Reactive versus proactive patterns of inhaled corticosteroid use.
Reactive versus proactive patterns of inhaled corticosteroid use.
复制标题
DOI：
10.1513/annalsats.201209-076bc
复制
发表时间：
2013-04-01
影响因子：
8.3
通讯作者：
Hartert, Tina V
中科院分区：
文献类型：
--
作者：
Sloan, Chantel D;Gebretsadik, Tebeb;Hartert, Tina V
对于持续性哮喘患者，吸入性皮质类固醇（ICS）是控制性治疗的主要手段。这些药物通常规定每天服用，并已被证明与降低哮喘发病率有关。在美国的许多人群中，每日治疗的依从性非常低。本研究的目的是评价季节性使用ICS处方填充作为儿童人群哮喘急性发作后的反应性行为。研究人群是田纳西哮喘和细支气管炎研究的一个亚组。这项研究中的儿童参加了田纳西州医疗补助计划（TennCare）。受试者患有哮喘，在2005年至2010年期间年龄为6至9岁。使用索赔数据确定处方填充，通过使用全身补救皮质类固醇（RCS）定义哮喘急性发作。在该队列的13，114名哮喘儿童中，ICS和RCS填充具有高度季节性，并且在秋季和冬季哮喘急性发作高峰期有趋势。处方补充率非常低，在研究期间，每个儿童平均补充三次ICS，至少补充一次。在这些儿童中，54.1%（7，096）在研究期间有哮喘加重。在ICS使用者中，68.5%（3，441/5，020）有疾病加重。ICS灌装与RCS灌装在同一天发生。ICS的季节性充盈模式与哮喘急性发作一致。在这一哮喘儿童人群中，ICS依从性较低且不一致。增加ICS的依从性，特别是在季节性病毒流行之前，可以大大降低哮喘发病率。
For patients with persistent asthma, inhaled corticosteroids (ICS) are a mainstay of controller therapy. These medications are usually prescribed to be taken daily and have been shown to be associated with decreased asthma morbidity. Adherence to daily treatment is very low in many populations in the United States. The purpose of this study is to evaluate the seasonal use of ICS prescription filling as reactive behavior primarily after an asthma exacerbation in a pediatric population. The study population is a subgroup of the Tennessee Asthma and Bronchiolitis Study. The children in this study were enrolled in Tennessee Medicaid (TennCare). The subjects had asthma and were 6 to 9 years of age during the years 2005 to 2010. Prescription filling was determined using claims data, and asthma exacerbations were defined by use of systemic rescue corticosteroids (RCS). In this cohort of 13,114 children with asthma, ICS and RCS filling were highly seasonal and trended with fall and winter peaks in asthma exacerbations. Prescription refilling was very low, with an average of three ICS fills per child who filled at least one during the study period. Among these children, 54.1% (7,096) had an asthma exacerbation during the study period. Among ICS users, 68.5% (3,441/5,020) had a disease exacerbation. ICS filling occurred overwhelmingly on the same day as RCS fills. The seasonal filling patterns of ICS coincide with asthma exacerbations. ICS adherence is low and inconsistent in this population of children with asthma. Increased adherence to ICS, particularly before the seasonal virus epidemics, could greatly reduce asthma morbidity.