Mawhinney H, Spector S L, Heitjan D, Kinsman R A, Dirks J F, Pines I
Department of Medicine, UCLA School of Medicine.
J Asthma. 1993;30(1):61-71. doi: 10.3109/02770909309066381.
Daily inhaled bronchodilator medication usage was recorded using an electronic device and airway obstruction by daily peak flow measurement. The demographic, clinical, and psychological characteristics of the subjects were noted. Subjects were allocated to as-needed (prn) medication usage groups according to the mean number of inhaler activations on days with zero, moderate, and severe airway obstruction. Segregation into arbitrary and nonarbitrary use, and into overuse, appropriate use, and underuse resulted in six usage groups. Appropriate use was observed in only 10 of 39 subjects. The major psychological variable to differ among groups was the MMPI variable Pt, representing general anxiety. Arbitrary users had a significantly higher mean score than nonarbitrary users. The variable Specific Internal Awareness, representing a perceived difficulty in recognizing the premonitory symptoms of an asthma attack, also differed among the usage groups, with arbitrary users having the lowest scores. These findings raise the possibility that reliance on an objective measurement of airway obstruction rather than on subjective symptomatology might enhance compliance with prn medication in some patients.
使用电子设备记录每日吸入支气管扩张剂的用药情况，并通过每日峰值流量测量来评估气道阻塞情况。记录受试者的人口统计学、临床和心理特征。根据在气道阻塞为零、中度和重度的日子里吸入器激活的平均次数，将受试者分配到按需（prn）用药组。分为随意使用和非随意使用，以及过度使用、适当使用和使用不足，从而形成六个用药组。在39名受试者中，只有10人观察到适当使用。各组之间存在差异的主要心理变量是明尼苏达多相人格调查表（MMPI）中的Pt变量，代表一般焦虑。随意使用者的平均得分显著高于非随意使用者。代表在识别哮喘发作先兆症状方面存在感知困难的特定内部意识变量在各用药组之间也存在差异，随意使用者得分最低。这些发现增加了一种可能性，即对于某些患者而言，依赖气道阻塞的客观测量而非主观症状可能会提高按需用药的依从性。
