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城市中心区儿童的父母对哮喘加重的家庭管理与美国国立心肺血液研究所(NHLBI)的指南建议有何不同?美国国立心肺血液研究所。

How does home management of asthma exacerbations by parents of inner-city children differ from NHLBI guideline recommendations? National Heart, Lung, and Blood Institute.

作者信息

Warman K L, Silver E J, McCourt M P, Stein R E

机构信息

Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York 10461, USA.

出版信息

Pediatrics. 1999 Feb;103(2):422-7. doi: 10.1542/peds.103.2.422.

Abstract

OBJECTIVES

  1. To describe the asthma morbidity, primary care practices, and asthma home management of inner-city children with asthma; 2) to determine the responses of parental caretakers to asthma exacerbations in their child; and 3) to compare these responses to the recommendations of the National Heart, Lung, and Blood Institute (NHLBI) asthma guidelines for home management of acute exacerbations of asthma.

DESIGN AND METHODS

A 64-item telephone survey was administered between July 1996 and June 1997 to 220 parental caretakers of 2- to 12-year-old children who had been hospitalized with asthma at an inner-city medical center from January, 1995 to February, 1996. Sociodemographics, primary care practices, asthma morbidity, and asthma home management were assessed. Parents were asked what they would do if their child "began wheezing and breathing faster than usual."

RESULTS

Morbidity measures indicated that there were an average of 2.5 +/- 4.5 emergency department visits for asthma in the last 6 months, 1.6 +/- 2.2 hospitalizations for asthma in the last 12 months, and 18.1 +/- 17.9 asthma-related school absences in the previous school year. Most, but not all, of the families had primary care providers and most had phone access to them. Half of the families (51%) reported having been given a written asthma action plan. Only 30% of families with children age 5 years and older had peak flow meters. In contrast, almost all families (97%) had equipment for inhalation of beta-agonists. Only 39% of the 181 children with persistent symptoms were receiving daily antiinflammatory agents as recommended in the guidelines of the NHLBI. In response to the scenario of an acute exacerbation of asthma, no one mentioned that they would refer to a written plan, only 1 caretaker would measure peak flow and 36% would give beta-agonists. Two percent would give oral steroids initially, and 1 additional person would do so if wheezing continued 40 minutes later. Only 4% responded that they would contact their clinician. Reports of actual practice differed from the scenario responses in that more people began beta-agonists and oral steroids in response to an exacerbation in the past 6 months than said they would in response to the scenario.

CONCLUSION

In this population of previously hospitalized inner-city children with asthma, the NHLBI guidelines for the home management of asthma exacerbations are not being followed. Interventions are needed to affect both clinician and caretaker practices.

摘要

目的

1)描述市中心区哮喘儿童的哮喘发病率、初级保健情况及哮喘家庭管理;2)确定家长照顾者对其孩子哮喘发作的应对措施;3)将这些应对措施与美国国立心肺血液研究所(NHLBI)哮喘指南中有关哮喘急性发作家庭管理的建议进行比较。

设计与方法

1996年7月至1997年6月,对1995年1月至1996年2月期间在市中心区医疗中心因哮喘住院的2至12岁儿童的220名家长照顾者进行了一项包含64个项目的电话调查。评估了社会人口统计学、初级保健情况、哮喘发病率及哮喘家庭管理情况。询问家长如果孩子“开始喘息且呼吸比平常快”他们会怎么做。

结果

发病率指标显示,在过去6个月中,哮喘患儿平均急诊就诊2.5±4.5次,过去12个月中平均哮喘住院1.6±2.2次,上一学年与哮喘相关的缺课天数为18.1±17.9天。大多数(但并非全部)家庭有初级保健提供者,且大多数家庭能通过电话联系到他们。一半的家庭(51%)报告曾收到过书面哮喘行动计划。5岁及以上儿童的家庭中只有30%有峰流速仪。相比之下,几乎所有家庭(97%)都有吸入β受体激动剂的设备。在181名有持续症状的儿童中,只有39%按照NHLBI指南的建议每日接受抗炎药物治疗。针对哮喘急性发作的情况,没有人提到会参考书面计划,只有1名照顾者会测量峰流速,36%的人会给予β受体激动剂。2%的人会首先给予口服类固醇,另有1人在喘息持续40分钟后会这样做。只有4%的人表示会联系他们的临床医生。实际做法的报告与情景应对不同,因为在过去6个月中,因哮喘发作而开始使用β受体激动剂和口服类固醇的人比在情景应对中表示会这样做的人更多。

结论

在这群之前住院的市中心区哮喘儿童中,未遵循NHLBI哮喘发作家庭管理指南。需要采取干预措施来影响临床医生和照顾者的做法。

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