Research on the intelligent internet nursing model based on the child respiratory and asthma control test scale for asthma management of preschool children

BACKGROUND Childhood asthma is a common respiratory ailment that significantly affects preschool children.Effective asthma management in this population is particularly challenging due to limited communication skills in children and the necessity for consistent involvement of a caregiver.With the rise of digital healthcare and the need for innovative interventions,Internet-based models can potentially offer relatively more efficient and patient-tailored care,especially in children.AIM To explore the impact of an intelligent Internet care model based on the child respiratory and asthma control test(TRACK)on asthma management in preschool children.METHODS The study group comprised preschoolers,aged 5 years or younger,that visited the hospital's pediatric outpatient and emergency departments between January 2021 and January 2022.Total of 200 children were evenly and randomly divided into the observation and control groups.The control group received standard treatment in accordance with the 2016 Guidelines for Pediatric Bronchial Asthma and the Global Initiative on Asthma.In addition to above treatment,the observation group was introduced to an intelligent internet nursing model,emphasizing the TRACK scale.Key measures monitored over a six-month period included the frequency of asthma attack,emergency visits,pulmonary function parameters(FEV1,FEV1/FVC,and PEF),monthly TRACK scores,and the SF-12 quality of life assessment.Post-intervention asthma control rates were assessed at six-month follow-up.RESULTS The observation group had fewer asthma attacks and emergency room visits than the control group(P<0.05).After six months of treatment,the children in both groups had higher FEV1,FEV1/FVC,and PEF(P<0.05).Statistically significant differences were observed between the two groups(P<0.05).For six months,children in the observation group had a higher monthly TRACK score than those in the control group(P<0.05).The PCS and MCSSF-12 quality of life scores were relatively higher than those before the nursing period(P<0.05).Furthermore,the groups showed statistically significant differences(P<0.05).The asthma control rate was higher in the observation group than in the control group(P<0.05).CONCLUSION TRACK based Intelligent Internet nursing model may reduce asthma attacks and emergency visits in asthmatic children,improve lung function,quality of life,and the TRACK score and asthma control rate.The effect of nursing was significant,allowing for development of an asthma management model.

Correlation between the Childhood-Asthma Control Test and the Criterion for Clinical Asthma Control

Setting: Three pediatric pneumatologist offices in Bucaramanga, Colombia. Objective: To establish the concordance between medical criteria and the Childhood-Asthma Control Test (cACT). Design: Study of the assessment of diagnostic technology using transverse sampling. 127 asthma patients aged between 4 and 11 years and their parents filled before clinical evaluation made by a pediatric pneumologist. Patients were classified as controlled or not controlled. Criteria validity was established comparing this classification using Cohen’s kappa and performance indicators according to ROC analysis. Results: 78% of the patients were controlled;patients who are not controlled have a higher score in cACT (mean difference: 3.25 points). Concordance among cACT subscales is acceptable (ρ = 0.554). cACT’s sensitivity was 53.6%, specificity 78.8%, positive likelihood ratio (LR+) 2.53, and negative likelihood ratio (LR-) 0.59. The best cut-off point is 15, with 98% sensitivity, a specificity of 14.3%, LR+ in 1.14, and LR- in 0.14. Conclusions: cACT is a valid tool to determine asthma control in children without replacing medical criteria or other clinical tests. In populations with difficult access to high complexity services, it is useful to decide whether urgent referral to the specialist is necessary.

