Bloomberg Gordon R, Banister Christina, Sterkel Randall, Epstein Jay, Bruns Julie, Swerczek Lisa, Wells Suzanne, Yan Yan, Garbutt Jane M
St Louis Children's Hospital, Washington University School of Medicine, Department of Pediatrics, Division of Allergy and Pulmonary Medicine, One Children's Place, St Louis, MO 63110, USA.
Pediatrics. 2009 Mar;123(3):829-35. doi: 10.1542/peds.2008-0504.
Multiple issues play a role in the effective control of childhood asthma.
To identify factors related to the level of asthma control in children receiving asthma care from community pediatricians.
Data for 362 children participating in an intervention study to reduce asthma morbidity were collected by a telephone-administered questionnaire. Level of asthma control (well controlled, partially controlled, or poorly controlled) was derived from measures of recent impairment (symptoms, activity limitations, albuterol use) and the number of exacerbations in a 12-month period. Data also included demographic characteristics, asthma-related quality of life, pediatric management practices, and medication usage. Univariable and multivariable analyses were used to identify factors associated with poor asthma control and to explore the relationship between control and use of daily controller medications.
Asthma was well controlled for 24% of children, partially controlled for 20%, and poorly controlled for 56%. Medicaid insurance, the presence of another family member with asthma, and maternal employment outside the home were significant univariable factors associated with poor asthma control. Medicaid insurance had an independent association with poor control. Seventy-six percent of children were reported by parents as receiving a daily controller medication. Comparison of guideline recommended controller medication with current level of asthma control indicated that a higher step level of medication would have been appropriate for 74% of these children. Significantly lower overall quality-of-life scores were observed in both parents and children with poor control.
Despite substantial use of daily controller medication, children with asthma continue to experience poorly controlled asthma and reduced quality of life. Although Medicaid insurance and aspects of family structure are significant factors associated with poorly controlled asthma, attention to medication use and quality-of-life indicators may further reduce morbidity.
多种因素对儿童哮喘的有效控制发挥作用。
确定在社区儿科医生处接受哮喘治疗的儿童中，与哮喘控制水平相关的因素。
通过电话问卷调查收集了362名参与一项旨在降低哮喘发病率的干预研究的儿童的数据。哮喘控制水平（控制良好、部分控制或控制不佳）源自近期损伤（症状、活动受限、使用沙丁胺醇）的测量指标以及12个月内的加重发作次数。数据还包括人口统计学特征、哮喘相关生活质量、儿科管理措施及药物使用情况。采用单变量和多变量分析来确定与哮喘控制不佳相关的因素，并探讨控制情况与每日控制药物使用之间的关系。
24%的儿童哮喘控制良好，20%部分控制，56%控制不佳。医疗补助保险、家中有另一位患有哮喘的家庭成员以及母亲在外工作是与哮喘控制不佳相关的显著单变量因素。医疗补助保险与控制不佳存在独立关联。据家长报告，76%的儿童正在使用每日控制药物。将指南推荐的控制药物与当前哮喘控制水平进行比较表明，74%的这些儿童本应使用更高阶梯水平的药物。控制不佳的父母和儿童的总体生活质量得分显著更低。
尽管大量使用每日控制药物，但哮喘儿童的哮喘仍持续控制不佳且生活质量下降。虽然医疗补助保险和家庭结构方面是与哮喘控制不佳相关的重要因素，但关注药物使用和生活质量指标可能会进一步降低发病率。
