Brown Michael D, Reeves Mathew J, Meyerson Karen, Korzeniewski Steven J
Grand Rapids MERC/Michigan State University Program in Emergency Medicine, Grand Rapids, Michigan, USA.
Ann Allergy Asthma Immunol. 2006 Jul;97(1):44-51. doi: 10.1016/S1081-1206(10)61368-3.
Patients with asthma who visit the emergency department (ED) may benefit from education that optimizes self-management and treatment.
To conduct a randomized trial of asthma education (AE) after an ED visit.
Patients who present with acute asthma and history consistent with moderate to severe persistent asthma or recent ED visits were stratified by age (adult, child) and randomly assigned to intervention or usual care during the ED visit. The intervention was conducted by trained asthma educators and included a facilitated office visit with the primary care physician followed by a home visit. Intention-to-treat analysis was conducted, with time to first asthma relapse (either ED or unscheduled urgent office visit) during the 6-month follow-up period used as the primary outcome.
Of the 239 patients analyzed, 46% were adults, 46% were male, 30% were African American, and 56% had moderate to severe persistent asthma. Follow-up information was obtained on 191 patients (80%) at 6 months; 23.1% of the intervention group vs 31.1% of the usual care group had an urgent asthma visit (hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.48-1.29). Overall, 39% of the 117 patients assigned to the intervention group did not comply with any of the post-ED activities. Subgroup analysis suggested greater benefit among children (HR, 0.62; 95% CI, 0.33-1.19) than adults (HR, 1.08; 95% CI, 0.50-2.33).
Delivery of a comprehensive AE program after an ED visit was ineffective in adult patients; however, it may be effective in children. Further research on alternative AE delivery strategies appears warranted to reduce the burden of asthma visits to the ED.
因哮喘前往急诊科（ED）就诊的患者可能会从优化自我管理和治疗的教育中获益。
开展一项关于急诊科就诊后哮喘教育（AE）的随机试验。
患有急性哮喘且病史符合中度至重度持续性哮喘或近期有急诊科就诊经历的患者按年龄（成人、儿童）分层，并在急诊科就诊期间随机分配至干预组或常规治疗组。干预由经过培训的哮喘教育工作者实施，包括与初级保健医生共同进行一次便利的门诊就诊，随后进行一次家访。进行意向性分析，将6个月随访期内首次哮喘复发（急诊科就诊或非预约紧急门诊就诊）的时间作为主要结局。
在分析的239例患者中，46%为成人，46%为男性，30%为非裔美国人，56%患有中度至重度持续性哮喘。6个月时获得了191例患者（80%）的随访信息；干预组23.1%的患者与常规治疗组31.1%的患者进行了紧急哮喘就诊（风险比[HR]，0.79；95%置信区间[CI]，0.48 - 1.29）。总体而言，分配至干预组的117例患者中，39%未遵守任何急诊科就诊后的活动。亚组分析表明，儿童（HR，0.62；95% CI，0.33 - 1.19）比成人（HR，1.08；95% CI，0.50 - 2.33）获益更大。
急诊科就诊后实施全面的哮喘教育计划对成年患者无效；然而，对儿童可能有效。似乎有必要对替代的哮喘教育实施策略进行进一步研究，以减轻哮喘患者前往急诊科就诊的负担。
