Jones K, Gruffydd-Jones K
University of Southampton, U.K.
Respir Med. 1996 Aug;90(7):419-25. doi: 10.1016/s0954-6111(96)90116-x.
Asthma attacks in general practice are frequently associated with respiratory tract infection. The aim of this study was to examine how U.K. general practitioners (GPs) might use oral steroids and antibiotics in such situations. The timing of follow-up and use of self-management plans were also examined. A postal questionnaire was sent to all 205 GP principals in Bath Health District, U.K. in February and March 1993. Respondents were asked questions regarding the management of an adult and a child presenting with acute asthma associated with respiratory tract infection. Replies were received from 185 of 205 (90%) doctors approached. Antibiotics would have been prescribed by 119 of 179 (66%) doctors for the adult and 98 of 169 (58%) doctors for the child. The modal initial dosage of oral prednisolone was 40 mg for the adult and 30 mg for the child, and modal duration of oral steroid dosage was 5 days for both adult and child. Planned follow-up was mainly doctor initiated within 24 h of initial consultation. There was low reported use of self-management plans (49% for adults and 33% in children over 7 years of age). Antibiotic prescription appears to be common practice by GPs when faced with an acute asthma attack associated with respiratory tract infection. There may also be inadequate duration of oral steroid courses in adults. There is a need to examine further the proper role, if any, of antibiotics in such situations, to determine the optimum dose and course length of oral steroid therapy, and to continue validating the use of self-management plans in acute asthma management.
在全科医疗中，哮喘发作常常与呼吸道感染相关。本研究的目的是探讨英国全科医生（GP）在这种情况下如何使用口服类固醇和抗生素。同时还研究了随访时间安排以及自我管理计划的使用情况。1993年2月和3月，向英国巴斯健康区的所有205名全科医生负责人发送了一份邮政调查问卷。询问受访者有关一名患有与呼吸道感染相关的急性哮喘的成人和儿童的管理问题。在205名被调查的医生中，有185名（90%）回复了问卷。179名医生中有119名（66%）会为成人开具抗生素，169名医生中有98名（58%）会为儿童开具抗生素。口服泼尼松龙的初始标准剂量成人是40毫克，儿童是30毫克，口服类固醇药物的标准疗程成人和儿童均为5天。计划的随访主要由医生在初次咨询后的24小时内发起。据报告，自我管理计划的使用比例较低（成人中为49%，7岁以上儿童中为33%）。当面对与呼吸道感染相关的急性哮喘发作时，全科医生开具抗生素似乎是常见做法。成人口服类固醇疗程的时长可能也不足。有必要进一步研究抗生素在这种情况下（如果有）的适当作用，确定口服类固醇治疗的最佳剂量和疗程长度，并继续验证自我管理计划在急性哮喘管理中的应用。
