儿科医师对哮喘控制类用药——吸入性糖皮质激素的用药选择及对患者用药依从性评价的调查
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摘要
目的:为临床吸入性糖皮质激素的选择提供参考。方法:对全国11个省(区、市)医疗机构的儿科医师进行问卷调查,分析医师对3种吸入性糖皮质激素布地奈德(BUD)、倍氯米松(BDP)、氟替卡松(FP)的选择倾向及原因、剂型选择倾向[以综合分数(CS)计]及对患儿用药依从性的评价及影响因素(以CS计)。结果:共发放问卷200份,回收有效问卷196份,有效率98.00%。儿科临床医师更倾向于选择BUD作为儿童哮喘控制类药物(158人,80.61%),其次是FP(22人,11.22%)和BDP(2人,1.02%),剩余无倾向(14人,7.14%);选择BUD的临床医师主要认为该药临床疗效更好、指南更推荐、专家更推荐、患者更认可等。儿科医师认为家长或患儿最易掌握的吸入设备是雾化器(CS4.04分),其次是压力定量气雾剂(加储物罐)(CS2.75分)、压力定量气雾剂(无储物罐)(CS1.71分)、干粉吸入剂(都保吸入器)(CS1.46分)及干粉吸入剂(准纳器)(CS1.08分)。儿科医师对患儿用药依从性评价结果显示,认为患儿实际用药比例占医嘱用药比例<50%、50%～74%或75%～99%的人数分别为48、88、58人(占比分别为24.49%、44.90%、29.59%),仅2人(1.02%)认为该比例达到100%,影响患儿用药依从性的因素主要有担心长期用药副反应(CS9.19分)、病情好转后停药(CS8.16分)、孩子治疗不配合(CS7.82分)等。结论:儿科医师倾向于选择BUD作为哮喘控制类用药,更易掌握的吸入设备为雾化器,同时儿科医师对家长及患儿用药依从性的评价较低。
OBJECTIVE:To provide reference for the selection of inhaled corticosteroids(ICS) in clinic. METHODS:Aquestionnaire survey was conducted among pediatricians from medical institutions of 11 provinces(districts,cities)to analyze thedrug selection and reasons,dosage form selection [by comprehensive score(CS)] of 3 kinds of ICS as budesonide(BUD),beclomethasone(BDP)and fluticasone(FP),medication compliance and influential factors(by CS). RESULTS:A total of 200 questionnaires were sent out,and 196 valid questionnaires were collected with effective rate of 98.00%. Pediatric clinicianspreferred BUD as a control drug for asthma in children(158 cases,80.61%),followed by FP(22 cases,11.22%)and BDP(2 cases,1.02%)and the rest had no tendency(14 cases,7.14%). Clinicians who chose BUD mainly believed that the drug hadbetter clinical efficacy,and was more recommended by guidelines and experts,more recognized by patients and so on. In addition,of all inhalation equipment for children asthma,pediatric clinicians believed that parents or children were more easier to masteratomizer(CS:4.04),followed by pressurized metered dose inhalers(pMDI)(with spacer)(CS:2.75),pMDI(without spacer)(CS:1.71),dry powder inhalers(DPI)(turbuhaler)(CS:1.46)and DPI(accuhaler)(CS:1.08). For the evaluation of patients' medication compliance,48(24.49%),88(44.90%),58(29.59%)pediatricians thought that the actual administration accountedfor <50%,50%-74%,75%-99% of the medical order dosages,respectively. Only 2(1.02%)subjects thought that the patientswould fully obey. The main factors affecting children's medication compliance were worrying about side effects of long-termmedication(CS:9.19),drug withdrawal after improvement(CS:8.16),and children's treatment incompatibility(CS:7.82).CONCLUSIONS:Pediatricians tend to choose BUD as drug for asthma control,and atomizer is treated as the easiest inhalationequipment for children. At the same time,pediatricians have low evaluation on the medication compliance of parents and children.
