Has asthma medication use in children become more frequent, more appropriate, or both?
Has asthma medication use in children become more frequent, more appropriate, or both?
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DOI：
10.1542/peds.104.2.187
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发表时间：
1999-08-01
期刊：
影响因子：
8
通讯作者：
Hecht, J
中科院分区：
文献类型：
--
作者：
Goodman, DC;Lozano, P;Hecht, J
Objective.尽管国家采取措施改善哮喘医疗，但医生为哮喘儿童开处方的适当性仍然未知。本研究测量了儿科使用批准用于可逆性阻塞性气道疾病的药物（哮喘药物）的趋势和最新模式。基于人口的纵向和横截面分析。位于华盛顿州普吉特海湾地区的一个非盈利性的员工模范健康维护组织。研究对象为1984 ~ 1993年连续入组的0 ~ 17岁儿童（1993年为83232例）。按药物类别和吸入性哮喘药物使用的估计持续时间填写哮喘药物处方的登记者百分比和填写率。在1984年至1993年期间，哮喘药物的使用频率增加了：服用任何哮喘药物处方的儿童比例从4.0%增加到8.1%，而服用吸入式可吸入气雾剂的儿童比例从0.4%增加到2.4%。相比之下，使用者中吸入式吸入器的使用强度下降; 1984年，37%的使用者在一年中填充了两个以上的吸入器，1993年为29%。高β受体激动剂使用者（每年每季度填充两个以上β-激动剂吸入器），吸入性兴奋剂使用的估计持续时间略有增加，从1984-1986年的平均每年4.1个月增加到1991-1993年的5.0个月; 10至17岁青少年的估计使用时间约为5至9岁儿童的一半。在研究期间，使用哮喘药物的儿童比例大幅增加，但即使是使用大量吸入性β受体激动剂的患者，每例患者吸入性哮喘药物的使用率仍然很低。这些研究结果表明，大多数哮喘药物用于轻度下呼吸道症状的儿童，而吸入性哮喘药物用于更严重疾病的儿童低于国家指南。
Objective. Despite national initiatives to improve asthma medical treatment, the appropriateness of physician prescribing for children with asthma remains unknown. This study measures trends and recent patterns in the pediatric use of medications approved for reversible obstructive airway disease (asthma medications).Design. Population-based longitudinal and cross-sectional analyses.Setting. A nonprofit staff model health maintenance organization located in the Puget Sound area of Washington state.Participants. Children 0 to 17 years of age enrolled continuously during any one of the years from 1984 to 1993 (N = 83 232 in 1993).Primary Outcome Measures. Percent of enrollees filling prescriptions for asthma medications and fill rates by medication class and estimated duration of inhaled antiinflammatory medication use.Results. Between 1984 and 1993, the frequency of asthma medication use increased: the percent of children filling any asthma medication prescription increased from 4.0% to 8.1%, whereas the percent filling an inhaled antiinflammatory inhaler rose from 0.4% to 2.4%. In contrast, the intensity of inhaled antiinflammatory use decreased among users; 37% of users filled more than two inhalers during the year in 1984, and 29% in 1993. In high beta-agonist users (filling more than two beta-agonist inhalers each quarter per year), the estimated duration of inhaled antiinflammatory use increased slightly from a mean of 4.1 months per year in 1984-1986 to 5.0 months in 1991-1993; estimated duration of use in adolescents 10 to 17 years of age was approximately half that of children 5 to 9 years of age.Conclusions. The proportion of children using asthma medications increased substantially during the study period, but the use of inhaled antiinflammatory medication per patient remained low even for those using large amounts of inhaled beta-agonists. These findings suggest that most asthma medications were used by children with mild lower airway symptoms and that inhaled antiinflammatory medication use in children with more severe disease fell short of national guidelines.