Evaluation of Asthma Symptoms to Assess Asthma Control Status in a Primary Care Setting: An Exploratory Analysis of Pooled Data from Three Trials

Background: Primary care physicians in Japan see many patients in a given day;consequently, they find it challenging to devote sufficient time for detailed clinical consultation and evaluation of asthma control status. The aim of this study was to investigate asthma symptoms that reveal the presence of inadequately controlled asthma. Methods: A pooled analysis of baseline data from 100 patients with asthma treated with inhaled corticosteroid(s) (ICS) alone or ICS/long-acting beta-agonist who participated in three previous clinical trials was performed. Asthma control status and asthmatic symptoms were determined using a five-item Asthma Control Questionnaire, and whether asthmatic symptoms reflect clinical markers was investigated. Results: Nocturnal awakening owing to asthmatic symptoms was observed only in the uncontrolled asthma group. Patient-reported wheezing was not observed in the group with well-controlled asthma, but was observed in all patients in the uncontrolled asthma group. Virtually all patients, irrespective of asthma control status, reported symptoms in the morning, limitation of normal daily activities, and shortness of breath. Conclusions: The presence of nocturnal awakening due to asthma and wheezing likely reflected uncontrolled asthma. These results will lead to re-recognition that clinical interview, querying nocturnal awakening from asthma and wheezing is a simple and useful approach to assess asthma control status in a primary care setting.

Current asthma control predicts future risk of asthma exacerbation： a 12-month prospective cohort study

Background The performance of asthma control test （ACT） at baseline for predicting future risk of asthma exacerbation has not been previously demonstrated. This study was designed to explore the ability of the baseline ACT score to predict future risk of asthma exacerbation during a 12-month follow-up. Methods This post hoc analysis included data from a 12-month prospective cohort study in patients with asthma （n=290）. The time to the first asthma exacerbation was analyzed and the association between baseline ACT scores and future risk of asthma exacerbation was calculated as adjusted odds ratio （OR） using Logistic regression models. Further, sensitivity and specificity were estimated at each cut-point of ACT scores for predicting asthma exacerbations. Results The subjects were divided into three groups, which were uncontrolled （U, n=128）, partly-controlled （PC, n=111）, and well controlled （C, n=51） asthma. After adjustment, the decreased ACT scores at baseline in the U and PC groups were associated with an increased probability of asthma exacerbations （OR 3.65 and OR 5.75, respectively）, unplanned visits （OR 8.03 and OR 8.21, respectively） and emergency visits （OR 20.00 and OR 22.60, respectively） over a 12-month follow-up period. The time to the first asthma exacerbation was shorter in the groups with U and PC asthma （all P 〈0.05）. The baseline ACT of 20 identified as the cut-point for screening the patients at high risk of asthma exacerbations had an increased sensitivity of over 90.0% but a lower specificity of about 30.0%. Conclusion Our findings indicate that the baseline ACT score with a high sensitivity could rule out patients at low risk of asthma exacerbations and predict future risk of asthma exacerbations in clinical practice.

Impact of guideline adherence and race on asthma control in children

Background Asthma control in African Americans(AA)is considered more difficult to achieve than in Caucasian Americans(CA).The aim of this study was to compare asthma control over time among AA and CA children w hose asthma is managed per NAEPP(EPR-3)guidelines.Methods This was a one-year prospective study of children referred by their primary care physicians for better asthma care in a specialty asthma clinic.All children received asthma care per NAEPP guidelines.Results were compared between CA and AA children at baseline and then at three-month intervals for one year.Results Of the 345 children,ages 2-17 years(mean=6.2±4),220(63.8%)were CA and 125(36.2%)were AA.There were no significant differences in demographics other than greater pet ownership in CA families.At baseline,AA children had significantly more visits to the Emergency Department for acute asthma symptoms(mean=2.3±3)compared to CA(1.4±23,P=0.003).There were no other significant differences in acute care utilization,asthma symptoms(mean days/month),or mean asthma control test(ACT)scores at base line.Within 3-6 months,in both groups,mean ACT scores,asthma symptoms and acute care utilization significantly improved(P<0.05 for all)and change over time in both groups was comparable except for a significantly greater decrease in ED visits in AA children compared to CA children(P=002).Conclusion Overall,improvement in asthma control during longitudinal assessment was similar between AA and CA children because of consistent use of NAEPP asthma care guidelines.

