个体化哮喘自我管理可提高药物依从性和哮喘控制指标。
Individualized asthma self-management improves medication adherence and markers of asthma control.
作者信息
Janson Susan L, McGrath Kelly Wong, Covington Jack K, Cheng Su-Chun, Boushey Homer A
机构信息
Department of Community Health Systems, University of California, San Francisco, CA 94143-0608, USA.
出版信息
J Allergy Clin Immunol. 2009 Apr;123(4):840-6. doi: 10.1016/j.jaci.2009.01.053.
BACKGROUND
Adherence to inhaled anti-inflammatory therapy and self-management skills are essential parts of the asthma treatment plan to improve asthma control and prevent exacerbations. Whether self-management education improves long-term medication adherence is less clear.
OBJECTIVE
A 24-week prospective, randomized controlled trial was performed to study the effect of self-management education on long-term adherence to inhaled corticosteroid (ICS) therapy and markers of asthma control.
METHODS
After stabilization on ICS medication during a run-in phase, 95 adults with moderate-to-severe asthma were recruited from a large metropolitan community, and 84 were randomized to individualized self-management education, including self-monitoring of symptoms and peak flow or usual care with self-monitoring alone. The key components of the 30-minute intervention were asthma information, assessment, and correction of inhaler technique; an individualized action plan based on self-monitoring data; and environmental control strategies for relevant allergen and irritant exposures. The intervention was personalized based on pulmonary function, allergen skin test reactivity, and inhaler technique and reinforced at 2-week intervals.
RESULTS
Participants randomized to the self-management intervention maintained consistently higher ICS adherence levels and showed a 9-fold greater odds of more than 60% adherence to the prescribed dose compared with control subjects at the end of the intervention (P = .02) and maintained a 3-fold greater odds of higher than 60% adherence at the end of the study. Perceived control of asthma improved (P = .006), nighttime awakenings decreased (P = .03), and inhaled beta-agonist use decreased (P = .01) in intervention participants compared with control subjects.
CONCLUSION
Our results show that individualized asthma self-management education attenuates the usual decrease in medication adherence and improves clinical markers of asthma control.
背景
坚持吸入抗炎治疗和自我管理技能是哮喘治疗计划的重要组成部分，有助于改善哮喘控制并预防病情加重。自我管理教育能否提高长期药物依从性尚不清楚。
目的
进行一项为期24周的前瞻性随机对照试验，以研究自我管理教育对吸入糖皮质激素（ICS）治疗的长期依从性及哮喘控制指标的影响。
方法
在导入期使用ICS药物使病情稳定后，从一个大型都市社区招募了95名中重度哮喘成人患者，其中84名被随机分为两组，一组接受个体化自我管理教育，包括症状自我监测和呼气峰流速监测，另一组仅接受常规护理及自我监测。30分钟干预的关键内容包括哮喘知识、吸入器技术评估与纠正；基于自我监测数据制定的个体化行动计划；针对相关过敏原和刺激物暴露的环境控制策略。干预根据肺功能、过敏原皮肤试验反应性和吸入器技术进行个性化调整，并每2周强化一次。
结果
随机分配到自我管理干预组的参与者在干预结束时ICS依从性水平持续更高，与对照组相比，按规定剂量依从率超过60%的几率高出9倍（P = 0.02），在研究结束时，依从率高于60%的几率高出3倍。与对照组相比，干预组参与者对哮喘的自我感知控制得到改善（P = 0.006），夜间觉醒次数减少（P = 0.03），吸入β受体激动剂的使用减少（P = 0.01）。
结论
我们的研究结果表明，个体化哮喘自我管理教育可减轻药物依从性通常出现的下降，并改善哮喘控制的临床指标。
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