智能设备提高反复喘息患儿吸入糖皮质激素治疗依从性的应用价值

Application Value of Intelligent Devices in Improving the Compliance of Inhaled Corticosteroid in Children with Recurrent Wheezing

目的:初步探索应用智能设备提高反复喘息患儿吸入糖皮质激素(ICS)治疗依从性的意义。方法:选取我院儿科2017年9月至2018年9月收治的需启动长期哮喘控制药物治疗的反复喘息患儿(≤5岁),根据患儿监护人意愿,在家庭雾化条件下,分为智能组和常规组。其中智能组安装智能设备实施远程监测管理,即根据儿童哮喘管理的临床监测评估要素,研发基于IOS及安卓手机操作系统的哮喘管家APP,并提供ICS追踪器,采用BLE 4.0连接的智能设备实施数据交互,评估患儿病情,实现及时沟通、提醒用药、交流病情及提供干预。两组患儿均给予布地奈德雾化吸入治疗,微信随访6个月,每月评估1次,比较治疗依从性、哮喘控制率、儿童呼吸和哮喘控制测试(TRACK)改良中文版得分、门急诊就诊次数、呼吸道感染次数、抗生素及全身糖皮质激素应用次数。结果:智能组33例、常规组37例完成随访。随访6个月时,智能组用药依从率57.6%,高于常规组的32.4%;哮喘样症状完全控制率63.6%,高于常规组的48.6%;TRACK评分症状控制率69.7%,高于常规组的45.9%;门急诊就诊总次数、呼吸道感染总次数、抗生素及全身激素应用总次数均少于常规组(P均<0.05)。结论:智能设备的应用能在一定程度上提高反复喘息患儿ICS治疗的依从性,改善患儿哮喘样症状,提高哮喘控制水平,减少门急诊就诊次数、呼吸道感染次数及抗生素、全身糖皮质激素的应用,值得临床推广应用。

Objective:To preliminarily explore the significance of intelligent devices in improving the compliance of inhaled corticosteroid(ICS)in children with recurrent wheezing.Methods:Children with recurrent wheezing(≤5 years old)admitted into our hospital from Sept.2017 to Sept.2018 and received long-term asthma control drug therapy were extracted.According to the willingness of the guardians,all children were divided into the intelligent group and the conventional group under the condition of family atomization.Among them,the intelligent group installed intelligent devices to implement remote monitoring and management,that is,according to the clinical monitoring and evaluation elements of childhood asthma management,the asthma housekeeper APP based on IOS and Android mobile operating system was developed,and the ICS tracker was provided.Intelligent devices connected with BLE 4.0 were used for data exchange,assessing the condition of the children and realizing timely communication,medication reminder,disease exchange and intervention.Children in both groups were given budesonide inhalation treatment and were followed up by WeChat for 6 months with monthly assessments.Treatment compliance,asthma control rate,scores of the modified Chinese version of the Pediatric Respiratory and Asthma Control Test(TRACK),outpatient and emergency department visits,respiratory infections,antibiotics and systemic glucocorticoids were compared.Results:Follow-up was completed in 33 cases in the intelligent group and 37 cases in the conventional group.After follow-up of 6 months,the medication compliance rate of the intelligent group was 57.6%,higher than that of the conventional group(32.4%).The complete control rate of asthma-like symptoms was 63.6%,higher than that of the conventional group(48.6%).And the symptom control rate of TRACK score was 69.7%,higher than that of the conventional group(45.9%).The total number of outpatient and emergency visits,the total number of respiratory tract infections,the application of antibiotics and systemic hormone in the intelligent group were lower than those in the conventional group(P<0.05).Conclusion:The application of intelligent devices can improve the compliance of ICS treatment in children with recurrent wheezing,improve the asthma-like symptoms in children,promote the control level of asthma,and reduce the number of outpatient and emergency visits,the number of respiratory infections and the application of antibiotics and systemic glucocorticoids,which is worthy of clinical promotion and application.