Municipal Health Authority, Pediatric Asthma Management Program Chairman, Itabira, Brazil.
Allergy. 2010 Nov;65(11):1472-7. doi: 10.1111/j.1398-9995.2010.02405.x.
The effectiveness of pediatric asthma management programs in reducing health services utilization during exacerbations in developing countries is not widely studied. This study was carried out to assess the effectiveness of an asthma management program to reduce the overall health services utilization by acute asthma in children and adolescents.
In this historical population-based real-life cohort study, we selected 582 patients with asthma aged 4-15 living in deprived areas in the town of Itabira, Brazil, of which 470 cases were assisted by the asthma management program and 112 were controls. The end point was the first physician-diagnosed asthma exacerbation occurring after study enrollment and within 12 months after admission. All 470 cases received a written plan about exacerbation self-management, including the use of inhaled albuterol at home. Three hundred and seventeen out of 470 cases (67.4%) were also treated with beclomethasone diproprionate (BDP).
Both groups were comparable regarding gender, age group, and place of residence. At the end of the study, only 5% of cases vs 34% of controls did seek health services because of acute asthma (P < 0.01). Statistical difference also remained when comparing the 112 controls with the 153 cases not treated with com BDP (Hazard Ratio = 0.04, 95% CI, 0.01-0.14, P < 0.01).
Results have demonstrated the effectiveness of the pediatric asthma management program in reducing dependence on the health services for acute asthma. Effectiveness was also observed in subjects with no use of BDP.
在发展中国家，儿科哮喘管理方案在减少哮喘加重期卫生服务利用方面的效果尚未得到广泛研究。本研究旨在评估哮喘管理方案在减少儿童和青少年急性哮喘整体卫生服务利用方面的效果。
在这项基于人群的历史性真实队列研究中，我们选择了巴西伊塔比拉镇贫困地区 4-15 岁的 582 名哮喘患者，其中 470 例由哮喘管理方案管理，112 例为对照组。终点是研究入组后 12 个月内首次确诊的哮喘加重。所有 470 例患者均收到了一份关于哮喘加重自我管理的书面计划，包括在家中使用吸入性沙丁胺醇。其中 370 例（67.4%）还接受了丙酸倍氯米松（BDP）治疗。
两组在性别、年龄组和居住地方面无差异。研究结束时，只有 5%的病例因急性哮喘而寻求医疗服务，而对照组为 34%（P<0.01）。与未接受 BDP 治疗的 153 例病例相比，仅 5%的病例 vs 34%的对照组（危险比=0.04，95%可信区间 0.01-0.14，P<0.01）也存在统计学差异。
研究结果表明，儿科哮喘管理方案可有效减少对卫生服务的依赖，用于治疗急性哮喘。在未使用 BDP 的患者中也观察到了该方案的有效性。