Evaluation of asthma control： a questionnaire-based survey in China

Background Little is known about asthma control and perception of asthma among asthmatic patients in China.This study marked the first survey conducted on a national scale that aimed at obtaining baseline information on asthma control and patients＇ perception of asthma and providing a point of reference for future studies.Methods This face-to-face,questionnaire-based survey was conducted from April 2007 to March 2008 with 3 069 asthmatic patients from the respiratory outpatient clinics of 36 general hospitals located in 10 geographically dispersed cities.Results Consistent with the Global Initiative for Asthma （GINA） guidelines,28.7% and 45.0% of our patients achieved control and partial control,respectively.Of the patients in the study,only 21.8% had used a peak flow meter （PFM）,and 6.6% of these patients used it daily.Inhaled corticosteroids （ICS） plus a long-acting β2 agonist （LABA） and ICS were the two most common medication regimens and were used in 45.6% and 30.4% of patients,respectively.Asthma had a significant effect on the patients＇ life and work.A considerable number of hospitalizations,emergency department visits,and sick days were observed.Conclusion Despite improvements in asthma control and ICS and PFM compliance compared with past literature,the current level of asthma control countrywide continues to fall short of the goals set in the GINA.

T-Helper I Cell/T-Helper 2 Cell Balance with Anti Inflammatory Therapy in Partly Controlled Asthmatic Children

The authors aimed to assess Thl （T-helper cell 1）/Th2 （T-helper cell 2） balance, through evaluation of serum IFN-γ （interferon gamma） and IL-4 （interleukin 4）, during asthma exacerbation and study the effect of anti inflammatory therapy. A randomized prospective case-control study was designed. The sludy included 30 asthmatic patients, aging 8-14 years. All were diagnosed as partly controlled asthmatics. Twenty, age and sex matched, healthy children were included in the study as control group All participants were subjected to medical history, clinical examination, pulmonary function testing, eosinophilic blood counting, estimation of serum interleukine-4 and interferon gamma. Patients were treated for 6 weeks with 2 different anti inflammatory drugs. All methods were then repeated for follow up. IL-4 serum level was significantly higher in subjects with partly controlled asthma than in control subjects （P = 0.01）, and then in asthmatic patients after therapy （P = 0.0000）, while IFN-）, serum level was significantly lower in subjects with partly controlled asthma than in control subjects （P = 0.01）, and than in asthmatic patients after therapy （P = 0.0000）. Interferon gamma showed a significant negative correlation with IL-4 among the healthy control group （r = -0.559, P = 0.010）. Both LTA （leukotriene antagonist） and ICS （inhaled corticosteroids） therapy lead to significant improvement, but there were no statistically significant differences （P 〉 0.05） between them as regard the pulmonary functions and the laboratory evaluating parameters. Both serum levels of IL-4 and IFN-γ, could be used as a reliable inflammatory biomarker for the evaluation and follow up of asthmatic patients.

针刺治疗咳嗽变异性哮喘有效性和安全性的Meta分析

目的:系统评价针刺治疗咳嗽变异性哮喘(CVA)的临床疗效和安全性。方法:计算机检索中国知网(CNKI)、维普数据库(VIP)、中国生物医学文献数据库(CBM)、万方数据库(WF)、荷兰医学文献数据库(Embase)、国际循证医学图书馆(Cochrane Library)和美国生物医学信息检索系统(PubMed),收集针刺治疗咳嗽变异性哮喘的随机对照试验,时间为建库至2023年12月。采用Cochrane风险偏倚评估工具对纳入的文献进行质量评价和风险评估,并采用RevMan5.4软件进行Meta分析。结果:本研究共纳入12篇文献,共953例患者,其中对照组496例,试验组497例。Meta分析结果显示,试验组临床有效率优于对照组[OR=3.61, 95%CI=(2.39, 5.45), P<0.00001];试验组咳嗽症状积分低于对照组[MD=-0.94, 95%CI=(-1.06,-0.82), P<0.00001];试验组第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、呼气流量峰值(PEF)均优于对照组[MD=0.73, 95%CI=(0.59,0.87), P<0.00001;MD=0.82, 95%CI=(0.77, 0.86), P<0.00001;MD=5.93, 95%CI=(3.10, 8.57), P<0.00001];试验组复发率低于对照组[OR=0.30, 95%CI=(0.18, 0.50), P<0.00001];试验组不良反应(9例)较对照组(56例)少,表明针刺疗法安全性更高。结论:针刺是治疗CVA的有效方法,其能明显提高总有效率,减轻咳嗽症状,改善肺功能,且复发率低安全性高。上述结论仅基于现有的研究结果开展,若要进一步围绕针刺对CVA的治疗效果开展研究、系统性评价其疗效,尚需进一步的开展大样本、高质量的随机对照研究。

