Greaves Colin J, Hyland Michael E, Halpin David M G, Blake Susan, Seamark David
Peninsula Medical School (Primary Care), Postgraduate Medical Centre, Barrack Road, Exeter EX2 5DW, UK.
Prim Care Respir J. 2005 Apr;14(2):99-105. doi: 10.1016/j.pcrj.2004.09.005. Epub 2005 Jan 21.
To identify specific patterns of corticosteroid use and examine their relationship with asthma outcomes.
An adherence questionnaire was developed and applied in a population-based observational survey; this compared unscheduled care visits and asthma quality of life for adherent and non-adherent patient groups within 176 patients from a semi-rural UK practice.
Three main patterns of medication use were identified: Regular; Regular-but-less (Low-Dosing); and Symptom-Directed variation. For mild-to-moderate asthma (BTS treatment step 2), non-adherence produced acceptable outcomes, not significantly different from outcomes for adherent patients. For more severe asthma, regular adherence was more effective, resulting in significantly less unscheduled visits.
The results suggest that flexible 'symptom-directed' medication use and patient-initiated dose reduction may be viable alternatives to regular medication for a number of lower severity patients. For milder asthma, clinicians should perhaps focus their efforts on patients with poor asthma outcomes, rather than poor adherence.
确定皮质类固醇使用的具体模式，并研究其与哮喘结局的关系。
编制一份依从性调查问卷，并应用于一项基于人群的观察性调查；该调查比较了英国一个半乡村诊所176例患者中依从性和非依从性患者组的非计划就诊情况及哮喘生活质量。
确定了三种主要用药模式：常规用药；常规但减量（低剂量）；症状导向型变化。对于轻至中度哮喘（英国胸科学会治疗第2步），不依从产生了可接受的结局，与依从性患者的结局无显著差异。对于更严重的哮喘，规律依从性更有效，导致非计划就诊显著减少。
结果表明，对于一些病情较轻的患者，灵活的“症状导向型”用药和患者自主减少剂量可能是常规用药的可行替代方案。对于较轻的哮喘，临床医生或许应将精力集中在哮喘结局较差的患者身上，而非依从性差的患者。
