Noncompliance and treatment failure in children with asthma
Noncompliance and treatment failure in children with asthma
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DOI：
10.1016/s0091-6749(96)80190-4
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发表时间：
1996-12-01
影响因子：
14.2
通讯作者：
Rand, C
中科院分区：
文献类型：
--
作者：
Milgrom, H;Bender, B;Rand, C
工作背景：准确和可靠的信息，儿童使用的吸入性药物是必要的，因为越来越多的依赖这些药物在治疗哮喘和过度的发病率和死亡率归因于这种diseases.Objective：本研究的目的是评估哮喘儿童的依从性方案吸入皮质类固醇和β-agonists.Methods：数据收集电子计量吸入器。将监护仪上的数据与患者在传统日记卡上记录的数据进行比较。24名8 - 12岁的哮喘儿童志愿者接受吸入性皮质类固醇和β受体激动剂治疗，参与了为期13周的研究。每名儿童均由父母陪同参加所有研究访视。主要结果的措施是使用药物的日记卡条目和记录的电子监测和疾病恶化，所示的要求口服皮质类固醇激素。结果：吸入皮质类固醇的患者报告的中位使用率为95.4%，而实际使用的中位数为58.4%。超过90%的患者夸大了他们吸入类固醇的使用，即使是依从性最差的受试者的日记记录也反映了高水平的依从性。经历疾病恶化足以需要口服皮质类固醇的儿童与其他儿童在电子监测器记录的处方治疗依从性方面明显不同。吸入性糖皮质激素的中位依从性为13.7%的那些谁经历了急性加重和68.2%的那些谁没有。结论：电子监测表明，遵守规定的治疗比日记卡上的患者报告的要低得多。低依从率吸入皮质类固醇与疾病恶化有关。哮喘控制不佳应提醒医生注意不依从的可能性。
Background: Accurate and reliable information about children's use of inhaled medications is needed because of the growing reliance on these drugs in the treatment of asthma and the excessive morbidity and mortality attributable to this disease.Objective: This study was designed to evaluate the adherence of children with asthma to regimens of inhaled corticosteroids and beta-agonists.Methods: Data collected electronically by metered-dose inhaler. monitors were compared with data recorded by patients on traditional diary cards. A volunteer sample of 24 children, between 8 and 12 years old, who had asthma for which they were receiving both inhaled corticosteroids and beta-agonists, participated over a 13-week period. Each child was accompanied by a parent to all study visits. The main outcome measures were the use of medication as reported by diary card entries and recorded by electronic monitoring and disease exacerbation, as indicated by requirement for oral corticosteroids.Results: The median use of inhaled corticosteroids reported by patients on their diaries was 95.4%, whereas the median actual use was 58.4%. More than 90% of patients exaggerated their use of inhaled steroids, and diary entries of even the least compliant subjects reflected a high level of adherence The children who experienced exacerbation of disease sufficient to require a burst of oral corticosteroids differed markedly from the others in their adherence to prescribed therapy as recorded by the electronic monitors. The median compliance with inhaled corticosteroids was 13.7% for those who experienced exacerbations and 68.2% for those who did not.Conclusions: Electronic monitoring demonstrated much lower adherence to prescribed therapy than was reported by patients on diary cards. Low rates of compliance with prescribed inhaled corticosteroids were associated with exacerbation of disease. Poor control of asthma should alert the physician to the possibility of noncompliance.