支气管哮喘规范化管理与教育对哮喘控制的效果评析

Evaluating the effectiveness of systematic asthma patient education programs and self-management

目的评价北京朝阳医院“健康呼吸中心”五年来成人支气管哮喘（简称哮喘）规范化管理与教育对哮喘控制的效果。方法对就诊“健康呼吸中心”，参加过“哮喘之家”活动的572例患者进行问卷调查，了解其对哮喘的认知水平、长期用药情况、哮喘日记、ACT评分和病情控制水平等，并比较哮喘患者教育前、教育后6个月、教育后1年、教育后3年时的生活质量评分的变化。结果572例被调查哮喘患者的病情控制水平未控制、部分控制、完全控制的分别占46．2％、38．7％和15．1％，其中，了解哮喘发作的诱因占89％，认识哮喘炎症本质占89％，了解哮喘的症状和诊断占72％，认识哮喘的危害并建立起慢性疾病理念占78％，哮喘药物以吸人为主占90％，了解病情的自我监测方法并坚持记录哮喘日记占28％，了解控制水平的分级占38％，了解哮喘临床控制的定义占52％，认识哮喘防治中存在的误区占62％，了解长期治疗的目标占58％，了解哮喘控制测试占68％，近一年内因哮喘急诊就医、住院、因哮喘误工患者分别占9．5％、3．6％和9．6％，定期行肺功能检查者占75．7％。以上结果均显著优于2008年亚太地区哮喘现状研究（AIRIAP）报道的平均水平。572例哮喘患者治疗6个月后，患者的哮喘症状得到较好的控制，活动受限、避免暴露危险因素以及对危险因素的反应均较教育前有所改善（P〈0．05），同时对疾病有了正确的认识，心理情绪、对疾病的担心得到改善，与教育前比较差异均有统计学意义（P〈0．05）；3年后再次评价改善更加明显，与教育后1年比较差异有非常显著统计学意义（P〈0．01）。结论通过“健康呼吸中心”的活动教育哮喘患者，促进患者的规范治疗，增强患者的认知能力和自我监测、自我管理能力，实现医患之间的伙伴式、互动式关系，减少急性发作、住院率及病死率，从而提高哮喘患者的生活质量，并最终达到控制哮喘的目的。

Objective To evaluate the effectiveness of systematic bronchial asthma （asthma） patient education programs and self-management in health respiratory center in Beijing Chaoyang Hospital over 5 years. Methods 572 patients who had taken part in the asthma education and management program were surveyed by questionnaire to estimate their knowledge about asthma, long-term utility of medication,possession and using peak flow meter daily, the Asthma Control Test scores were recorded and asthma controlled level were assessed. Results Among 572 patients, the percentages of uncontrolled, partly controlled, controlled asthma assessed by current symptom were 46.2%, 38.7%, and 15.1%, respectively. Among these patients, understanding the inflammatory nature of asthma accounted for 89% ,knowing the cause of asthma and taking precautionary measures 89%, and taking down a asthma diary account for 28 %, within the past year, the percentage of patients with emergency department visit, hospital admission and work miss due to asthma were 9.5%, 3.6%, 9.6%, respectively 75.7% of the patients had underwent lung function test were measured at regular intervals. All these results were significantly better than those reported in 2008 AIRIAP. At the end of 6 months treatment, asthma quality of life scores were improved significantly （ P 〈0.05）, and at the end of 3 years treatment whichshowed significant difference with the first year （ P 〈0. 01）. Conclusions After long term systematic education and management asthmatic patients understanding of the disease has been improved greatly, and the efficacy of guided sell-management has been demonstrated for patients with asthma. As a result the disease gets better control.