Electronic monitoring of adherence to inhaled corticosteroids: an essential tool in identifying severe asthma in children
Electronic monitoring of adherence to inhaled corticosteroids: an essential tool in identifying severe asthma in children
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DOI：
10.1183/13993003.00910-2017
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发表时间：
2017-12-01
影响因子：
24.3
通讯作者：
Fleming, Louise J.
中科院分区：
文献类型：
--
作者：
Jochmann, Anja;Artusio, Luca;Fleming, Louise J.
国际指南建议，只有在解决包括依从性在内的影响因素后才能诊断严重哮喘。在临床实践中准确评估依从性是很困难的。我们假设儿童的电子监测可以识别不依从性，从而确定少数患有真正严重哮喘的儿童。前瞻性地招募已经接受吸入皮质类固醇处方的哮喘儿童，并使用电子监测设备评估依从性的持续性。在监测期开始和结束时测量肺活量、气道炎症和哮喘控制情况。对 93 名儿童（62 名男性；中位年龄 12.4 岁）进行了中位监测 92 天。监测的依从性中位数（范围）为 74% (21-99%)。我们确定了四组：1) 监测期间依从性良好且控制得到改善，24%（可能之前依从性较差）； 2) 依从性好但控制不佳，18%（严重难治性哮喘）； 3) 控制良好但依从性差，26%（可能过度治疗）； 4) 依从性差且控制差，32%。监测前没有临床参数可以区分这些群体。电子监测是识别需要加强治疗的儿童的有用工具。对于那些在遵守或不遵守时受到控制的人，需要采取不同的方法。电子监测对于儿科严重哮喘诊所至关重要。
International guidelines recommend that severe asthma can only be diagnosed after contributory factors, including adherence, have been addressed. Accurate assessment of adherence is difficult in clinical practice. We hypothesised that electronic monitoring in children would identify nonadherence, thus delineating the small number with true severe asthma.Asthmatic children already prescribed inhaled corticosteroids were prospectively recruited and persistence of adherence assessed using electronic monitoring devices. Spirometry, airway inflammation and asthma control were measured at the start and end of the monitoring period.93 children (62 male; median age 12.4 years) were monitored for a median of 92 days. Median (range) monitored adherence was 74% (21-99%). We identified four groups: 1) good adherence during monitoring with improved control, 24% (likely previous poor adherence); 2) good adherence with poor control, 18% (severe therapy-resistant asthma); 3) poor adherence with good control, 26% (likely overtreated); and 4) poor adherence with poor control, 32%. No clinical parameter prior to monitoring distinguished these groups.Electronic monitoring is a useful tool for identifying children in whom a step up in treatment is indicated. Different approaches are needed in those who are controlled when adherent or who are nonadherent. Electronic monitoring is essential in a paediatric severe asthma clinic.