儿童行为特点及家庭管理方式对哮喘控制水平影响路径分析

目的探讨儿童行为特点及其家庭管理方式对儿童哮喘控制水平影响路径。方法采用便利抽样法选取82例哮喘患儿,应用一般资料问卷、适应行为量表(AAMR)、家庭管理测量量表(FaMM)及儿童哮喘控制测试表(Childhood asthma control test,C-ACT)进行问卷调查,分析其影响路径。结果患儿AAMR适应行为量表得分(84.87±9.16)分,FaMM量表得分(188.77±19.01)分,C-ACT得分(15.20±4.66)分。Pearson相关分析结果显示,适应性行为分别与家庭管理、哮喘控制呈正相关关系(r=0.580、0.219,P<0.05),家庭管理与哮喘控制呈正相关关系(r=0.401,P<0.05)。结构方程模型结果表明,家庭管理在哮喘患儿适应性行为和哮喘控制有部分中介调节作用,效应占比为45.95%。结论儿童行为特点能够通过家庭管理方式对患儿哮喘控制水平产生影响,临床护理人员应重视对患儿家属的健康教育管理,提升家属对疾病的认知度及家庭管理能力,以改善患儿的行为方式,达到有效控制患儿疾病的目的。

TRACK与C-ACT评分在儿童哮喘管理中的价值评估

目的:通过研究儿童呼吸和哮喘控制测试(test for respiratory and asthma control in kids,TRACK)和儿童哮喘控制测试(childhood asthma control test,C-ACT)与全球哮喘防治创议(global initiative for asthma,GINA)标准哮喘控制水平评估的一致性、与哮喘儿童肺功能指标的相关性,探讨2种评分方法在儿童哮喘管理中的价值。方法:选择2020年8月至2022年3月重庆市妇幼保健院儿科门诊就诊的哮喘患儿135例为研究对象,用TRACK评分表和C-ACT评分表对相应年龄的患儿及其家长进行问卷调查,分析2种评分方法与GINA标准哮喘控制水平评估分级的一致性、与肺功能指标的相关性,并比较不同评分结果组肺功能指标差异。结果:TRACK评分、C-ACT评分与GINA哮喘控制水平分级一致性检验Kappa值分别为0.517和0.531,均显示一致性一般;TRACK评分与TPF%TE和VPF%VE存在显著的正相关,但TRACK评分、C-ACT评分与FEV1%均没有显著性相关;不同TRACK评分组哮喘患儿的FEV1%差异无统计学意义(F=2.054,P=0.134),但多重比较发现≥80分组与<60分组FEV1%的差异有统计学意义(P=0.048);不同TRACK评分组哮喘患儿的TPTEF/TE(%)(F=3.171,P=0.044)和VPEF/VE(%)(F=3.919,P=0.022)差异有统计学意义,进一步多重比较发现其差异主要来自于≥80分组与60~80分组,其中VPEF/VE(%)(P=0.017)的组间差异较TPTEF/TE(%)(P=0.030)更为明显;比较不同C-ACT评分组哮喘患儿的FEV1%差异无统计学意义(F=1.756,P=0.182)。结论:TRACK评分能更好反映儿童肺功能的差异,可作为5岁以下儿童哮喘管理的一个有效评估工具。

