Kaplan Alan, Price David
University of Toronto Department of Family and Community Medicine, Toronto, ON, Canada.
Family Physician Airways Group of Canada, Edmonton, AB, Canada.
J Asthma Allergy. 2020 Jan 14;13:39-49. doi: 10.2147/JAA.S233268. eCollection 2020.
The burden of asthma is particularly notable in adolescents, and is associated with higher rates of prevalence and mortality compared with younger children. One factor contributing to inadequate asthma control in adolescents is poor treatment adherence, with many pediatric studies reporting mean adherence rates of 50% or lower. Identifying the reasons for poor disease control and adherence is essential in order to help improve patient quality of life. In this review, we explore the driving factors behind non-adherence in adolescents with asthma, consider their consequences and suggest possible solutions to ensure better disease control. We examine the impact of appropriate inhaler choice and good inhaler technique on adherence, as well as discuss the importance of selecting the right medication, including the possible role of as-needed inhaled corticosteroids/long-acting β-agonists vs short-acting β-agonists, for improving outcomes in patients with mild asthma and poor adherence. Effective patient/healthcare practitioner communication also has a significant role to engage and motivate adolescents to take their medication regularly.
哮喘负担在青少年中尤为显著,与年幼儿童相比,其患病率和死亡率更高。导致青少年哮喘控制不佳的一个因素是治疗依从性差,许多儿科研究报告的平均依从率为50%或更低。确定疾病控制不佳和依从性差的原因对于帮助改善患者生活质量至关重要。在本综述中,我们探讨了青少年哮喘患者不依从的驱动因素,考虑了其后果,并提出了可能的解决方案以确保更好的疾病控制。我们研究了合适的吸入器选择和良好的吸入器技术对依从性的影响,还讨论了选择正确药物的重要性,包括按需吸入糖皮质激素/长效β受体激动剂与短效β受体激动剂相比在改善轻度哮喘和依从性差的患者预后方面可能发挥的作用。有效的患者/医护人员沟通在促使和激励青少年定期服药方面也起着重要作用。