Hospitalizations for Asthma in Children Are Linked to Undertreatment and Insufficient Asthma Education
Hospitalizations for Asthma in Children Are Linked to Undertreatment and Insufficient Asthma Education
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DOI：
10.3109/02770903.2011.580031
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发表时间：
2011-08-01
影响因子：
1.9
通讯作者：
Delmas, Marie-Christine
中科院分区：
文献类型：
--
作者：
Fuhrman, Claire;Dubus, Jean-Christophe;Delmas, Marie-Christine
背景资料。通过适当的疾病管理，大多数因哮喘加重而住院的患者是可以避免的。目标。这项研究的目的是描述哮喘恶化住院儿童的特征，以确定导致住院的可改变因素。方法：研究方法。这项研究是在14个儿科病房进行的，包括因哮喘恶化而住院的3-17岁儿童。目前的分析涵盖了498名患有哮喘的儿童。专职医生使用标准化问卷收集数据。哮喘史来自父母的访谈，包括通常的哮喘护理，前一个月症状和快速缓解药物的使用频率，过去一年的恶化频率和非计划医疗就诊次数，以及以前与哮喘相关的住院治疗。结果。超过一半的儿童以前曾因病情恶化而住院，42%的儿童使用持续吸入的皮质类固醇，57%的儿童有哮喘的定期随访。哮喘在过去一年中得到良好控制的比例为11%，12%的患者在过去一年中经历了恶化，但在前一个月得到了最佳控制，11%的患者最近控制不佳(前一年很少出现恶化，前一个月未达到最佳控制)。其余327名儿童(66%)一直控制不佳(上个月哮喘控制不佳，与前一年相比经常恶化)。在这一组中，69%的人至少有下列可预防的住院危险因素之一：没有常规的控制者治疗(49%)，没有哮喘行动计划(40%)，或者没有哮喘的随访(35%)。结论。在因病情恶化而住院的哮喘儿童中，三分之二的人在前一年一直控制不佳。他们经常得不到足够的治疗和关于哮喘的教育。需要进一步努力改善法国的哮喘治疗和教育。
Background. Most hospital admissions for asthma exacerbation are avoidable with adequate disease management. Objectives. The objective of this study was to describe the characteristics of children hospitalized with an asthma exacerbation to identify modifiable factors leading to hospitalization. Methods. The study was conducted in 14 pediatric units and included children 3--17 years of age who were hospitalized for an asthma exacerbation. The present analysis covers 498 children with known asthma. Staff physicians used a standardized questionnaire to collect data. Asthma history came from a parental interview and included usual asthma care, frequency of symptoms and quick-relief medication use in the previous month, frequency of exacerbations and number of unscheduled healthcare visits during the past year, and prior asthma-related hospitalizations. Results. More than half the children had previously been hospitalized for an exacerbation, 42%% used continuous inhaled corticosteroids, and 57%% had a regular follow-up for asthma. Asthma had been well controlled over the past year for 11%%, 12%% had experienced exacerbations during the past year but that had been optimally controlled during the previous month, and 11%% had recently become poorly controlled (infrequent exacerbations in the previous year and non-optimal control in the previous month). The remaining 327 children (66%%) were consistently poorly controlled (non-optimal asthma control in the previous month and frequent exacerbations over the previous year). Among this group, 69%% had at least one of the following preventable risk factors for hospitalization: no regular controller therapy (49%%), no asthma action plan (40%%), or no follow-up for asthma (35%%). Conclusions. Two-thirds of the children with asthma hospitalized for an exacerbation had been consistently poorly controlled during the previous year. They were frequently undertreated and insufficiently educated about asthma. Further efforts are needed to improve asthma treatment and education in France.