Asthma Patient Care: The Pharmacist’s Perspective

Aim of the Study: To compare effect of asthma care by pharmacist intervention versus routine care on asthma control. Patients and Methods: A 2-month randomised, controlled trial was conducted in outpatient clinics of Ain Shams University Hospitals, Cairo, Egypt. Patients were randomly assigned to receive routine care or a pre-defined pharmacist intervention. This intervention was mainly focused on patient education, improving inhalation technique and medication assessment. Primary outcome was the level of asthma control, as assessed by the Asthma Control Questionnaire (ACQ). Results: By the end of the study, intervention patients who received a written action plan significantly improved their ACQ results than routine care group who did not receive a plan (p < 0.0001). Inhalation technique and adherence to controller medication were significantly better in the intervention group. Conclusion: The present study results provide supportive evidence concerning pharmacists’ favourable effects on asthma patient care and support pharmacists as valuable members of the health care team.

过敏性哮喘个案管理的临床应用实践

目的评估基于个案管理模式的慢性疾病管理在过敏性哮喘患者中的临床应用效果。方法回顾性分析2020年2月至2023年2月北京清华长庚医院呼吸与危重症医学科门诊收治的过敏性哮喘患者。通过跟踪观察个案管理后1个月、3个月、6个月及1年的哮喘症状控制(ACT评分)及肺功能,分析个案管理对哮喘症状控制及肺功能的改善作用。结果纳入175例患者,男70例(40%)、女105例(60%);年龄(45.58±13.78)岁;合并过敏性鼻炎139例(79.4%)。个案管理前后肺功能指标第一秒用力呼气容积占预计值百分比(FEV1%pred)、第一秒用力呼气容积(FEV1)、一秒率(FEV1/FVC)、最大呼气中段流量占预计值百分比(MMEF75/25%pred)和呼气峰流速(PEF)分别由87.09%±18.56%、(2.65±0.88)L、75.09%±11.93%、52.20%(34.70%,69.30%)、(6.65±1.94)L/s升至97.80%±13.81%、(2.96±0.76)L、84.72%±11.18%、69.20%(53.70%,86.90%)、(7.57±1.89)L/s(P均<0.001)。ACT评分显示,个案管理1年控制良好率100%,其中完全控制率达到69.7%。重复测量方差分析显示性别和过敏性鼻炎史对症状控制效果均无影响(F=0.575,P=0.681;F=2.317,P=0.059);年龄组与个案管理时间存在交互作用,≥60岁患者在个案管理时间6个月时,ACT评分低于≤44岁和45~59岁组患者(P均<0.05)。吸入药物使用率和使用药物装置正确率在个案管理1个月、3个月、6个月、1年时分别为98.8%、86.8%、68.0%、51.4%和98.8%、100%、100%、100%。结论个案管理模式可显著提高患者使用吸入药物的使用率和使用吸入药物装置正确率,提高症状控制率,促进患者肺功能恢复。

