Laforest L, Van Ganse É, Devouassoux G, Chatté G, Tamberou C, Belhassen M, Chamba G
UMR 5558-CNRS, unité de pharmacoépidémiologie, faculté d'odontologie, 11, rue Guillaume-Paradin, 69372 Lyon cedex 08, France.
UMR 5558-CNRS, unité de pharmacoépidémiologie, faculté d'odontologie, 11, rue Guillaume-Paradin, 69372 Lyon cedex 08, France; Service de pneumologie, hôpital de la Croix-Rousse, HCL, 69004 Lyon, France.
Rev Mal Respir. 2015 Jan;32(1):8-17. doi: 10.1016/j.rmr.2014.04.103. Epub 2014 Aug 8.
Adherence to inhaled corticosteroids (ICS) remains a major issue for asthma management, even among patients receiving a regular prescription from their doctor. The frequency of deliberate interruption of ICS, and of spontaneous changes of dose, were studied in a population of asthma patients recruited in community pharmacies.
Asthma patients (aged 18-50) recruited in community pharmacies reported in self-administered questionnaires their spontaneous interruptions and changes of doses of ICS during the past 3 months. The characteristics of patients who interrupted their therapy or who modified the dose were compared with other patients.
The studied population included 252 patients (mean age 35 year-old, females: 59%), of whom 62% had inadequately controlled asthma. Among these patients, 25% had interrupted ICS therapy during the past 3 months, while 21% spontaneously changed the dose. The most reported reason for interrupting ICS was the cessation of symptoms (50%). In multivariate analysis, interrupting ICS was mainly associated with inadequate asthma control (OR=3.1, 95% CI 1.5-6.4), while the strongest association with changing ICS doses was the patients' perception of asthma as a concern in their lives (OR=3.2, 95% CI 1.2-8.4).
These results underline a poor understanding of the purpose of ICS therapy by patients. They also highlight the need of therapeutic education to improve the management of the disease.
即使在那些从医生处获得常规处方的患者中，吸入性糖皮质激素（ICS）的依从性仍是哮喘管理中的一个主要问题。我们在社区药房招募的哮喘患者群体中，研究了故意中断ICS治疗的频率以及剂量的自发变化情况。
在社区药房招募的年龄在18至50岁之间的哮喘患者，通过自行填写问卷报告他们在过去3个月内ICS治疗的自发中断情况和剂量变化。将中断治疗或改变剂量的患者特征与其他患者进行比较。
研究人群包括252名患者（平均年龄35岁，女性占59%），其中62%的患者哮喘控制不佳。在这些患者中，25%在过去3个月内中断了ICS治疗，而21%自发改变了剂量。报告最多的中断ICS治疗的原因是症状缓解（50%）。在多变量分析中，中断ICS治疗主要与哮喘控制不佳相关（比值比=3.1，95%置信区间1.5 - 6.4），而与改变ICS剂量关联最强的是患者将哮喘视为生活中的一个担忧因素（比值比=3.2，95%置信区间1.2 - 8.4）。
这些结果强调了患者对ICS治疗目的的理解不足。它们还突出了进行治疗教育以改善疾病管理的必要性。
