Kuschner W G, Hankinson T C, Wong H H, Blanc P D
Department of Medicine, and the Cardiovascular Research Institute, University of California, San Francisco, USA.
Chest. 1997 Oct;112(4):987-93. doi: 10.1378/chest.112.4.987.
Many persons with asthma self-medicate with widely available and potentially hazardous nonprescription medicines. This study assessed the demographic and clinical covariates of self-treatment with over-the-counter asthma medications (OTCs).
We conducted an analytical investigation using questionnaires and measures of lung function, comparing OTC and prescription medication users. We recruited adults with asthma by public advertisement.
We studied 22 exclusive prescription asthma medication users, 15 exclusive OTC users, and 13 other subjects who combined prescription medication use with self-treatment with asthma OTCs. All but one OTC user self-medicated with a nonselective, sympathomimetic metered-dose inhaler.
Taking income, access to care, and self-assessed disease severity into account, male gender was strongly associated with exclusive OTC use alone (odds ratio [OR]=8.9, 95% confidence interval [CI]= 1.3 to 61) and mixed OTC-prescription medication use (OR=9.7, 95% CI=1.1 to 83). The covariates of income, access to care, and self-assessed disease severity provided significant additional explanatory power to the model of exclusive OTC use (model chi2 difference 11.3, 5 df, p<0.05). Pulmonary function was similar among OTC and prescription medication users. However, prescription medication users' self-assessed asthma severity (mild compared to more severe) was associated with postbronchodilator reversibility of FEV1 obstruction (6% vs 18% reversibility, p<0.05) while exclusive OTC users' self-assessed severity showed the reverse pattern (19% vs 8%, p=0.2).
Asthma education programs attempting to discourage unregulated bronchodilator use should give consideration to this profile of the "asthmatic-at-risk."
许多哮喘患者自行使用广泛可得且可能有危害的非处方药进行自我治疗。本研究评估了使用非处方哮喘药物（OTC）进行自我治疗的人口统计学和临床协变量。
我们通过问卷调查和肺功能测量进行了一项分析性调查，比较了OTC和处方药使用者。我们通过公开广告招募了成年哮喘患者。
我们研究了22名仅使用处方哮喘药物的使用者、15名仅使用OTC的使用者以及13名将处方药使用与哮喘OTC自我治疗相结合的其他受试者。除一名OTC使用者外，所有OTC使用者均使用非选择性拟交感神经定量吸入器进行自我治疗。
考虑到收入、就医机会和自我评估的疾病严重程度，男性性别与仅使用OTC（优势比[OR]=8.9，95%置信区间[CI]=1.3至61）以及混合使用OTC和处方药（OR=9.7，95%CI=1.1至83）密切相关。收入、就医机会和自我评估的疾病严重程度这些协变量为仅使用OTC的模型提供了显著的额外解释力（模型卡方差异11.3，5自由度，p<0.05）。OTC使用者和处方药使用者的肺功能相似。然而，处方药使用者自我评估的哮喘严重程度（轻度与更严重相比）与支气管扩张剂后FEV1阻塞的可逆性相关（6%与18%的可逆性，p<0.05），而仅使用OTC的使用者自我评估的严重程度呈现相反模式（19%与8%，p=0.2）。
试图劝阻无节制使用支气管扩张剂的哮喘教育项目应考虑这种“高危哮喘患者”的特征。
