Guarnaccia Sebastiano, Quecchia Cristina, Festa Andrea, Magoni Michele, Zanardini Elena, Brivio Valentina, Scarcella Carmelo, Gretter Valeria, Gasparotti Cinzia, Frassine Malica, Ferrari Martina, Limina Rosa Maria, Spiazzi Raffaele, Badolato Raffaele, Donato Francesco
Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
"Io e l'Asma" Center, Ospedale dei Bambini, ASST Spedali Civili, Brescia, Italy.
Front Pediatr. 2020 Mar 11;8:39. doi: 10.3389/fped.2020.00039. eCollection 2020.
Limited evidence exists for the effectiveness of educational programs that improve pediatric asthma control in real-world settings. We aimed to assess the impact of a diagnostic, therapeutic, and educational pathway (DTEP) for asthma management in children and adolescents attending an asthma referral center. This is a retrospective population-based cohort study, including two groups of patients with asthma, aged 6-17 years and residing in the Local Health Authority (LHA) of Brescia, Italy: (a) the children who followed a DTEP (intervention group) and (b) all the children residing in the LHA who did not follow DTEP (control group). The incidence rates (IRs) of hospitalization, emergency room visit, use of outpatient services, and drug prescription for dyspnea, wheezing, or respiratory symptoms were computed for time before and after attending DTEP in the intervention group and for "early" and "late" time since asthma diagnosis in the control group. There were 9,191 patients included in the study, 804 of whom followed DTEP. In the before-DTEP/early time, the intervention and control groups showed similar IRs for all the outcomes apart from emergency room visits (IRs of 138.6 and 60.3 per 1,000 person-years, respectively). The IRs decreased from before to after DTEP and from early to late time in both groups. The IR decrease for emergency room visits was significantly higher in the intervention than in the control group (-51.3 and -28.2%, respectively; IRR = 0.61, = 0.001). The DTEP can increase patients' capability in managing asthma and preventing asthma attacks.
在现实环境中，关于改善儿童哮喘控制的教育项目有效性的证据有限。我们旨在评估一种针对哮喘转诊中心儿童和青少年的哮喘管理诊断、治疗及教育路径（DTEP）的影响。这是一项基于人群的回顾性队列研究，包括两组年龄在6至17岁、居住在意大利布雷西亚地方卫生当局（LHA）的哮喘患者：（a）遵循DTEP的儿童（干预组）和（b）居住在LHA但未遵循DTEP的所有儿童（对照组）。计算了干预组参加DTEP前后以及对照组哮喘诊断后“早期”和“晚期”因呼吸困难、喘息或呼吸道症状的住院率、急诊室就诊率、门诊服务使用率和药物处方率。该研究共纳入9191名患者，其中804名遵循DTEP。在DTEP之前/早期，除急诊室就诊外，干预组和对照组在所有结局方面的发病率相似（每1000人年的发病率分别为138.6和60.3）。两组的发病率从DTEP之前到之后以及从早期到晚期均有所下降。干预组急诊室就诊率的下降幅度显著高于对照组（分别为-51.3%和-28.2%；发病率比=0.61，P=0.001）。DTEP可提高患者管理哮喘和预防哮喘发作的能力。
