Detection and home management of worsening asthma symptoms.
Detection and home management of worsening asthma symptoms.
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DOI：
10.1016/s1081-1206(10)60262-1
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发表时间：
2009-12
影响因子：
5.9
通讯作者：
Strunk, Robert
中科院分区：
文献类型：
--
作者：
Garbutt, Jane;Highstein, Gabriellle;Nelson, Kyle A.;Rivera-Spoljaric, Katherine;Strunk, Robert
哮喘指南建议对病情恶化的患者尽早进行家庭治疗。然而，家庭治疗往往是次优的和延迟的。描述父母注意到的哮喘恶化的先期症状和体征，并了解父母何时以及如何加强哮喘治疗。在过去12个月中，2-12岁哮喘恶化需要紧急护理的儿童的父母填写了电话问卷。对于一些问题，可以有多个答复，答复频率的百分比总和可能超过100%。101名家长参加了登记和访谈，其中94%是孩子的母亲。70%的儿童是非裔美国人，有医疗补助保险。父母报告了多个既往症状和体征(每个孩子的中位数=3，范围1-6)。这些症状包括呼吸道症状(79%)、过敏/感冒症状(43%)、行为改变(24%)和其他非特异性症状(29%)。23名父母报告说，呼吸急促和使用附属肌肉呼吸等呼吸道症状是最早的先兆。当父母发现咳嗽(55%)、呼吸急促(54%)和喘息(25%)时，最常加强治疗，包括添加沙丁胺醇(92%)、口服皮质类固醇(17%)、吸入皮质类固醇(8%)或其他非哮喘药物(16%)。尽管父母描述了他们在孩子身上一直注意到的哮喘恶化的先兆和体征，但许多人等待下呼吸道迹象出现后才加强治疗。口服糖皮质激素使用频率较低。需要采取干预措施，提高父母和儿童准确识别恶化症状并启动及时、有效治疗的能力。
Asthma guidelines recommend early home treatment of exacerbations. However, home treatment is often suboptimal and delayed. To describe antecedent symptoms and signs of asthma exacerbations noticed by parents, and learn when and how parents intensify asthma treatment. Parents of children 2-12 years old with asthma exacerbations requiring urgent care in the past 12 months completed telephone questionnaires. For some questions, multiple responses were possible and percentages for the frequency of responses may sum to more than 100%. One hundred and one parents were enrolled and interviewed; 94% were the children's mothers. 70% of the children were African American and 64% had Medicaid insurance. Parents reported multiple antecedent symptoms and signs (median number per child = 3, range 1-6). These included respiratory symptoms (79%), allergy/cold symptoms (43%), behavioral changes (24%), and other non-specific symptoms (29%). Twenty-three parents reported late respiratory symptoms such as gasping for breath, and using accessory muscles to breath as the earliest antecedent signs. Treatment was most often intensified when the parent noticed cough (55%), shortness of breath (54%), and wheeze (25%), and included adding albuterol (92%), oral corticosteroid (17%), inhaled corticosteroid (8%) or other non-asthma medications (16%). Although parents described antecedent symptoms and signs of impending asthma exacerbations they consistently noticed in their children, many waited for lower respiratory signs to be present before intensifying treatment. Oral corticosteroids were used infrequently. Interventions to improve the ability of parents and children to accurately recognize worsening symptoms and initiate timely, effective treatment are needed.