智能手机应用程序在哮喘患儿吸入性糖皮质激素治疗依从性中的应用研究

Smartphone App improves adherence with inhaled glucocorticoids therapy in asthma children

目的研究智能手机应用程序在哮喘患儿吸人性糖皮质激素（ICS）治疗依从性中的应用效果。方法选择2016年7月至2017年2月在上海儿童医学中心儿童哮喘门诊就诊的0—3岁哮喘患儿66例，按照随机数字表法随机分为干预组和对照组各33例。2组患儿均给予常规健康教育及吸入技术指导，干预组额外给予安装在智能手机上的哮喘应用程序“哮喘无忧”，重点干预模块包括实时监测用药情况和健康教育。每个月评价ICS治疗依从性，每3个月评价近1个月哮喘发作次数、急诊就诊次数和住院次数，随访6个月。结果干预后6个月，虽然2组的ICS依从性皆有下降，干预组第1个月的依从性为98（97．0，100．0）％，第6个月为96（92．0，100．0）％；对照组第1个月的依从性为93（68．5，100．0）％，第6个月为28（0，55．5）％，2组比较差异有统计学意义（Z=2．664、4．318，P〈0．01）。通过重复方差分析结果提示对照组的依从性随着时间的增加，下降趋势大于干预组（F=25．097，P〈0．01），干预后2组在1个月内哮喘发作、急诊就诊及住院次数0、1、2、2次以上例数比较差异无统计学意义（P〉0．05）。结论智能手机应用程序的干预手段，能有效地改善哮喘患儿吸入性ICS药物依从性，但是由于样本量较少以及随访的时间较短所以对发作、急诊就诊和住院次数上未体现出差异。

Objective To investigate the use of smartphone applications in the adherence with inhaled glucocortiocoids （ICS） therapy in asthma children. Methods Sixty-six asthma children and their caregivers in Shanghai Childrren＇s Medical center from July 2016 to February 2017 were recruited in this study using convenience sampling. All participants were randomly allocated to intervention and control groups. All participants were given routine education and technical guidance on inhalation. In addition all participants had the same chips attached to their regular nebulizers. The APP was installed on each caregivers＇ smartphone in the intervention group. Key modules of mobile applications include real-time monitoring of medication and health education. The ICS adherence rates were recorded by the chips andwere monitored monthly by researcher. The frequency of asthma exacerbations, emergency department visits and hospital admissions in intervention group was collected by smartphone APP every 3 months, the frequency of asthma exacerbations, emergency department visits and hospital admissions in control group was investigated by researcher every 3 month. Results After 6 months follow up, although ICS compliance decreased in both groups. The first month＇s adherence in the intervention group was 98 （97.0, 100.0）% , in the sixth month＇s was 96（92.0, 100.0）%, The first month＇s adherence in the control group was 93（68.5,100.0）%, in the sixth month＇s was 28（0, 55.5）%. The difference in adherence between the two groups was significant （Z=2.664, 4.318, P〈0.01）. The decline trend of the control group was significantly greater than that of the intervention group （F=25.097, P〈0.01）. The compliance of the control group was less than 60% from the third month and below 30% by the sixth month, below the average ICS compliance of 30% to 60% in China. Though the ICS compliance of intervention group was declining, the ICS compliance was more than 90% and higher than the mean compliance in our country. No significant differences were found in the frequency of asthma exacerbations, emergency department visits and hospital admissions between the intervention and control group （,/2=3.043, 1.065, 1.015, P〉0.05）. But the frequency of asthma exacerbations, emergency department visits and hospital admissions of two times or more intervention group was lower than that in the control group. Conclusions Smartphone APP significantly improved the compliance of children with asthma aged 0 month to 3years old.