A randomized trial of peak-flow and symptom-based action plans in adults with moderate-to-severe asthma.
A randomized trial of peak-flow and symptom-based action plans in adults with moderate-to-severe asthma.
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DOI：
10.1046/j.1440-1843.2001.00350.x
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发表时间：
2001-12-01
期刊：
影响因子：
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通讯作者：
Ruffin, R E
中科院分区：
文献类型：
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作者：
Adams, R J;Boath, K;Ruffin, R E
目的：峰值流量计（PFM）继续被推荐为哮喘自我管理计划的重要组成部分。目前还不清楚，如果有一个优势，在使用PFM的人与中度至重度哮喘谁不是穷人percivers的bronchconstrictions.METHODOLOGY：前瞻性，随机对照试验的134名成年人与中度至重度哮喘谁没有证据表明，组胺激发试验，谁被招募从住院病人和门诊病人的支气管收缩。比较了12个月内使用峰流量监测或症状指导管理的书面行动计划的有效性。每月通过电话联系受试者，以加强和评估行动计划的使用情况，并提供持续教育。每3个月测量一次肺量测定和PD 20组胺。每月测量医疗保健利用和发病率（哮喘急性发作、住院、急诊（艾德）就诊、因哮喘缺勤或缺课天数、药物使用和哮喘严重程度自我评定）。一个社会心理问卷（态度和信念，状态-特质焦虑，否认）在进入和12个月或退出的study.RESULTS：有显着改善两组住院，艾德访问，从学校或工作，PD 20组胺，但没有组间差异。在症状组和PFM组中，正确使用行动计划的比例分别为85%和86%。对于所有受试者，那些随后有一个艾德访问有显着较高的否认水平（P=0.04）和较低的分数为自信（P=0.04），相比那些谁没有一个艾德visit.CONCLUSIONS：使用书面行动计划，结合定期接触，以加强自我管理，改善气道反应性和减少医疗保健利用。然而，PFM的使用并不上级基于XML的计划。
OBJECTIVE: Peak flow meters (PFM) continue to be recommended as an important part of asthma self-management plans. It remains unclear if there is an advantage in using PFM in people with moderate-to severe asthma who are not poor perceivers of bronchoconstriction.METHODOLOGY: Prospective, randomized controlled trial of 134 adults with moderate-to-severe asthma who did not have evidence of poor perception of bronchoconstriction on histamine challenge testing, who were recruited from inpatients and outpatients of a university teaching hospital. Comparison was made over 12 months of the effectiveness of written action plans using either peak flow monitoring or symptoms to guide management. Subjects were contacted at monthly intervals by telephone for reinforcement and evaluation of use of the action plans, and to provide ongoing education. Spirometry and PD20 histamine were measured at 3-monthly intervals. Measures of health care utilization and morbidity (asthma exacerbations; hospitalizations; emergency department (ED) visits; days absent from work or school due to asthma; medication use and a self-rating of asthma severity) were made monthly. A psychosocial questionnaire (attitudes and beliefs, state-trait anxiety, denial) was given at entry and at 12-months or at withdrawal from the study.RESULTS: There were significant improvements for both groups for hospitalizations, ED visits, days off from school or work, and PD20 histamine, but no between-group differences. Appropriate use of action plans was 85% in the symptoms group and 86% in the PFM group. For all subjects, those who subsequently had an ED visit had significantly higher levels of denial (P=0.04) and lower scores for self-confidence (P=0.04), compared to those who did not have an ED visit.CONCLUSIONS: Use of written action plans, combined with regular contact to reinforce self-management, improved airway reactivity and reduced health care utilization. However, use of PFM was not superior to symptom-based plans.