评估哮喘住院患儿吸入器教育干预措施的随机对照试验。
Evaluating inhaler education interventions for hospitalized children with asthma: A randomized controlled trial.
机构信息
Department of Medicine, University of Chicago, Chicago, Illinois; Department of Pediatrics, University of Chicago, Chicago, Illinois.
Department of Medicine, University of Chicago, Chicago, Illinois.
出版信息
Ann Allergy Asthma Immunol. 2023 Aug;131(2):217-223.e1. doi: 10.1016/j.anai.2023.02.023. Epub 2023 Mar 3.
BACKGROUND
Most children with asthma have poor inhaler technique, with detrimental morbidity effects. Guidelines recommend clinicians provide inhaler education at every opportunity, yet resources are limited. A low-cost, technology-based intervention-Virtual Teach-to-Goal (V-TTG)-was developed to deliver tailored inhaler technique education with high fidelity.
OBJECTIVE
To evaluate whether V-TTG leads to less inhaler misuse among children with asthma who are hospitalized vs brief intervention (BI, reading steps aloud).
METHODS
A single-center randomized controlled trial of V-TTG vs BI was conducted with 5-to-10-year-old children with asthma hospitalized between January 2019 and February 2020. Inhaler technique was assessed pre- and post-education using 12-step validated checklists (misuse: < 10 steps correct).
RESULTS
Among 70 children enrolled, mean age was 7.8 years (SD = 1.6). Most (86%) were Black. Most had an emergency department visit (94%) or hospitalization (90%) in the previous year. At baseline, nearly all children misused inhalers (96%). The proportion of children with inhaler misuse decreased significantly in V-TTG (100%→74%, P = .002) and BI (92%→69%, P = .04) groups, with no difference between groups at both time points (P = .2 and .9). On average, children performed 1.5 more steps correctly (SD = 2.0), with greater improvement with V-TTG (mean [SD] = 1.7 [1.6]) vs BI (mean [SD] = 1.4 [2.3]), though not significant (P = .6). Concerning pre and post technique, older children were significantly more likely than younger children to show more correct steps (mean change = 1.9 vs 1.1, P = .002).
CONCLUSION
A technology-based intervention for tailored inhaler education led to improved technique among children, similarly to reading steps aloud. Older children saw greater benefits. Future studies should evaluate the V-TTG intervention across diverse populations and disease severities to identify the greatest impact.
CLINICAL TRIAL REGISTRATION
NCT04373499.
背景
大多数哮喘儿童的吸入器技术较差，这会导致不良的发病率。指南建议临床医生在任何机会都提供吸入器教育，但资源有限。一种低成本、基于技术的干预措施-Virtual Teach-to-Goal（V-TTG）-被开发出来，以提供高保真度的定制吸入器技术教育。
目的
评估 V-TTG 是否比简短干预（BI，大声朗读步骤）导致住院哮喘儿童的吸入器使用不当更少。
方法
对 2019 年 1 月至 2020 年 2 月期间住院的 5 至 10 岁哮喘儿童进行了 V-TTG 与 BI 的单中心随机对照试验。使用 12 步验证检查表评估吸入器技术在教育前后（错误：<10 步正确）。
结果
在 70 名入组的儿童中，平均年龄为 7.8 岁（SD=1.6）。大多数（86%）为黑人。大多数（94%）儿童在过去一年中有过急诊就诊或住院（90%）。在基线时，几乎所有的儿童都错误地使用了吸入器（96%）。在 V-TTG（100%→74%，P=.002）和 BI（92%→69%，P=.04）组中，吸入器使用不当的儿童比例均显著下降，两组在两个时间点均无差异（P=。2 和.9）。平均而言，儿童正确完成的步骤增加了 1.5 个（SD=2.0），V-TTG（平均[SD] 1.7 [1.6]）的改善大于 BI（平均[SD] 1.4 [2.3]），但无统计学意义（P=。6）。关于吸入器技术的前后变化，年龄较大的儿童比年龄较小的儿童更有可能显示出更多的正确步骤（平均变化 1.9 比 1.1，P=.002）。
结论
针对定制吸入器教育的基于技术的干预措施可改善儿童的技术，与大声朗读步骤相似。年龄较大的儿童受益更大。未来的研究应评估 V-TTG 干预措施在不同人群和疾病严重程度中的效果，以确定最大的影响。
临床试验注册
NCT04373499。
Zotero 插件