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[一项关于正确使用吸入器的简短教育干预对慢性阻塞性肺疾病患者预防病情加重的有效性]

[Effectiveness of a brief educational intervention relating to the correct use of inhalers on the prevention of exacerbation in patients suffering from chronic obstructive pulmonary disease].

作者信息

Martínez Ibán M, Alonso Porcel C, Sánchez Rodríguez L M, Arce Rodríguez A, Díaz Pérez P, Arboleya Álvarez L

机构信息

Médico de Atención Primaria, Avilés, Asturias, España.

Médico de Urgencias, Hospital Universitario de Cabueñes, Gijón, Asturias, España.

出版信息

Semergen. 2019 Jan-Feb;45(1):15-22. doi: 10.1016/j.semerg.2018.04.009. Epub 2018 Oct 22.

Abstract

OBJECTIVE

To predict the effect of a brief educational intervention aimed at improving the inhaler technique on the reduction of exacerbations in patients with COPD over a year.

MATHERIAL AND METHODS

A triple blind, randomised controlled clinical trial with parallel design.

INCLUSION CRITERIA

to be between 40-75 years, having been diagnosed with COPD, and being on treatment with inhalers. A total of 97 patients were randomly selected. They were randomly assigned into 2groups according to their functional severity measured with spirometry. Intervention group: evaluation of the inhalation technique. Their mistakes were corrected using a brief educational intervention. Reinforcement visits were made in the second and seventh month.

CONTROL GROUP

evaluation of the inhalation technique. No educational intervention was made. After 1 year of follow-up, the number of exacerbations in each group was checked.

VARIABLES MEASURED

social and demographic, study, dyspnoea level, body-mass index, tobacco use, FEV, FEV/FVC, COPD stage, BODEX index, number, type, and inhaler technique, number of previous exacerbations. Bayesian inference analysis was performed using logistic regression models.

RESULTS

A total of 56 patients were assigned to de intervention group and 41 to the control one. There were 16 and 14 lost to follow-up, respectively. In the intervention group, 44.6% of the patients had an exacerbation, compared to the control group, with 56.1%. OR adjusted = 0.57 (95% CI: 0.22-1.22). Posterior probability OR < 1 = 93%. Exacerbations which required hospital admission had an OR = 0.21 (95% CI: 0.02-0.75) with posterior probability OR < 1= 99%.

CONCLUSIONS

A brief educational technique is an effective method for reducing the number of exacerbations in patients with COPD.

摘要

目的

预测一项旨在改善吸入技术的简短教育干预措施对慢性阻塞性肺疾病(COPD)患者一年内病情加重次数减少的效果。

材料与方法

采用平行设计的三盲随机对照临床试验。

纳入标准

年龄在40 - 75岁之间,已被诊断为COPD且正在使用吸入器治疗。共随机选取97例患者。根据用肺活量测定法测量的功能严重程度将他们随机分为两组。干预组:评估吸入技术。通过简短的教育干预纠正他们的错误。在第二个月和第七个月进行强化随访。

对照组

评估吸入技术。未进行教育干预。随访1年后,检查每组的病情加重次数。

测量变量

社会人口统计学、研究、呼吸困难程度、体重指数、吸烟情况、第一秒用力呼气容积(FEV)、FEV/用力肺活量(FVC)、COPD分期、BODEX指数、吸入器技术的数量、类型及使用情况、既往病情加重次数。使用逻辑回归模型进行贝叶斯推断分析。

结果

共56例患者被分配到干预组,41例被分配到对照组。分别有16例和14例失访。干预组中44.6%的患者病情加重,而对照组为56.1%。校正后的比值比(OR)= 0.57(95%置信区间:0.22 - 1.22)。后验概率OR < 1 = 93%。需要住院治疗的病情加重的OR = 0.21(95%置信区间:0.02 - 0.75),后验概率OR < 1 = 99%。

结论

简短的教育技术是减少COPD患者病情加重次数的有效方法。

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