OBJECTIVE:To provide reference for the selection of inhaled corticosteroids(ICS) in clinic. METHODS:Aquestionnaire survey was conducted among pediatricians from medical institutions of 11 provinces(districts,cities)to analyze thedrug selection and reasons,dosage form selection [by comprehensive score(CS)] of 3 kinds of ICS as budesonide(BUD),beclomethasone(BDP)and fluticasone(FP),medication compliance and influential factors(by CS). RESULTS:A total of 200 questionnaires were sent out,and 196 valid questionnaires were collected with effective rate of 98.00%. Pediatric clinicianspreferred BUD as a control drug for asthma in children(158 cases,80.61%),followed by FP(22 cases,11.22%)and BDP(2 cases,1.02%)and the rest had no tendency(14 cases,7.14%). Clinicians who chose BUD mainly believed that the drug hadbetter clinical efficacy,and was more recommended by guidelines and experts,more recognized by patients and so on. In addition,of all inhalation equipment for children asthma,pediatric clinicians believed that parents or children were more easier to masteratomizer(CS:4.04),followed by pressurized metered dose inhalers(pMDI)(with spacer)(CS:2.75),pMDI(without spacer)(CS:1.71),dry powder inhalers(DPI)(turbuhaler)(CS:1.46)and DPI(accuhaler)(CS:1.08). For the evaluation of patients' medication compliance,48(24.49%),88(44.90%),58(29.59%)pediatricians thought that the actual administration accountedfor <50%,50%-74%,75%-99% of the medical order dosages,respectively. Only 2(1.02%)subjects thought that the patientswould fully obey. The main factors affecting children's medication compliance were worrying about side effects of long-termmedication(CS:9.19),drug withdrawal after improvement(CS:8.16),and children's treatment incompatibility(CS:7.82).CONCLUSIONS:Pediatricians tend to choose BUD as drug for asthma control,and atomizer is treated as the easiest inhalationequipment for children. At the same time,pediatricians have low evaluation on the medication compliance of parents and children.
引文
[1]何影仪,潘永芳,谢惠芬.支气管哮喘患者激素吸入治疗不依从性影响因素分析[J].现代临床护理,2011,10(11):15-16.
[2]全国儿科哮喘协作组.第三次中国城市儿童哮喘流行病学调查[J].中华儿科杂志,2013,51(10):729-736.
[3]MARK J,REDDEL H,PHILIPPE L.Pocket guide for asthma management and prevention[EB/OL].[2018-08-18].https://www.mendeley.com/catalogue/ria-l-lt-pocket-guidephysicians-nurses-co-er-pocket-guide-asthma-managementprevention-global-initi/.
[4]GINA Executive and Science Committee.Global strategy for asthma management and prevention 2018[EB/OL].[2018-08-18].http://www.gina.com.
[5]中华医学会儿科学分会呼吸学组.儿童支气管哮喘诊断与防治指南(2016年版)[J].中华儿科杂志,2016,54(3):167-181.
[6]FRITZ H,DANIEL D,ERNST E,et al.Diagnosis and management of asthma:statement on the 2015 GINA guidelines[J].Wien Klin Wochenschr,2016,128(15):541-554.
[7]鲍一笑,林芊,包军.提高吸入性糖皮质激素治疗依从性有效控制儿童哮喘发生[J].中国实用儿科杂志,2013,28(11):804-808.
[8]WHO.Model list of essential medicines for children(5th list)[EB/OL].[2018-08-18].http://www.who.int/medicines/publications/essentialmedicines/en/.
[9]DYE TL,DIEHL KJ,WHEELER SL,et al.Randomized,controlled trial of budesonide and prednisone for the treatment of idiopathic inflammatory bowel disease in dogs[J].J Vet Intern Med,2013,27(6):1385-1391.
[10]洪建国.重视吸入性糖皮质激素在5岁以下儿童中的应用[J].中国实用儿科杂志,2013,28(11):801-803.
[11]RUGE CA,KIRCH J,LEHR CM.Pulmonary drug delivery:from generating aerosols to overcoming biological barriers:therapeutic possibilities and technological challenges[J].Lancet Respir Med,2013,1(5):402-413.
[12]ZEIGER RS,KELLY HW.Effect of inhaled glucocorticoids in childhood on adult height:NEJM[J].N Engl JMed,2012,367(10):904.
