A pediatric asthma management program in a low-income setting resulting in reduced use of health service for acute asthma
A pediatric asthma management program in a low-income setting resulting in reduced use of health service for acute asthma
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DOI：
10.1111/j.1398-9995.2010.02405.x
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发表时间：
2010-11-01
期刊：
影响因子：
12.4
通讯作者：
Bousquet, J.
中科院分区：
文献类型：
--
作者：
Andrade, W. C. C.;Camargos, P.;Bousquet, J.
背景：在发展中国家，儿童哮喘管理方案在减少急性发作期间卫生服务利用率方面的有效性尚未得到广泛研究。本研究旨在评估哮喘管理方案的有效性，以减少儿童和青少年急性哮喘的总体卫生服务利用率。方法：在这项基于历史人群的现实队列研究中，我们选择了582例生活在巴西Itabira镇贫困地区的4-15岁哮喘患者，其中470例哮喘管理程序辅助，112例为对照组。终点是在研究入组后和入院后12个月内发生的首次经医生诊断的哮喘恶化。所有470例患者都收到了关于病情恶化自我管理的书面计划，包括在家中使用吸入沙丁胺醇。470例患者中有317例（67.4%）同时接受双本体酸倍氯米松（BDP）治疗。结果：两组在性别、年龄组和居住地方面具有可比性。在研究结束时，只有5%的病例和34%的对照组因为急性哮喘而寻求医疗服务（P < 0.01）。112例对照患者与153例未接受BDP治疗的患者比较，差异也有统计学意义（风险比= 0.04,95% CI, 0.01 ~ 0.14, P < 0.01）。结论：结果证明了儿童哮喘管理方案在减少急性哮喘对卫生服务的依赖方面的有效性。在未使用BDP的受试者中也观察到有效性。
P>Background:The effectiveness of pediatric asthma management programs in reducing health services utilization during exacerbations in developing countries is not widely studied. This study was carried out to assess the effectiveness of an asthma management program to reduce the overall health services utilization by acute asthma in children and adolescents.Methods:In this historical population-based real-life cohort study, we selected 582 patients with asthma aged 4-15 living in deprived areas in the town of Itabira, Brazil, of which 470 cases were assisted by the asthma management program and 112 were controls. The end point was the first physician-diagnosed asthma exacerbation occurring after study enrollment and within 12 months after admission. All 470 cases received a written plan about exacerbation self-management, including the use of inhaled albuterol at home. Three hundred and seventeen out of 470 cases (67.4%) were also treated with beclomethasone diproprionate (BDP).Results:Both groups were comparable regarding gender, age group, and place of residence. At the end of the study, only 5% of cases vs 34% of controls did seek health services because of acute asthma (P < 0.01). Statistical difference also remained when comparing the 112 controls with the 153 cases not treated with com BDP (Hazard Ratio = 0.04, 95% CI, 0.01-0.14, P < 0.01).Conclusions:Results have demonstrated the effectiveness of the pediatric asthma management program in reducing dependence on the health services for acute asthma. Effectiveness was also observed in subjects with no use of BDP.