支气管哮喘患儿血清LCN2、SDC⁃1水平及临床意义

目的分析支气管哮喘患儿血清脂质运载蛋白2(LCN2)和多配体蛋白聚糖1(SDC⁃1)水平,并探讨两者与病情严重程度、哮喘控制水平的关系,以及对儿童支气管哮喘的诊断价值。方法纳入112例支气管哮喘患儿作为哮喘组,104例健康儿童作为正常组。根据病情严重程度再将哮喘组患儿分为轻度间歇组(36例)、轻度持续组(25例)、中度持续组(32例)和重度持续组(19例)。比较哮喘组与正常组之间,以及哮喘组不同病情严重程度患儿之间血清LCN2、SDC⁃1水平。分析哮喘组患儿血清LCN2和SDC⁃1的相关性,以及二者与第1秒用力呼气量(FEV_(1))、FEV_(1)/用力肺活量(FVC)值、儿童哮喘控制测试(C⁃ACT)评分的相关性。绘制受试者工作特征(ROC)曲线分析血清LCN2、SDC⁃1水平对儿童支气管哮喘的诊断价值。结果与正常组相比,哮喘组血清LCN2、SDC⁃1水平升高(P<0.05)。轻度间歇组、轻度持续组、中度持续组、重度持续组支气管哮喘患儿血清LCN2、SDC⁃1水平依次升高(P<0.05)。支气管哮喘患儿血清LCN2水平与血清SDC⁃1水平呈正相关,血清LCN2和SDC⁃1水平分别与FEV_(1)、FEV_(1)/FVC值、C⁃ACT评分呈负相关(P<0.05)。血清LCN2、SDC⁃1水平联合诊断儿童支气管哮喘的曲线下面积(AUC)为0.881,大于血清LCN2、SDC⁃1水平单独诊断的AUC(分别为0.778和0.768,P<0.05)。结论支气管哮喘患儿血清LCN2、SDC⁃1水平升高,且与病情严重程度和哮喘控制水平有关。血清LCN2、SDC⁃1水平可作为辅助诊断儿童支气管哮喘的生物标志物,且两者联合诊断的效能更高。

基于奥瑞姆自理理论的医院-家庭延续性护理在变应性哮喘患儿中的应用效果

目的探讨基于奥瑞姆自理理论的医院-家庭延续护理在变应性哮喘患儿中的应用效果。方法选择2021年1月—2023年1月医院收治的108例变应性哮喘患儿为研究对象,根据基本资料具有可比性的原则将其分为对照组和观察组各54例。对照组予以常规家庭健康管理,观察组采用基于奥瑞姆自理理论的医院-家庭延续护理。两组均持续干预3个月,随访6个月。观察两组干预前、干预3个月后的用药依从性、病情发作控制及肺功能水平。结果干预前,两组用药依从性比较差异无统计学意义(P>0.05);干预3个月后,观察组的用药依从性高于对照组,差异有统计学意义(P<0.05);观察组出院3个月、6个月内的病情发作次数分别为1.52±1.17次、2.80±1.20次,均少于对照组的2.45±1.05次、4.45±1.27次,差异有统计学意义(P<0.05);观察组出院6个月内再入院次数为1.64±0.71次,少于对照组的2.47±0.92次,差异有统计学意义(P<0.05);干预前,两组FEV1及FVC水平比较差异无统计学意义(P>0.05);干预3个月后,观察组的FEV1及FVC水平高于对照组,差异有统计学意义(P<0.05)。结论基于奥瑞姆自理理论的医院-家庭延续护理能够提高变应性哮喘患儿的用药依从性,同时有助于改善病情发作控制效果及肺功能水平。

门诊成人支气管哮喘患者临床控制水平及其影响因素分析

目的分析门诊成人支气管哮喘患者的临床控制水平及其影响因素,为哮喘的规范化治疗提供参考。方法选取2017年7月至2022年7月上海中医药大学附属龙华医院呼吸科门诊就诊的100例成人哮喘患者,根据哮喘控制测试(asthma control test,ACT)评分表评估患者哮喘控制水平,将患者分为控制良好组(n=36)与未控制组(n=64)。采用多因素Logistic回归分析门诊成人支气管哮喘患者控制水平的影响因素。结果100例门诊成人支气管哮喘患者的控制率(ACT≥20分)为36%。单因素Logistic回归分析显示两组患者的性别、年龄、吸烟史、家族史、急性加重住院史、合并过敏性鼻窦炎、肺功能等差异无统计学意义(P>0.05)。两组患者的BMI、FeNO、嗜酸性粒细胞计数以及嗜酸性粒细胞百分比差异具有统计学意义(P<0.05)。多因素Logistic回归分析显示,有吸烟史、发病年龄≤33岁、FeNO>54ppb、血嗜酸性粒细胞百分比>5.5%是影响门诊成人支气管哮喘患者控制水平的危险因素(P<0.05)。ROC曲线分析显示,以Logistic回归分析总体模型为检验变量时,曲线下面积最大(0.778)。结论门诊成人支气管哮喘患者控制水平未达理想标准。有吸烟史、发病年龄小、FeNO水平高、血嗜酸粒细胞百分比高是影响门诊成人支气管哮喘患者控制水平的危险因素。