[13]AL-JAHDALI H,AHMED A,AL-HARBI A,et al.Improper inhaler technique is associated with poor asthma control and frequent emergency department visits[J].Allergy Asthma Clin Immunol,2013,9(1):8.
[14]邓立新,韩方璇,谢静,等.吸入装置的正确使用[J].中南药学,2013,11(8):629-630.
[15]中华医学会呼吸病学分会《雾化吸入疗法在呼吸疾病中的应用专家共识》制定专家组.雾化吸入疗法在呼吸疾病中的应用专家共识[J].中华医学杂志,2016,96(34):2696-2708.
[15]GRAY WN,MALLORY NETZ MS,ANDREW MCCON-VILLE BS,et al.Medication adherence in pediatric asthma:a systematic review of the literature[J].Pediatr Pulmonol,2018,53(5):668-684.
[16]刘国群,朱波.儿童哮喘使用吸入型糖皮质激素依从性与对策[J].西部医学,2012,24(5):901-902.
[2]全国儿科哮喘协作组.第三次中国城市儿童哮喘流行病学调查[J].中华儿科杂志,2013,51(10):729-736.
[3]MARK J,REDDEL H,PHILIPPE L.Pocket guide for asthma management and prevention[EB/OL].[2018-08-18].https://www.mendeley.com/catalogue/ria-l-lt-pocket-guidephysicians-nurses-co-er-pocket-guide-asthma-managementprevention-global-initi/.
[4]GINA Executive and Science Committee.Global strategy for asthma management and prevention 2018[EB/OL].[2018-08-18].http://www.gina.com.
[5]中华医学会儿科学分会呼吸学组.儿童支气管哮喘诊断与防治指南(2016年版)[J].中华儿科杂志,2016,54(3):167-181.
[6]FRITZ H,DANIEL D,ERNST E,et al.Diagnosis and management of asthma:statement on the 2015 GINA guidelines[J].Wien Klin Wochenschr,2016,128(15):541-554.
[7]鲍一笑,林芊,包军.提高吸入性糖皮质激素治疗依从性有效控制儿童哮喘发生[J].中国实用儿科杂志,2013,28(11):804-808.
[8]WHO.Model list of essential medicines for children(5th list)[EB/OL].[2018-08-18].http://www.who.int/medicines/publications/essentialmedicines/en/.
[9]DYE TL,DIEHL KJ,WHEELER SL,et al.Randomized,controlled trial of budesonide and prednisone for the treatment of idiopathic inflammatory bowel disease in dogs[J].J Vet Intern Med,2013,27(6):1385-1391.
[10]洪建国.重视吸入性糖皮质激素在5岁以下儿童中的应用[J].中国实用儿科杂志,2013,28(11):801-803.
[11]RUGE CA,KIRCH J,LEHR CM.Pulmonary drug delivery:from generating aerosols to overcoming biological barriers:therapeutic possibilities and technological challenges[J].Lancet Respir Med,2013,1(5):402-413.
[12]ZEIGER RS,KELLY HW.Effect of inhaled glucocorticoids in childhood on adult height:NEJM[J].N Engl JMed,2012,367(10):904.
[13]AL-JAHDALI H,AHMED A,AL-HARBI A,et al.Improper inhaler technique is associated with poor asthma control and frequent emergency department visits[J].Allergy Asthma Clin Immunol,2013,9(1):8.
[14]邓立新,韩方璇,谢静,等.吸入装置的正确使用[J].中南药学,2013,11(8):629-630.
[15]中华医学会呼吸病学分会《雾化吸入疗法在呼吸疾病中的应用专家共识》制定专家组.雾化吸入疗法在呼吸疾病中的应用专家共识[J].中华医学杂志,2016,96(34):2696-2708.
[15]GRAY WN,MALLORY NETZ MS,ANDREW MCCON-VILLE BS,et al.Medication adherence in pediatric asthma:a systematic review of the literature[J].Pediatr Pulmonol,2018,53(5):668-684.
[16]刘国群,朱波.儿童哮喘使用吸入型糖皮质激素依从性与对策[J].西部医学,2012,24(5):901-902.