Ip Ka Ian, Hon Kam Lun, Tsang Kathy Yin Ching, Leung Theresa Ngan Ho
Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, People's Republic of China.
Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China.
Clin Respir J. 2018 Apr;12(4):1559-1564. doi: 10.1111/crj.12705. Epub 2017 Oct 12.
Inhaled corticosteroids (ICS) are the mainstay of treatment for asthma. Corticosteroid (CS) phobia and fears are prevalent, and these may influence therapeutic efficacy and asthma control.
The aim of this study was to evaluate if CS fear is associated with asthma control in children.
Patients aged >4 years with asthma at a pediatric outpatient clinic were surveyed, and the Asthma Control Test (ACT) was used for the assessment of asthma control.
Ninety-eight patients and their parents were interviewed. Thirty-four (35%) parents reported moderate or significant CS fear. They were more likely than those with no or little fear to have poorer asthma control (mean ACT scores 21.3 ± 4.0 vs 23.1 ± 3.3, P = 0.02), discuss their fears with their doctors (P < 0.001), request CS sparing medications (P = 0.044) and resort to Chinese medicine (CM) usage (P < 0.001). Backward binomial logistic regression showed parents with moderate/significant fears were more likely to discuss their fears with their doctors (OR: 5.21; 95% CI: 1.86-14.59; P = 0.002) and have used CM (OR: 4.28; 95% CI: 1.61-11.41; P = 0.004). CS fear was not translated to reduced self-reported compliance in the prescribed ICS. About 40% of the respondents had ever used Chinese Medicine (CM) with 82% of the users reported having used Chinese herbal medicine and 49% had used cold moxibustion.
CS fear and CM usage are prevalent. Parents with CS fear were more likely to have children with poorer asthma control and have used Chinese medicine. Physicians caring for children with asthma should be aware of parents with CS fear, prepared to address the fear or concerns and offer evidence-based alternative treatment.
吸入性糖皮质激素（ICS）是哮喘治疗的主要药物。对糖皮质激素（CS）的恐惧很普遍，这可能会影响治疗效果和哮喘控制。
本研究旨在评估对CS的恐惧是否与儿童哮喘控制相关。
对一家儿科门诊中年龄大于4岁的哮喘患者进行调查，并使用哮喘控制测试（ACT）评估哮喘控制情况。
对98名患者及其父母进行了访谈。34名（35%）父母报告有中度或严重的CS恐惧。与无恐惧或轻度恐惧的父母相比，他们的孩子哮喘控制情况更差的可能性更大（ACT平均得分21.3±4.0 vs 23.1±3.3，P = 0.02），与医生讨论他们的恐惧（P < 0.001），要求使用减少CS剂量的药物（P = 0.044）并采用中药（CM）治疗（P < 0.001）。反向二项逻辑回归显示，有中度/严重恐惧的父母更有可能与医生讨论他们的恐惧（比值比：5.21；95%置信区间：1.86 - 14.59；P = 0.002）并使用过中药（比值比：4.28；95%置信区间：1.61 - 11.41；P = 0.004）。对CS的恐惧并未转化为自我报告的ICS规定用药依从性降低。约40%的受访者曾使用过中药，其中82%的使用者报告使用过中草药，49%使用过冷灸。
对CS的恐惧和中药的使用很普遍。有CS恐惧的父母其孩子哮喘控制情况更差且使用过中药的可能性更大。照顾哮喘儿童的医生应意识到有CS恐惧的父母，准备好解决他们的恐惧或担忧，并提供基于证据的替代治疗方法。
