Respiratory Institute, Dean Medical Center, Madison, Wisconsin, USA.
Allergy Asthma Proc. 2011 Jul-Aug;32(4):265-71. doi: 10.2500/aap.2011.32.3455.
Medical advances have allowed many patients with chronic diseases to lead relatively normal lives, but disparity between patient perceptions of "normal" and therapeutically defined disease control contributes to lowered adherence to treatment. This disconnect is greatest in diseases such as allergic rhinitis (AR) in which patients experience varying symptom severity over time-from asymptomatic periods to episodes of severe illness. This study was designed to evaluate the concept of adherence as applied to patients with AR. We reviewed the published literature. Adherence (or nonadherence) is an active process involving decision making on the part of the patient. Poor adherence with therapy can be the major barrier to achieving disease control, and the "on again, off again" approach to AR treatment embraced purposely by some patients may contribute to symptom lability, disease exacerbations, and higher costs. Evidence from surveys suggests that although specific educational interventions can temporarily improve adherence, in the long term most patients eventually revert to their former behavior. The available data suggest a need to reappraise how we address adherence with therapy in patients with chronic diseases with variable symptoms such as AR. The question is not just whether patient behavior can conform to recommended treatment plans, but whether it should. Experience suggests that successful strategies will be brief, easy to use, and capable of being tailored to individual patients in diverse clinical settings. Increased flexibility with medications is a corollary, particularly when patients are relatively asymptomatic (i.e., considered in control).
医学的进步使许多慢性病患者能够过上相对正常的生活，但患者对“正常”的感知与治疗上定义的疾病控制之间的差异导致治疗的依从性降低。在变应性鼻炎（AR）等疾病中，患者的症状严重程度会随时间变化，从无症状期到严重发作期，这种差异最大。本研究旨在评估适用于 AR 患者的依从性概念。我们回顾了已发表的文献。依从性（或不依从性）是一个涉及患者决策的主动过程。治疗依从性差可能是实现疾病控制的主要障碍，而一些患者故意采用的 AR 治疗“时断时续”方法可能导致症状不稳定、疾病恶化和更高的成本。调查证据表明，尽管特定的教育干预措施可以暂时提高依从性，但从长期来看，大多数患者最终会恢复到以前的行为。现有数据表明，我们需要重新评估如何解决 AR 等症状多变的慢性病患者的治疗依从性问题。问题不仅在于患者的行为是否符合推荐的治疗计划，还在于是否应该这样做。经验表明，成功的策略将是简短、易于使用的，并能够针对不同临床环境中的个体患者进行调整。增加药物的灵活性是一个必然结果，特别是当患者相对无症状时（即被认为得到控制）。
