Morosova M E, Salman N V, Kulikov S M, Oganov R G
National Research Centre for Preventive Medicine, Ministry of Health of the Russian Federation, Moscow, Russia.
Patient Educ Couns. 1998 Feb;33(2):113-27. doi: 10.1016/s0738-3991(97)00073-6.
To address the recent rise in asthma morbidity and mortality in Russia, an intervention study was conducted to improve asthma diagnosis, treatment and prevention. US recommendations for asthma management were adapted for use in educating Moscow families with children with asthma. Two hundred and fifty-two children with asthma aged 4-14 years receiving health care in eight Moscow public health clinics together with their parents were enrolled in the study to see whether US teaching manuals for asthma management would be acceptable and effective in Russia. Children at four of the clinics with recent asthma attacks were randomly assigned to either the education or control group to test if patient education and guided asthma care would improve outcomes for patients. Modern medications were made available to both groups to see if training in the US guidelines was necessary to get physicians to use the medications. Children with recent asthma attacks at the other four clinics were defined as comparison group 1 to control for the possible effect of medication availability. All children at the eight clinics who had no asthma attacks composed comparison group 2 to see if the outcomes for these children would change over time. One-year follow-up results showed significant improvement in asthma self-management skills of children and parents, in terms of asthma treatment, only among those in the education group. Significant increases were observed in the subgroup of children in the education group using anti-inflammatory drugs for asthma control. Children in the education group had markedly increased peak flow rates and reduced daily peak flow variability as compared to control and comparison groups. There was a significantly greater reduction in doctor visits by the education group of children compared to control. Presumably, changes in parents' and children's behaviour in terms of asthma treatment and prevention skills, proper treatment of the disease and access to medications could be responsible for reducing asthma morbidity in children.
为应对俄罗斯近期哮喘发病率和死亡率的上升，开展了一项干预研究，以改善哮喘的诊断、治疗和预防。美国哮喘管理建议被改编用于对莫斯科有哮喘患儿的家庭进行教育。在莫斯科的八家公共卫生诊所接受医疗服务的252名4至14岁哮喘患儿及其父母被纳入该研究，以观察美国哮喘管理教学手册在俄罗斯是否可接受且有效。四家近期有哮喘发作患儿的诊所的儿童被随机分配到教育组或对照组，以测试患者教育和指导性哮喘护理是否会改善患者的治疗效果。两组都可获得现代药物，以观察按照美国指南进行培训对于促使医生使用这些药物是否必要。其他四家诊所近期有哮喘发作的儿童被定义为比较组1，以控制药物可得性可能产生的影响。八家诊所中所有未发作哮喘的儿童组成比较组2，以观察这些儿童的治疗效果是否会随时间变化。一年的随访结果显示，仅在教育组中，儿童和父母在哮喘自我管理技能方面，以及在哮喘治疗方面有显著改善。在教育组中使用抗炎药物控制哮喘的儿童亚组中观察到显著增加。与对照组和比较组相比，教育组儿童的峰值流速显著提高，每日峰值流速变异性降低。与对照组相比，教育组儿童的就诊次数显著减少。据推测，父母和儿童在哮喘治疗和预防技能、疾病的适当治疗以及药物获取方面的行为变化可能是儿童哮喘发病率降低的原因。
