Takemura Masaya, Kobayashi Michiru, Kimura Kiyomi, Mitsui Katsumi, Masui Hiroko, Koyama Misuzu, Itotani Ryo, Ishitoko Manabu, Suzuki Shinko, Aihara Kensaku, Matsumoto Masataka, Oguma Tsuyoshi, Ueda Tetsuya, Kagioka Hitoshi, Fukui Motonari
Division of Respiratory Medicine, Kitano Hospital, Tazuke Kofukai, Medical Research Institute, Osaka, Japan.
J Asthma. 2010 Mar;47(2):202-8. doi: 10.3109/02770900903581692.
Adherence to inhalation therapy is a critical determinant of the success of asthma management. Reasons for nonadherence have been well studied, but reasons for good adherence are poorly understood. Understanding the mechanisms of adherence to inhalation therapy is important in developing strategies to promote adherence. The objective of this study was to assess the factors and mechanisms that contribute to and the clinical outcomes relating to adherence to inhalation therapy.
The factors and outcomes related to adherence to inhalation therapy were examined cross-sectionally in 176 adults with asthma using a self-reported adherence questionnaire that consisted of four items dealing with the use of inhaled controller medications. A 5-point Likert scale was used for the responses to each item. Adherence was assessed based on the overall mean adherence score.
Of the 176 patients who were potential participants, 146 (83%) responded with usable information. Significant factors associated with the overall mean adherence score were older age (r = .18, p = .032) and receiving repeated instruction on inhalation techniques (p = .0016). Of the 146 respondents, 25 (17.1%) patients were given repeated verbal instruction or demonstrations of inhalation technique by a respiratory physician. On logistic regression analysis, good adherence to inhalation therapy was significantly related to the receiving of repeated instruction on inhalation technique, with an odds ratio of 2.90 (95% confidence interval 1.07-7.88; p = .037). Furthermore, less intentional nonadherent behavior was reported in patients with repeated instruction on inhalation technique compared to those without it. A significant correlation was found between the overall mean adherence score and the frequency of asthma exacerbations (r = -.19, p = .021), emergency room visits (r = -.19, p = .042), and the health-related quality of life score (St. George's Respiratory Questionnaire: Total, r = -.22, p = .024; Symptoms, r = -.21, p = .022; Impacts, r = -.20, p = .035).
Repeated instruction on inhalation techniques may contribute to adherence to inhalation therapy through decreasing intentional nonadherence. Furthermore, good adherence to the therapeutic regimen may offer good asthma-related outcomes.
坚持吸入治疗是哮喘管理成功的关键决定因素。不坚持治疗的原因已得到充分研究，但良好坚持治疗的原因却知之甚少。了解吸入治疗的坚持机制对于制定促进坚持治疗的策略很重要。本研究的目的是评估有助于坚持吸入治疗的因素和机制以及与之相关的临床结局。
使用一份自我报告的坚持问卷对176名成年哮喘患者进行横断面研究，以检查与坚持吸入治疗相关的因素和结局。该问卷包含四个关于吸入控制药物使用的问题。每个问题的回答采用5点李克特量表。根据总体平均坚持得分评估坚持情况。
在176名潜在参与者中，146名（83%）提供了可用信息。与总体平均坚持得分相关的显著因素包括年龄较大（r = 0.18，p = 0.032）以及接受过吸入技术的重复指导（p = 0.0016）。在146名受访者中，25名（17.1%）患者接受了呼吸科医生关于吸入技术的重复口头指导或示范。逻辑回归分析显示，良好的吸入治疗坚持情况与接受吸入技术的重复指导显著相关，比值比为2.90（95%置信区间1.07 - 7.88；p = 0.037）。此外，与未接受重复指导的患者相比，接受吸入技术重复指导的患者报告的故意不坚持行为较少。总体平均坚持得分与哮喘发作频率（r = -0.19，p = 0.021）、急诊就诊次数（r = -0.19，p = 0.042）以及健康相关生活质量得分（圣乔治呼吸问卷：总分，r = -0.22，p = 0.024；症状，r = -0.21，p = 0.022；影响，r = -0.20，p = 0.035）之间存在显著相关性。
吸入技术的重复指导可能通过减少故意不坚持来促进吸入治疗的坚持。此外，良好地坚持治疗方案可能带来良好的哮喘相关结局。
