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

Investigation on Drugs for Asthma Control Administered by Pediatric Clinicians-Selection of Inhaled Corticosteroids and Compliance Evaluation of Patients

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:A questionnaire survey was conducted among pediatricians from medical institutions of 11 provinces(districts,cities)to analyze the drug 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 clinicians preferred 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 had better 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 master atomizer(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 accounted for<50%,50%-74%,75%-99%of the medical order dosages,respectively.Only 2(1.02%)subjects thought that the patients would fully obey.The main factors affecting children’s medication compliance were worrying about side effects of long-term medication(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 inhalation equipment for children.At the same time,pediatricians have low evaluation on the medication compliance of parents and children.