Is there a best strategy to prevent asthma exacerbations in inner-city patients with asthma?
Is there a best strategy to prevent asthma exacerbations in inner-city patients with asthma?
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是否有最佳策略来预防市中心哮喘患者的哮喘恶化？
DOI：
10.1016/j.anai.2023.07.003
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发表时间：
2024
期刊：
影响因子：
--
通讯作者：
Eakin,MichelleN
中科院分区：
文献类型：
--
作者：
Zaeh,SandraE;Chupp,Geoffrey;Eakin,MichelleN
哮喘是美国儿童和成人慢性疾病的主要原因，居住在市中心地区是哮喘发病的独立危险因素。许多因素被怀疑是导致内城地区哮喘发病率增加的原因，内城地区被定义为城市人口普查区，其中20%或更多的家庭收入低于联邦贫困线。这些因素包括不合格的住房质量、更严重的空气污染、更多地暴露于二手烟和其他室内空气污染、更多地暴露于老鼠和蟑螂等常见的家庭害虫、更高程度的社会压力、在获得医疗保健方面的差异，以及在获得和坚持服用哮喘药物方面的挑战。在过去的几十年里，虽然有许多干预措施旨在减轻市中心哮喘的负担，但问题仍然存在：有没有最好的策略来预防市中心哮喘患者的哮喘恶化？1112国家哮喘教育和预防计划（NAEPP）的哮喘管理指南建议哮喘管理有四个关键组成部分：1)使用肺功能来评估和监测哮喘的严重程度，2)环境控制措施来减少暴露于诱因，3)患者教育，也侧重于与家庭和临床医生的合作，4)药物治疗来预防气道炎症和控制哮喘恶化。虽然这些策略中的每一种都已被证明在改善哮喘管理方面是有效的，但在哮喘护理和有效哮喘管理策略的实施方面，特别是在高风险群体中，仍然存在差距。20 21
Asthma is a leading cause of chronic disease for children and adults living in the United States, 1 with residence in an inner-city area being an independent risk factor for asthma morbidity. 1 A 2 number of factors are suspected to contribute to increased asthma morbidity within inner-city 3 areas, which are defined as urban census tracts in which 20% or more of households have 4 incomes below the federal poverty line. 1 These factors include substandard housing quality, 5 worse air pollution, increased exposure to secondhand smoke and other indoor air pollution, 6 exposure to common household pests such as mice and cockroaches, higher levels of social 7 stress, differences in access to health care2 and challenges with access and adherence to asthma 8 medications. While numerous interventions have aimed to reduce the burden of inner city asthma 9 over the past several decades, the question remains: is there a best strategy to prevent asthma 10 exacerbations in inner city asthmatics? 1112 Asthma management guidelines from the National Asthma Education and Prevention Program 13 (NAEPP) suggest there are four key components of asthma management: 1) use of lung function 14 to assess and monitor the severity of asthma, 2) environmental control measures to reduce 15 exposure to triggers, 3) patient education which also focuses on partnerships with family and 16 clinicians, and 4) pharmacologic therapy to prevent airway inflammation and manage asthma 17 exacerbations. While each of these strategies has been shown to be effective in improving 18 asthma management, there continue to be gaps in asthma care and in the implementation of 19 effective asthma management strategies, particularly among high risk groups. 20 21