Starnet Community Health Sciences, St Georges Hospital Medical School, London, UK.
Clin Exp Allergy. 2010 Jan;40(1):143-52. doi: 10.1111/j.1365-2222.2009.03350.x. Epub 2009 Sep 28.
Allergy contributes significantly to asthma exacerbation, yet avoidance of triggers, in particular allergens, is rarely addressed in detail in regular asthma review in primary care.
To determine whether structured, individually tailored allergen and trigger avoidance advice, given as part of a primary care asthma review, improves lung function and asthma control.
In a randomized-controlled trial 214 adults with asthma in six general practices were either offered usual care during a primary care asthma review or usual care with additional allergen and trigger identification (by skin prick testing and structured allergy assessment) and avoidance advice according to a standardized protocol by trained practice nurses. Main outcome measures were lung function, asthma control, asthma self-efficacy.
Both intervention groups were equivalent in demographic and asthma-related variables at baseline. At 3-6-month follow-up, patients receiving the allergen and trigger avoidance review showed significant improvements in lung function (assessed by blinded research nurses) compared with those receiving usual care. Significantly more patients in the intervention group than in the control group showed improvements in forced expiratory volume in 1 s > or =15%. No significant differences were found in self-report measures of asthma control. Asthma-specific self-efficacy improved in both groups but did not differ between groups.
Allergen and trigger identification and avoidance advice, given as part of a structured asthma review delivered in primary care by nurses results in clinically important improvements in lung function but not self-report of asthma control.
ISRCTN45684820.
过敏对哮喘恶化有重大影响，但在初级保健中的常规哮喘评估中，很少详细涉及避免诱因，尤其是过敏原。
确定在初级保健哮喘评估中提供结构化的、个体化的过敏原和触发因素避免建议是否可以改善肺功能和哮喘控制。
在一项随机对照试验中，六家普通诊所的 214 名成年哮喘患者要么在初级保健哮喘评估中接受常规护理，要么在常规护理的基础上，由经过培训的护士根据标准化方案进行过敏原和触发因素识别（通过皮肤点刺试验和结构化过敏评估）和避免建议。主要结局指标是肺功能、哮喘控制、哮喘自我效能。
两组干预组在基线时的人口统计学和哮喘相关变量方面相当。在 3-6 个月的随访中，接受过敏原和触发因素避免评估的患者的肺功能（由盲法研究护士评估）明显优于接受常规护理的患者。干预组中有更多的患者比对照组有更好的 1 秒用力呼气量改善>或=15%。自我报告的哮喘控制措施没有发现显著差异。两组的哮喘特异性自我效能都有所提高，但组间没有差异。
在护士提供的结构化哮喘评估中进行过敏原和触发因素的识别和避免建议，可以显著改善肺功能，但不能改善自我报告的哮喘控制。
ISRCTN45684820。
