Moth Grete, Schiotz Peter Oluf, Parner Erik, Vedsted Peter
Danish Paediatric Asthma Centre, Aarhus University Hospital, Aarhus, Denmark.
J Asthma. 2010 Nov;47(9):1022-30. doi: 10.3109/02770903.2010.514632.
Asthma is the most common chronic disease in childhood. Large variations in hospitalization rates are observed and adherence to and appropriateness of guidelines are often subject of discussion. The aim was to examine if adherence to guidelines concerning use of lung function tests at time of diagnosis and during the first year after the start of medical treatment was associated with risk of hospitalization.
A Danish nationwide population-based cohort study was performed for the study period 1999-2004 using data from five nationwide registries linked by a unique personal registration number.
Risk of hospitalization was examined in relation to whether asthmatic children aged 6-14 had a lung function test at the start of treatment and during the first year of follow-up and a medication ratio of controller-to-total medication of at least 0.5. Cox regression analysis was used to calculate hazard ratios (HRs) adjusted for sex, age, socioeconomic factors, care provider, and severity of disease.
A total of 27,193 asthmatic children were followed for at least 1 year after the start of medication. The adjusted HR for hospitalization was 0.64 (95% confidence interval: 0.55-0.74) for having had a lung function test at the start of treatment; 0.82 (0.68-1.00) for having had a lung function test during the first 6 months of follow-up; 0.67 (0.55-0.81) for having a medication ratio of at least 0.5. Children from low-income families and children aged 6-8 had an increased risk of hospitalization.
Adherence to the guidelines concerning use of lung function test for asthmatic children was associated with a reduced risk of hospitalization. Likewise, a medication ratio of controller-to-total medication of at least 0.5 was associated with a lower risk of hospitalization.
哮喘是儿童期最常见的慢性疾病。观察到住院率存在很大差异，并且对指南的依从性和适宜性常常是讨论的话题。目的是研究在诊断时以及开始药物治疗后的第一年，对肺功能测试使用指南的依从性是否与住院风险相关。
在1999年至2004年的研究期间，利用五个全国性登记处的数据，通过唯一的个人登记号码进行链接，开展了一项丹麦全国性基于人群的队列研究。
研究了6至14岁哮喘儿童在治疗开始时以及随访的第一年是否进行肺功能测试，以及控制药物与总药物的用药比例是否至少为0.5与住院风险的关系。采用Cox回归分析计算经性别、年龄、社会经济因素、医疗服务提供者和疾病严重程度调整后的风险比（HRs）。
共有27193名哮喘儿童在开始用药后至少随访了1年。治疗开始时进行肺功能测试的住院调整后HR为0.64（95%置信区间：0.55 - 0.74）；随访前6个月内进行肺功能测试的为0.82（0.68 - 1.00）；用药比例至少为0.5的为0.67（0.55 - 0.81）。低收入家庭的儿童和6至8岁的儿童住院风险增加。
哮喘儿童对肺功能测试使用指南的依从性与住院风险降低相关。同样，控制药物与总药物的用药比例至少为0.5与较低的住院风险相关。
