Press Valerie G, Hasegawa Kohei, Heidt Jonathan, Bittner Jane C, Camargo Carlos A
a Department of Medicine , University of Chicago Medicine , Chicago , IL , USA.
b Department of Emergency Medicine , Harvard Medical School, Massachusetts General Hospital , Boston , MA , USA.
J Asthma. 2017 Nov;54(9):968-976. doi: 10.1080/02770903.2017.1281295. Epub 2017 Jan 17.
Hospitalizations for acute asthma are thought to be highly preventable through the use of efficacious medications, though many patients have poor metered-dose inhaler (MDI) techniques, thus lessening these medications' real-world effectiveness. Teaching MDI techniques during hospitalization may therefore lead to improved outcomes. However, MDIs may be underutilized to deliver short-acting β-agonists (SABAs) in the inpatient setting, despite equivalent efficacy to nebulizer delivery. We sought to characterize delivery methods of SABAs among hospitalized patients with acute asthma to understand if there are missed opportunities for self-management education.
In this secondary analysis of a cross-sectional 25-center chart review study of children and adults (ages 2-54 years) hospitalized for acute asthma across 18 states (2012-2013), we studied SABA therapy delivery methods during hospitalization and receipt of action plans and follow-up visits. Unadjusted associations were analyzed using chi-square, Fisher's exact, or Kruskal-Wallis tests.
Of 987 patients, 44% received only nebulizer-SABA (children 32% vs. adults 53%; p < 0.001) during hospitalization, and 55% (children 68% vs. adults 47%; p < 0.001) received any MDI-SABA during hospitalization. Children receiving only nebulizer- vs. MDI-SABA were significantly less likely to receive individualized action plans (p < 0.001). Compared to children, adults were overall less likely to receive written plans (47% vs. 78%, p < 0.001) or to have a follow-up appointment (38% vs. 59%, p < 0.001) at discharge.
Opportunities exist to increase the delivery of MDI-SABA during hospitalization, particularly for adult inpatients with asthma. Further studies are needed to determine if increased use of MDI-delivered therapies improves patient education and outcomes.
尽管使用有效药物可高度预防急性哮喘住院，但许多患者的定量吸入器（MDI）使用技术欠佳，从而降低了这些药物在实际应用中的效果。因此，在住院期间教授MDI使用技术可能会改善治疗结果。然而，在住院环境中，MDI在用于输送短效β受体激动剂（SABA）方面可能未得到充分利用，尽管其疗效与雾化器输送相当。我们试图描述急性哮喘住院患者中SABA的给药方式，以了解自我管理教育是否存在机会缺失。
在这项对18个州（2012 - 2013年）因急性哮喘住院的儿童和成人（2至54岁）进行的25中心横断面图表回顾研究的二次分析中，我们研究了住院期间SABA治疗的给药方式以及行动计划的接收情况和随访情况。使用卡方检验、Fisher精确检验或Kruskal - Wallis检验分析未经调整的关联。
987例患者中，44%在住院期间仅接受雾化器 - SABA治疗（儿童为32%，成人为53%；p < 0.001），55%（儿童为68%，成人为47%；p < 0.001）在住院期间接受了任何MDI - SABA治疗。仅接受雾化器 - SABA治疗的儿童与接受MDI - SABA治疗的儿童相比，接受个性化行动计划的可能性显著更低（p < 0.001）。与儿童相比，成人总体上在出院时接受书面计划的可能性更低（47%对78%，p < 0.001），或进行随访预约的可能性更低（38%对59%，p < 0.001）。
在住院期间存在增加MDI - SABA给药的机会，尤其是对于成年哮喘住院患者。需要进一步研究以确定增加MDI给药疗法的使用是否能改善患者教育和治疗结果。
