Division of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Conn.
Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
J Allergy Clin Immunol Pract. 2022 Feb;10(2):386-394. doi: 10.1016/j.jaip.2021.11.003. Epub 2021 Nov 14.
Medication nonadherence and health literacy are key factors that influence the management of difficult-to-control asthma. Adherence, or the extent to which a patient follows a treatment plan, extends beyond asthma medication use and includes an appropriate inhaler technique. Assessment of adherence is critical before making a diagnosis of severe asthma and stepping up asthma therapy but is challenging in the clinical context. Health literacy, or the degree to which individuals can obtain, process, and understand health information and services needed to make health care decisions, is additionally important for asthma management and has been shown to impact medication adherence. Initiatives aiming to improve difficult-to-control asthma should address medication adherence and health literacy. Universal health literacy precautions are recommended while communicating with patients, in addition to the creation of low health literacy asthma action plans. To improve adherence, a comprehensive assessment of adherence should be conducted. Additional evidence-based interventions aiming to improve adherence focus on appropriate inhaler use, improved access to medications, the use of digital platforms, school-based asthma interventions, and the implementation of culturally tailored interventions. Data are limited regarding the use of these initiatives in patients with severe or difficult-to-control asthma.
药物依从性和健康素养是影响难治性哮喘管理的关键因素。依从性，即患者遵循治疗计划的程度，不仅包括哮喘药物的使用，还包括适当的吸入器技术。在做出严重哮喘的诊断并加强哮喘治疗之前，评估依从性至关重要，但在临床环境中具有挑战性。健康素养，即个人获取、处理和理解健康信息以及做出医疗决策所需的服务的程度，对于哮喘管理也很重要，并已被证明会影响药物依从性。旨在改善难治性哮喘的举措应解决药物依从性和健康素养问题。在与患者沟通时，除了制定低健康素养哮喘行动计划外，还建议采取普遍的健康素养预防措施。为了提高依从性，应进行全面的依从性评估。旨在提高依从性的其他基于证据的干预措施侧重于适当的吸入器使用、改善药物获取、使用数字平台、基于学校的哮喘干预措施以及实施文化适应性干预措施。关于这些举措在严重或难治性哮喘患者中的应用，数据有限。
