Center for Health Services Research, Henry Ford Health System, Detroit, MI 48202, USA.
J Allergy Clin Immunol. 2011 Dec;128(6):1185-1191.e2. doi: 10.1016/j.jaci.2011.09.011. Epub 2011 Oct 21.
Asthma is an inflammatory condition often punctuated by episodic symptomatic worsening, and accordingly, patients with asthma might have waxing and waning adherence to controller therapy.
We sought to measure changes in inhaled corticosteroid (ICS) adherence over time and to estimate the effect of this changing pattern of use on asthma exacerbations.
ICS adherence was estimated from electronic prescription and fill information for 298 participants in the Study of Asthma Phenotypes and Pharmacogenomic Interactions by Race-Ethnicity. For each patient, we calculated a moving average of ICS adherence for each day of follow-up. Asthma exacerbations were defined as the need for oral corticosteroids, an asthma-related emergency department visit, or an asthma-related hospitalization. Proportional hazard models were used to assess the relationship between ICS medication adherence and asthma exacerbations.
Adherence to ICS medications began to increase before the first asthma exacerbation and continued afterward. Adherence was associated with a reduction in exacerbations but was only statistically significant among patients whose adherence was greater than 75% of the prescribed dose (hazard ratio, 0.61; 95% CI, 0.41-0.90) when compared with patients whose adherence was 25% or less. This pattern was largely confined to patients whose asthma was not well controlled initially. An estimated 24% of asthma exacerbations were attributable to ICS medication nonadherence.
ICS adherence varies in the time period leading up to and after an asthma exacerbation, and nonadherence likely contributes to a large number of these exacerbations. High levels of adherence are likely required to prevent these events.
哮喘是一种炎症性疾病，常伴有间歇性症状恶化，因此，哮喘患者可能会出现控制器治疗的依从性时高时低。
我们旨在测量随时间推移吸入皮质类固醇（ICS）依从性的变化，并估计这种使用模式变化对哮喘加重的影响。
我们根据种族和民族哮喘表型和药物基因组相互作用研究中的 298 名参与者的电子处方和用药信息来估计 ICS 依从性。对于每位患者，我们计算了随时间推移的 ICS 依从性的移动平均值。哮喘加重定义为需要口服皮质类固醇、哮喘相关急诊就诊或哮喘相关住院治疗。比例风险模型用于评估 ICS 药物依从性与哮喘加重之间的关系。
ICS 药物的依从性在首次哮喘加重之前开始增加，并在之后继续增加。依从性与减少加重有关，但仅在依从性大于规定剂量的 75%（危险比，0.61；95%CI，0.41-0.90）的患者中具有统计学意义，而在依从性为 25%或更少的患者中则无统计学意义。这种模式主要局限于最初哮喘控制不佳的患者。估计有 24%的哮喘加重归因于 ICS 药物不依从。
ICS 依从性在哮喘加重前后的时间段内有所变化，不依从可能导致大量哮喘加重。高依从性可能是预防这些事件的关键。
