van der Palen J, Klein J J, Rovers M M
Dept of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands.
Eur Respir J. 1997 Mar;10(3):652-7.
Two of the principal components of self-management are compliance with medication and adherence to self-treatment guidelines. The aim of this study was to evaluate compliance objectively. Twenty two adult asthmatics attended a self-management programme. During a 2 week run-in period, compliance with inhaled steroids and peak expiratory flow (PEF) were electronically-registered. For PEF this resulted in a personal best value (PBV). Subsequently, patients attended four educational group sessions. During the four weeks of follow-up, patients were instructed to measure their PEF on a fixed day of the week and when they experienced an increase in symptoms. If PEF fell below 80% of PBV, patients had to double their use of inhaled steroids; if PEF fell below 60%, they had to start a short course of oral steroids. During run-in, mean compliance was 83% and compliance per patient varied from 6 to 106%. During follow-up, on days without exacerbation, compliance with inhaled steroids increased by 12% (95% confidence interval (95% CI) 3-21%) compared to run-in, ranging 21-200%. On days when patients should have doubled their inhaled steroids, compliance decreased by 28% (95% CI -39 to -17), and compliance ranged 46-94%. Of the 10 patients who should have doubled their medication, only three did so, whilst four increased the use of inhaled steroids but only by one or two puffs; three patients did not alter their behaviour. In five patients (24%) PEF fell below 60% of their PBV, after which four started prednisolone (self-report). In conclusion, even after a formal self-management programme, patients with asthma comply only partially to self-treatment guidelines. Most are willing to increase, but not double, their inhaled steroids. This suggests that more emphasis is needed to reassure patients about the safety of inhaled steroids.
自我管理的两个主要组成部分是药物依从性和遵循自我治疗指南。本研究的目的是客观评估依从性。22名成年哮喘患者参加了一个自我管理项目。在为期2周的导入期，通过电子方式记录吸入类固醇的依从性和呼气峰值流速（PEF）。对于PEF，由此得出个人最佳值（PBV）。随后，患者参加了四次教育小组会议。在随访的四周内，患者被要求在每周固定的一天以及症状加重时测量PEF。如果PEF降至PBV的80%以下，患者必须将吸入类固醇的用量加倍；如果PEF降至60%以下，他们必须开始短期口服类固醇治疗。在导入期，平均依从性为83%，每位患者的依从性在6%至106%之间。在随访期间，在没有病情加重的日子里，与导入期相比，吸入类固醇的依从性提高了12%（95%置信区间（95%CI）3 - 21%），范围在21%至200%之间。在患者应该将吸入类固醇用量加倍的日子里，依从性下降了28%（95%CI - 39至 - 17），依从性范围在46%至94%之间。在10名应该将药物用量加倍的患者中，只有3名做到了，而4名患者增加了吸入类固醇的用量，但只增加了一两次喷量；3名患者没有改变他们的行为。在5名患者（24%）中，PEF降至其PBV的60%以下之后，4名患者开始使用泼尼松龙（自我报告）。总之，即使在参加了正式的自我管理项目之后，哮喘患者对自我治疗指南的依从性也只是部分的。大多数患者愿意增加但不是加倍吸入类固醇的用量。这表明需要更多地强调让患者放心吸入类固醇的安全性。
