基于网络的与标准哮喘自我管理的临床疗效比较。

Clinical efficacy of web-based versus standard asthma self-management.

机构信息

Serviço de Imunologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.

出版信息

J Investig Allergol Clin Immunol. 2012;22(1):28-34.

Abstract

BACKGROUND

Guided self-management is an important component of asthma care. Most trials have evaluated paper-based strategies. The effectiveness of new communication technologies remains uncertain.

OBJECTIVES

To compare the feasibility and clinical outcomes of a standard paper-based asthma self-management strategy with web-based strategies.

METHODS

In a crossover trial, 21 patients using inhaled corticosteroids and long-acting B2-agonists (mean [SD] age 29 [10] years) were randomly assigned to use a sequence of web-based and paper-based diary and action plan. Quality of life, asthma control, lung function, and airway inflammation were assessed using the Asthma Life Quality Questionnaire (ALQ), Asthma Control Questionnaire (ACQ-5), Mini Asthma Quality of Life Questionnaire (Mini AQLQ), and office spirometry. The ratio of forced expiratory volume in the first second of expiration (FEV1) to peak expiratory flow (PEF) rate (PiKo-1) and fraction of exhaled nitric oxide (FE(NO)) were monitored. The main clinical outcomes were asthma control and FE(NO). Quality of data and adherence to monitoring tools were the main process outcomes.

RESULTS

Significant improvements were observed in the AQL and ACQ scores, although lung function did not change. FE(NO) was significantly reduced only after a web-based strategy but a significant period effect occurred (P = .006). There were no differences in clinical outcomes between web-based and paper-based management. No intervention-related adverse effects were observed. Adherence seemed higher with the paper-based strategy (P < .001). However, paper data were unreliable when compared to automatic daily electronic FEV1/PEF records. Twelve patients were very interested in continuing self-management with the web-based approach compared with 2 in using paper tools (P = .002).

CONCLUSIONS

Web-based management was feasible, safe, and preferred by patients. Short-term outcomes were at least as good, and data quality was improved.

摘要

背景

指导自我管理是哮喘护理的重要组成部分。大多数试验评估了基于纸张的策略。新的通信技术的有效性仍不确定。

目的

比较标准基于纸张的哮喘自我管理策略与基于网络的策略的可行性和临床结果。

方法

在一项交叉试验中，21 名使用吸入皮质激素和长效 B2-激动剂的患者（平均[标准差]年龄 29[10]岁）被随机分配使用基于网络和基于纸张的日记和行动计划序列。使用哮喘生活质量问卷（ALQ）、哮喘控制问卷（ACQ-5）、迷你哮喘生活质量问卷（Mini AQLQ）和办公肺量计评估生活质量、哮喘控制、肺功能和气道炎症。监测用力呼气量（FEV1）与呼气峰流速（PEF）率（PiKo-1）和呼出一氧化氮（FE（NO））的比值。主要临床结果是哮喘控制和 FE（NO）。数据质量和监测工具的依从性是主要的过程结果。

结果

尽管肺功能没有变化，但 AQL 和 ACQ 评分均有显著改善。仅在基于网络的策略后，FE（NO）显著降低，但出现显著的时期效应（P =.006）。基于网络和基于纸张的管理之间在临床结果上没有差异。未观察到与干预相关的不良事件。与基于纸张的策略相比，依从性似乎更高（P <.001）。然而，与自动每日电子 FEV1/PEF 记录相比，基于纸张的数据不可靠。与使用纸张工具相比，有 12 名患者非常有兴趣继续使用基于网络的方法进行自我管理（P =.002）。