儿童哮喘缓解期吸入性糖皮质激素用药依从性现况调查

Investigation on compliance to inhaled corticosteroids in children with asthma in remission stage

目的:探讨儿童哮喘缓解期吸入性糖皮质激素(Inhaled Corticosteroids, ICS)用药依从性及影响因素。方法:对90名哮喘患儿家长进行问卷调查,分析患儿近3个月哮喘缓解期内ICS的使用情况、用药依从性、吸入装置掌握情况及相关影响因素。结果:患儿近3个月内使用最多的ICS为BUD(48.89%),其次是FP(35.56%)、BDP(6.67%)及其他(8.89%)。使用吸入装置最多的是雾化器(24.44%)和干粉吸入剂(都保)(24.44%),其次是压力定量气雾剂(加储物罐)(23.33%)、干粉吸入剂(准纳器)(14.44%)及压力定量气雾剂(无储物罐)(13.33%)。Morisky用药依从性量表调查结果显示,调查对象对于ICS的用药依从性平均得分为5.39,总体判定为依从性差(<6分)。影响依从性的主要影响因素是担心长期用药不良反应、病情好转后停药、各种原因引起的漏用、孩子治疗不配合、吸入装置复杂、用药后无效、用药方案复杂、家庭经济原因以及医师指导不到位等。结论:儿科临床医师和药师应进一步加强诊疗管理,强化吸入技术的使用培训,通过多种途径不断深化哮喘控制宣传、教育和培训工作,提高哮喘患儿长期用药依从性。

OBJECTIVE To explore the medication compliance and influencing factors of inhaled corticosteroids(ICS) in children with asthma during the remission period.METHODS A questionnaire was conducted among 90 parents of children with asthma to analyze the use of ICS, medication compliance, skills on inhalation devices and related factors during the remission period of asthma in the past three months. RESULTS The most commonly used ICS by children with asthma were budesonide(48.89%), followed by fluticasone(35.56%), beclomethasone(6.67%) and others(8.89%).The most commonly used inhaler devices were nebulizers(24.44%) and dry powder inhalers(DPI)(turbuhaler)(24.44%), followed by pressurized metered dose inhalers(pMDI)(with spacer)(23.33%), DPI(accuhaler)(14.44%) and pMDI(without spacer)(13.33%).The average score of morisky scale for patient’s compliance was only 5.39, which was generally judged as poor compliance(<6 points).The main influencing factors on patients’ compliance included fear of long-term drug side effects, drug withdrawal on its own, miss the dose of medicine, noncooperation of children, complexity of inhaler devices, inefficacy of medication, complexity of the drug regimen, economic reasons and inadequate physician guidance.CONCLUSION The pediatric clinicians and pharmacists should further strengthen the management of diagnosis, treatment and the training of inhaler devices. At the same time, they should also deepen the publicity of asthma control, education and training through various channels, so as to improve the long-term medication compliance of children with asthma.