Jébrak G, Houdouin V, Terrioux P, Lambert N, Maitre B, Ruppert A-M
Service de pneumologie B et de transplantations pulmonaires, hôpital Bichat, Paris, France.
Service de pneumologie, allergologie et CRCM pédiatrique, hôpital Robert-Debré, Paris, France.
Rev Mal Respir. 2022 May;39(5):442-454. doi: 10.1016/j.rmr.2022.01.017. Epub 2022 May 18.
While asthma patients' treatment adherence (TA) generally leaves to be desired, few data exist on TA evolution from age group to another. During the meeting of a working group of pneumo-pediatricians and adult pulmonologists, we reviewed the literature on adherence according to age group, examined explanations for poor adherence, and explored ways of improving adherence via new technologies. Asthma is a chronic disease for which TA is particularly low, especially during adolescence, but also among adults. Inhaled medications are the least effectively taken. Several explanations have been put forward: cost and complexity of treatments, difficulties using inhalation devices, poor understanding of their benefits, erroneous beliefs and underestimation of the severity of a fluctuating disease, fear of side effects, neglect, and denial (especially among teenagers). Poor TA is associated with risks of needless treatment escalation, aggravated asthma with frequent exacerbations, increased school absenteeism, degraded quality of life, and excessive mortality. Better compliance is based on satisfactory relationships between caregivers and asthmatics, improved caregiver training, and more efficient transmission to patients of relevant information. The recent evolution of innovative digital technologies opens the way for enhanced communication, via networks and dedicated applications, and thanks to connected inhalation devices, forgetfulness can be limited. Clinical research will also help to ameliorate TA. Lastly, it bears mentioning that analysis of the existing literature is hampered by differences in terms of working definitions and means of TA measurement.
虽然哮喘患者的治疗依从性(TA)总体上仍不尽人意,但关于不同年龄组TA变化的数据却很少。在一次儿科肺病专家和成人肺病专家工作组会议上,我们回顾了按年龄组划分的关于依从性的文献,研究了依从性差的原因,并探索了通过新技术提高依从性的方法。哮喘是一种慢性病,其TA特别低,尤其是在青少年时期,在成年人中也是如此。吸入药物的服用效果最差。人们提出了几种解释:治疗的成本和复杂性、使用吸入装置的困难、对其益处的理解不足、错误观念以及对病情波动严重性的低估、对副作用的恐惧、疏忽和否认(尤其是在青少年中)。TA差与不必要的治疗升级风险、哮喘加重伴频繁发作、学校缺勤率增加、生活质量下降以及过高的死亡率相关。更好的依从性基于护理人员与哮喘患者之间令人满意的关系、护理人员培训的改善以及向患者更有效地传递相关信息。创新数字技术的最新发展为通过网络和专用应用程序加强沟通开辟了道路,并且借助联网的吸入装置,可以减少遗忘。临床研究也将有助于改善TA。最后需要提及的是,现有文献的分析受到TA工作定义和测量方法差异的阻碍。