哮喘管理中针对学龄前儿童的诊断治疗教育路径方案的影响。
Impact of a diagnostic therapeutic educational pathway program for asthma management in preschool children.
机构信息
Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Centro "Io e l'Asma", Ospedale dei Bambini, ASST Spedali Civili, Brescia, Italy.
出版信息
Ital J Pediatr. 2021 Mar 10;47(1):60. doi: 10.1186/s13052-021-00992-y.
BACKGROUND
Preschool children with clinically-diagnosed asthma have a higher rate of emergency department visits and consume more resources for management than older children. However, no clinical trials have yet been performed measuring the impact of a combined diagnostic, therapeutic and educational pathway regimen for evaluation of wheezing control in children aged less than 6 years. The purpose of the present study was to assess the impact of a pediatric program developed in Italy, the Diagnostic Therapeutic Educational Pathway (DTEP), for asthma management in children less than 6 years old attending an asthma referral center.
METHODS
This is a retrospective population-based cohort study performed in children with asthma aged 0-5 years, attending at "Io e l'Asma center", Brescia, Italy between September 2007 and December 2014. The incidence rates (IRs) of hospitalization, emergency room visits, use of outpatient services and drug usage for dyspnea, wheezing, or respiratory symptoms were evaluated for time periods prior to and after DTEP intervention.
RESULTS
A total of 741 patients, aged 0-5 years completed the DTEP, including 391 and 350 children aged 0-2 and 3-5 years, respectively. The percentage of children aged 0-2 and 3-5 years showing improved control of wheezing symptoms during the 1st to 3rd visit interval as a result of the DTEP intervention increased from 39.5 to 60.9% and from 25.5 to 75.5%, respectively. During these periods, the IRs showed a significant decrease for all outcomes, from-8.6% to - 80.4%. Although specific IRs for drug prescriptions declined, particularly for LABA plus corticosteroids, antibiotics, and systemic corticosteroids, they increased for SABA, inhaled corticosteroid and leukotriene receptor antagonist usage.
CONCLUSIONS
The results suggest that a real-world assessment of the integrated DTEP program for preschool children provides evidence for improved wheezing control and reduction of adverse therapeutic related outcomes.
背景
与年长儿童相比，经临床诊断患有哮喘的学龄前儿童急诊就诊率更高，管理所需资源更多。然而，目前尚无临床试验评估针对 6 岁以下儿童喘息控制评估的综合诊断、治疗和教育路径方案对管理喘息的影响。本研究的目的是评估在意大利开发的儿科方案——诊断治疗教育路径（DTEP）在一家哮喘转诊中心就诊的 6 岁以下哮喘患儿管理中的作用。
方法
这是一项在意大利布雷西亚的“我和哮喘中心”就诊的 0-5 岁哮喘患儿中开展的基于人群的回顾性队列研究。在 DTEP 干预前后的时间段内，评估住院、急诊就诊、使用门诊服务和药物治疗呼吸困难、喘息或呼吸道症状的发生率（IR）。
结果
共有 741 名 0-5 岁患儿完成了 DTEP，其中 391 名和 350 名患儿年龄分别为 0-2 岁和 3-5 岁。DTEP 干预后，0-2 岁和 3-5 岁儿童第 1 至 3 次就诊期间喘息症状控制改善的患儿比例分别从 39.5%增加到 60.9%和从 25.5%增加到 75.5%。在此期间，所有结局的 IR 均显著下降，从-8.6%降至-80.4%。尽管特定药物处方的 IR 有所下降，尤其是 LABA 加皮质激素、抗生素和全身皮质激素，但 SABA、吸入皮质激素和白三烯受体拮抗剂的使用增加。
结论
这些结果表明，对学龄前儿童综合 DTEP 方案的真实世界评估为改善喘息控制和减少不良治疗相关结局提供了证据。
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