Use of herbal remedies and adherence to inhaled corticosteroids among inner-city asthmatic patients.
Use of herbal remedies and adherence to inhaled corticosteroids among inner-city asthmatic patients.
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DOI：
10.1016/j.anai.2009.11.024
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发表时间：
2010-02
影响因子：
5.9
通讯作者：
Wisnivesky, Juan P.
中科院分区：
文献类型：
--
作者：
Roy, Angkana;Lurslurchachai, Linda;Halm, Ethan A.;Li, Xiu-Min;Leventhal, Howard;Wisnivesky, Juan P.
补充和替代药物（CAM）被哮喘等慢性疾病患者广泛使用。然而，目前尚不清楚CAM的使用是否与吸入皮质类固醇（ICS）依从性降低有关，ICS是哮喘治疗的关键组成部分。我们调查了326名在市内两家门诊接受治疗的成人持续性哮喘患者。患者被问及在过去6个月内使用CAM治疗哮喘的情况。使用药物依从性报告量表评估药物依从性，这是一种有效的自我报告测量。采用单变量和多元回归分析来评估CAM使用、ICS依从性、药物和疾病信念之间的关系。总体而言，25% （95% CI: 20-30%）的患者报告使用辅助治疗。在使用辅助治疗的患者中，39% （95% CI: 19-59%）与医生讨论过，21% （95% CI: 12-31%）使用辅助治疗代替处方哮喘治疗。单因素分析显示，CAM的使用与ICS依从性降低和哮喘发病率增加有关。在多变量分析中，在调整了年龄、性别、种族/民族、教育程度、诊断年限、语言和合病后，CAM的使用与较低的ICS依从性相关（优势比[OR]: 0.5, 95% CI: 0.3-0.9）。CAM使用者也更可能担心ICS的副作用（p=0.01）。在市中心的哮喘患者中，CAM的使用与ICS依从性降低有关。对ICS副作用的担忧等用药信念可能在一定程度上调解了这种关系。CAM的使用可能是依从性降低的标志，特别是在哮喘控制不佳的患者中。
Complementary and alternative medicines (CAM) are used widely by patients with chronic diseases such as asthma. However, it is unclear whether use of CAM is associated with decreased adherence to inhaled corticosteroids (ICS), a key component of asthma management. We surveyed 326 adults with persistent asthma receiving care at two inner-city outpatient clinics. Patients were asked about CAM use for treatment of asthma in the prior six months. Medication adherence was assessed using the Medication Adherence Report Scale, a validated self-report measure. Univariate and multiple regression analyses were used to assess the relationship between CAM use, adherence to ICS, and medication and disease beliefs. Overall, 25% (95% CI: 20–30%) of patients reported CAM use. Of those who used CAM, 39% (95% CI: 19–59%) discussed it with their physician, and 21% (95% CI: 12–31%) used CAM in place of prescribed asthma therapy. Univariate analyses showed that CAM use was associated with decreased ICS adherence and increased asthma morbidity. In multivariable analysis, CAM use was associated with lower ICS adherence (odds ratio [OR]: 0.5, 95% CI: 0.3–0.9) after adjusting for age, gender, race/ethnicity, education, years since diagnosis, language, and co-morbidities. CAM users were also more likely to worry about side effects of ICS (p=0.01). CAM use was associated with decreased ICS adherence among inner-city asthmatics. Medication beliefs such as worry about ICS side effects may in part mediate this relationship. CAM use may be a marker for decreased adherence to ICS, particularly among patients with poor asthma control.
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