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肺科医生教育:教授哮喘和 COPD 患者使用目标导向吸入器技术。

Pulmonologist Education of the Teach-to-Goal Inhaler Technique for Those With Asthma and COPD.

机构信息

Division of Pulmonary Medicine and Critical Care, Department of Medicine, Nassau University Medical Center, East Meadow, New York

Division of Pulmonary Medicine and Critical Care, Department of Medicine, Nassau University Medical Center, East Meadow, New York.

出版信息

Respir Care. 2024 Jul 24;69(8):975-981. doi: 10.4187/respcare.11478.

Abstract

BACKGROUND

Inhaler education for patients with asthma and patients with COPD is typically provided by non-pulmonologists. We studied inhaler education by pulmonologists to determine changes in clinical outcomes and inhaler use.

METHODS

This was a retrospective study of 296 subjects diagnosed with asthma, COPD, or both that evaluated use of inhaler technique education and its impact on (1) inhaler/dosage change consisting of dosage change in the same class of inhaler and/or change in number of inhalers, (2) forced expiratory volume in one second/forced vital capacity (FEV/FVC%), (3) disease symptom control, (4) out-patient visits, (5) urgent care visits (6) emergency department visits, and (7) hospital admissions. One group received inhaler technique education by a pulmonologist while the other group did not.

RESULTS

The pulmonologist inhaler technique-educated group had significantly decreased relative risk for inhaler/dosage increase (relative risk 0.57 [95% CI 0.34-0.96], = .03) and significantly increased odds for symptom control (odds ratio 2.15 [95% CI 1.24-3.74], = .01) at 1-y follow-up as compared to the no education group. No differences occurred for FEV/FVC%, out-patient visits, urgent care visits, emergency department visits, and hospital admissions.

CONCLUSIONS

Pulmonologist education of inhaler technique for patients with asthma and patients with COPD was associated with decreased relative risk for inhaler/dosage increase and increased odds for symptom control. We recommend pulmonologists provide education of inhaler technique to patients with asthma and patients with COPD and not rely on non-pulmonologist education alone. Prospective research is needed to confirm the importance of proper inhaler techniques.

摘要

背景

哮喘和 COPD 患者的吸入器教育通常由非肺病专家提供。我们研究了肺病专家提供的吸入器教育,以确定临床结果和吸入器使用的变化。

方法

这是一项回顾性研究,共纳入 296 例被诊断为哮喘、COPD 或两者兼有的患者,评估了吸入器技术教育的使用情况及其对(1)吸入器/剂量变化的影响,包括同一类吸入器的剂量变化和/或吸入器数量的变化,(2)第一秒用力呼气量/用力肺活量(FEV/FVC%),(3)疾病症状控制,(4)门诊就诊,(5)紧急护理就诊,(6)急诊就诊,以及(7)住院治疗。一组患者接受了肺病专家的吸入器技术教育,而另一组患者则没有。

结果

与未接受教育的组相比,接受肺病专家吸入器技术教育的组在 1 年随访时,吸入器/剂量增加的相对风险显著降低(相对风险 0.57 [95% CI 0.34-0.96], =.03),症状控制的优势比显著增加(优势比 2.15 [95% CI 1.24-3.74], =.01)。FEV/FVC%、门诊就诊、紧急护理就诊、急诊就诊和住院治疗无差异。

结论

肺病专家对哮喘和 COPD 患者进行吸入器技术教育与吸入器/剂量增加的相对风险降低和症状控制的优势比增加相关。我们建议肺病专家为哮喘和 COPD 患者提供吸入器技术教育,而不仅仅依赖非肺病专家的教育。需要进行前瞻性研究来证实正确的吸入器技术的重要性。

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本文引用的文献

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Effect of an Asthma Exacerbation on Medication Adherence.哮喘加重对药物依从性的影响。
J Allergy Clin Immunol Pract. 2023 Jan;11(1):248-254. doi: 10.1016/j.jaip.2022.10.014. Epub 2022 Oct 22.
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Effect of asthma education on health outcomes in children: a systematic review.哮喘教育对儿童健康结局的影响:系统评价。
Arch Dis Child. 2022 Dec;107(12):1100-1105. doi: 10.1136/archdischild-2021-323496. Epub 2022 Feb 23.

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