Dept of Respiratory Paediatrics, Royal Brompton Hospital, London, UK.
University of Basel, University Children's Hospital (UKBB), Basel, Switzerland.
Eur Respir J. 2017 Dec 21;50(6). doi: 10.1183/13993003.00910-2017. Print 2017 Dec.
International guidelines recommend that severe asthma can only be diagnosed after contributory factors, including adherence, have been addressed. Accurate assessment of adherence is difficult in clinical practice. We hypothesised that electronic monitoring in children would identify nonadherence, thus delineating the small number with true severe asthma.Asthmatic children already prescribed inhaled corticosteroids were prospectively recruited and persistence of adherence assessed using electronic monitoring devices. Spirometry, airway inflammation and asthma control were measured at the start and end of the monitoring period.93 children (62 male; median age 12.4 years) were monitored for a median of 92 days. Median (range) monitored adherence was 74% (21-99%). We identified four groups: 1) good adherence during monitoring with improved control, 24% (likely previous poor adherence); 2) good adherence with poor control, 18% (severe therapy-resistant asthma); 3) poor adherence with good control, 26% (likely overtreated); and 4) poor adherence with poor control, 32%. No clinical parameter prior to monitoring distinguished these groups.Electronic monitoring is a useful tool for identifying children in whom a step up in treatment is indicated. Different approaches are needed in those who are controlled when adherent or who are nonadherent. Electronic monitoring is essential in a paediatric severe asthma clinic.
国际指南建议，只有在解决了促成因素（包括依从性）后，才能诊断严重哮喘。在临床实践中，准确评估依从性是困难的。我们假设电子监测可以在儿童中识别不依从性，从而确定真正患有严重哮喘的儿童人数很少。
前瞻性招募已经开具吸入皮质激素的哮喘儿童，并使用电子监测设备评估其依从性的持续性。在监测期开始和结束时测量肺功能、气道炎症和哮喘控制情况。
93 名儿童（62 名男性；中位年龄 12.4 岁）中位监测时间为 92 天。中位（范围）监测依从性为 74%（21-99%）。我们确定了四个组：1）监测期间依从性良好，控制改善，占 24%（可能之前依从性差）；2）依从性好但控制差，占 18%（严重治疗抵抗性哮喘）；3）依从性差但控制好，占 26%（可能过度治疗）；4）依从性差且控制差，占 32%。在监测前没有任何临床参数可以区分这些组。
电子监测是识别需要升级治疗的儿童的有用工具。对于依从性好或不依从性好的患者，需要采取不同的方法。电子监测对于儿科严重哮喘诊所至关重要。
