Division of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut.
Division of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut.
Ann Allergy Asthma Immunol. 2024 Sep;133(3):318-324. doi: 10.1016/j.anai.2024.06.011. Epub 2024 Jun 17.
The use of single-combination inhaled corticosteroid and long-acting bronchodilator for maintenance and relief therapy (MART) significantly reduces asthma exacerbations and has been incorporated into asthma guidelines since December 2020, but there are limited data regarding the implementation of this approach to asthma management.
To determine the frequency at which MART was recommended to patients with moderate-to-severe asthma being seen at subspecialty pulmonary and allergy practices at an academic healthcare system, and the patient and clinician characteristics associated with the use of MART.
We conducted a retrospective cross-sectional study of the electronic medical records of an academic healthcare system in the Northeastern United States between January 2021 and October 2023. Patient demographic and clinician data were collected, and MART recommendation was confirmed by chart review. We assessed the relationships among patient demographics, clinician characteristics, and MART recommendation.
Of 2016 patients reviewed, 293 (14.5%) were recommended MART, with 255 (87%) concurrently prescribed short-acting bronchodilators. Patients on inhaled corticosteroid-formoterol at baseline were significantly more likely to be recommended MART, whereas older patients and those on Medicare were significantly less likely to be recommended MART; 22 of 50 clinicians (44%) did not recommend MART ever, and only 3 clinicians recommended MART to 30% to 60% of their patients. Clinicians who were part of the asthma group were significantly more likely to recommend MART.
Among academic subspecialty clinicians, there has been limited implementation of MART, with a small number of clinicians adopting MART routinely and more than 40% of clinicians not recommending it.
单一联合吸入皮质类固醇和长效支气管扩张剂作为维持和缓解治疗（MART），可显著减少哮喘恶化，自 2020 年 12 月以来已被纳入哮喘指南，但关于这种哮喘管理方法的实施数据有限。
确定在学术医疗保健系统的专科肺科和过敏实践中，为中度至重度哮喘患者推荐 MART 的频率，以及与使用 MART 相关的患者和临床医生特征。
我们对美国东北部一家学术医疗保健系统的电子病历进行了回顾性横断面研究，时间为 2021 年 1 月至 2023 年 10 月。收集了患者人口统计学和临床医生数据，并通过病历审查确认 MART 推荐。我们评估了患者人口统计学、临床医生特征与 MART 推荐之间的关系。
在 2016 名接受审查的患者中，有 293 名（14.5%）被推荐使用 MART，其中 255 名（87%）同时开具短效支气管扩张剂。基线时使用吸入皮质类固醇-福莫特罗的患者更有可能被推荐使用 MART，而年龄较大的患者和使用医疗保险的患者则不太可能被推荐使用 MART；50 名临床医生中有 22 名（44%）从未推荐过 MART，只有 3 名临床医生向 30%至 60%的患者推荐 MART。属于哮喘组的临床医生更有可能推荐 MART。
在学术专科临床医生中，MART 的实施有限，少数临床医生常规采用 MART，超过 40%的临床医生不推荐使用 MART。
