Assessment of adherence to corticosteroids in asthma by drug monitoring or fractional exhaled nitric oxide: A literature review.
Assessment of adherence to corticosteroids in asthma by drug monitoring or fractional exhaled nitric oxide: A literature review.
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DOI：
10.1111/cea.13787
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发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Fowler SJ
中科院分区：
文献类型：
--
作者：
Alahmadi F;Peel A;Keevil B;Niven R;Fowler SJ
尽管皮质类固醇治疗在控制哮喘方面的有效性被广泛接受，但其有效性因依从性差而受到损害。然而，衡量哮喘治疗依从性的最佳方法仍不清楚。对报道哮喘患者吸入或口服皮质类固醇依从性的生物学、客观方法的文献进行综述；我们纳入了直接测量血液中外源性皮质类固醇的研究，或依从性对呼出一氧化氮的影响。我们检索了三个数据库MEDLINE（同时使用PubMed和Ovid）、护理和相关健康文献累积索引（CINAHL）和Web of Science，以获取1975年1月至2020年7月间发表的文章。使用国家卫生研究所的检查表评估研究的质量。从2850篇筛选文章中，26篇符合纳入标准。8项研究使用含或不含皮质醇的血液泼尼松龙作为口服皮质类固醇依从性的测量，17项研究使用分数呼气一氧化氮（FeNO）作为吸入皮质类固醇依从性的测量。在一项研究中，吸入的皮质类固醇是直接在血液中测量的。通过直接测量血液中的药物水平，口服皮质类固醇的依从率从47%到92%不等，尽管通常不知道测试的性能和时间，使得解释结果和血清强的松龙浓度变得困难。黏附患者的FeNO通常低于非黏附患者，但根据现有数据无法提出绝对的临界值。然而，在监督下吸入皮质类固醇剂量后FeNO下降可能表明先前依从性差。尽管泼尼松龙和皮质醇水平在临床实践中通常被用作依从性标志，但需要进一步的工作来评估剂量和时间对血液水平的影响。FeNO抑制试验的有希望的发现需要在进一步的前瞻性研究中探索。
Although the efficacy of corticosteroid treatment in controlling asthma is widely accepted, its effectiveness is undermined by poor adherence. However, the optimal method for measuring adherence to asthma therapy remains unclear. To perform a review of the literature reporting biological, objective methods for assessing adherence to inhaled or oral corticosteroids in asthma; we included studies reporting direct measurement of exogenous corticosteroids in blood, or the effect of adherence on exhaled nitric oxide. We searched three databases MEDLINE (using both PubMed and Ovid), the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Web of Science for articles published between January 1975 and July 2020. Quality of the studies was assessed using the National Institute of Health checklist. From 2850 screened articles, 26 fulfilled the inclusion criteria. Measurement of blood prednisolone with or without cortisol was used in eight studies as a measure of oral corticosteroid adherence, and fractional exhaled nitric oxide (FeNO) in 17 studies for inhaled corticosteroid adherence. Inhaled corticosteroids were measured directly in the blood in one study. By direct measurement of drug levels in the blood, adherence rates to oral corticosteroids ranged from 47% to 92%, although the performance and timing of the test were often not known, making interpretation of findings and serum prednisolone concentrations difficult. FeNO is generally lower in adherent than non‐adherent patients, but no absolute cut‐off can be proposed based on the available data. However, a fall in FeNO following supervised inhaled corticosteroid dosing could indicate previous poor adherence. Despite prednisolone and cortisol levels commonly being used as adherence markers in clinical practice, further work is required to assess the influence of the dose and timing on blood levels. The promising findings of FeNO suppression testing should be explored in further prospective studies.
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影响因子：
24.3
作者：
Bossley, C. J.;Saglani, S.;Bush, A.
通讯作者：
Bush, A.
DOI：
10.1164/ajrccm.153.1.8542158
发表时间：
1996-01-01
影响因子：
24.7
作者：
Kharitonov, SA;Yates, DH;Barnes, PJ
通讯作者：
Barnes, PJ
影响因子：
9.6
作者：
Mansur, Adel H.;Hassan, Maged;Webster, Craig
通讯作者：
Webster, Craig
DOI：
10.1164/rccm.201108-1553oc
发表时间：
2012-07-01
影响因子：
24.7
作者：
Bafadhel, Mona;McKenna, Susan;Brightling, Christopher E.
通讯作者：
Brightling, Christopher E.
影响因子：
24.3
作者：
Jochmann, Anja;Artusio, Luca;Fleming, Louise J.
通讯作者：
Fleming, Louise J.