组讨论和深入访谈，以确定患者将哪些副作用与使用ICS联系起来。在一项国际多中心横断面调查中，395名来自社区药房的吸入器使用者（平均年龄50岁，53%为女性），分为4个每日剂量组（无ICS的β2激动剂组n = 66，丙酸倍氯米松（BDP）等效ICS低剂量400微克，n = 109；中剂量401 - 800微克，n = 151；高剂量> 800微克，n = 69），用7点李克特量表报告这些副作用对他们的影响程度。
焦点小组讨论和访谈揭示了57种与使用ICS相关的副作用。横断面调查结果显示，3样1项在四个剂量组之间的副作用感知存在显著差异（均P<0.01），且总副作用得分随ICS剂量增加而强度上升（P<0.001）。对于报告最困扰副作用（在0 - 6量表上得分为3）的ICS使用者，34项副作用的患病率随ICS剂量增加而上升。多变量模型证实，在控制其他因素和协变量后，中高剂量ICS在统计学上与副作用感知显著相关。
每日较高的ICS剂量与许多患者察觉到的副作用的较高强度和较高患病率相关，这支持了在临床实践中进行剂量滴定的呼吁。结果表明患者自我报告量表对于了解社区中ICS副作用负担的有用性。
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