Koya Toshiyuki, Hasegawa Takashi, Takasawa Junko, Yoshimine Fumitoshi, Sakagami Takuro, Hayashi Masachika, Suzuki Eiichi, Kikuchi Toshiaki
Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Japan.
Department of General Medicine, Niigata University Medical and Dental Hospital, Japan.
Intern Med. 2018 Dec 1;57(23):3357-3363. doi: 10.2169/internalmedicine.0986-18. Epub 2018 Aug 10.
Objective High adherence to medications and accurate handling of inhaler devices are important for asthma management. However, few reports to date have simultaneously evaluated adherence and handling errors. We therefore investigated the adherence to inhaled corticosteroid (ICS) and inhaler handling errors in the same patients in cooperation with pharmacists. Methods Data were derived from a survey of physicians and pharmacists treating asthma patients who visited participating hospitals and pharmacies from July 2012 to January 2013. The patients were evaluated for asthma control using the Asthma Control Test (ACT) and for inhaler handling errors using checklists. ICS adherence was evaluated based on pharmaceutical records. Results Adherence among participants (n=290) was 33.3% (mean), and the percentage of inhaler handling errors was 20.0% (mean). Total inhalation times in the high-adherence group were fewer than those in the low-adherence group. In a comparison by device, adherence to pressurized metered dose inhalers was significantly lower than that to Diskus inhalers, presumably attributable to the total number of inhalations per day. Adherence, handling errors, and total number of inhalations per day were significantly different between the asthma-controlled group and the uncontrolled group. A multivariate analysis showed that adherence and handling errors were independent factors contributing to asthma control. Conclusion Our data indicated that both adherence to ICS and device handling errors contributed to asthma control in this population.
目的 对药物的高依从性以及正确使用吸入装置对于哮喘管理至关重要。然而，迄今为止，很少有报告同时评估依从性和操作失误情况。因此，我们与药剂师合作，对同一批患者的吸入性糖皮质激素（ICS）依从性和吸入装置操作失误情况进行了调查。方法 数据来自于对2012年7月至2013年1月期间前往参与研究的医院和药房就诊的哮喘患者进行治疗的医生和药剂师的调查。使用哮喘控制测试（ACT）评估患者的哮喘控制情况，使用检查表评估吸入装置操作失误情况。根据药房记录评估ICS依从性。结果 参与者（n = 290）的依从性平均为33.3%，吸入装置操作失误的比例平均为20.0%。高依从性组的总吸入次数少于低依从性组。按装置进行比较时，定量气雾剂的依从性显著低于都保吸入器，这可能归因于每日吸入总数。哮喘控制组和未控制组在依从性、操作失误和每日吸入总数方面存在显著差异。多变量分析表明，依从性和操作失误是影响哮喘控制的独立因素。结论 我们的数据表明，ICS依从性和装置操作失误均对该人群的哮喘控制有影响。