益气补肾止喘汤结合中医推拿对哮喘患儿PET、C-ACT评分的影响

目的:观察益气补肾止喘汤结合中医推拿对哮喘患儿正电子发射计算机断层显像(positron emission tomography PET)、儿童哮喘控制测试(children-asthma control test, C-ACT)评分的影响。方法:选取太原市中医医院2021年1月至2022年12月收治的哮喘患儿104例,均符合小儿哮喘临床诊断标准,随机分成对照组和研究组,每组52例。对照组给予常规西药治疗,研究组给予益气补肾止喘汤结合中医推拿治疗。观察两组患儿治疗前后肺功能相关指标[1秒用力呼气容积(forced expiratory volume in one second, FEV1)、用力肺活量(forced vital capacity, FVC)与FEV1/FVC]、正电子发射计算机断层显像(positron emission tomography, PET)、C-ACT评分及临床症状消失时间、临床疗效。结果:研究组治疗后FEV1、FVC、FEV1/FVC高于对照组,差异有统计学意义(P<0.05);对照组有效率为67.31%,研究组有效率为96.15%,两组有效率比较,差异具有统计学意义(P<0.05);研究组临床症状消失时间短于对照组,差异具有统计学意义(P<0.05);研究组治疗后PET、C-ACT评分高于对照组,差异具有统计学意义(P<0.05)。结论:益气补肾止喘汤结合中医推拿能提高哮喘患儿肺功能,改善其临床症状。

“互联网+”药学服务模式对哮喘患儿用药依从性及病情控制的影响

目的 探讨“互联网+”药学服务模式对哮喘患儿用药依从性及病情控制的影响。方法 本研究为随机对照试验,收集2020年6月至2023年6月在我院治疗的183例支气管哮喘患儿作为研究对象,按照随机数字表法平均分为对照组和观察组。对照组行常规药学服务,观察组接受“互联网+”药学服务模式,对比两组哮喘患儿用药依从性、儿童哮喘控制测试(C-ACT)评分、肺功能指标和血清生物标志物的变化。结果 与对照组相比,观察组治疗后用药依从性和C-ACT得分提升,肺功能指标改善,血清IgE、IL-4、TNF-α等指标降低,组间差异均具有统计学意义(P<0.05)。结论 “互联网+”药学服务模式可以改善哮喘患儿的用药依从性,改善哮喘控制水平,适合用于儿童哮喘的长期管理。

支气管哮喘患儿自我感受负担状况及其与哮喘控制水平的关系

目的探讨支气管哮喘患儿自我感受负担状况及其与哮喘控制水平的关系。方法选取2021年6月至2022年3月收治的100例支气管哮喘患儿为研究对象。治疗前,采用自我感受负担量表(SPBS)评估支气管哮喘患儿的自我感受负担状况,比较不同特征支气管哮喘患儿的自我感受负担状况;治疗3个月后采用儿童哮喘控制测试问卷(C-ACT)评估患儿的哮喘控制水平,并分析支气管哮喘患儿自我感受负担与哮喘控制水平的相关性。结果治疗前,100例支气管哮喘患儿的SPBS评分为(32.58±3.62)分,总体自我感受负担处于中等水平。不同性别、年龄、住院次数、家庭年收入、呼吸道感染史、掌握用药技术的支气管哮喘患儿自我感受负担状况比较,差异具有统计学意义(P<0.05)。治疗3个月后,100例支气管哮喘患儿的C-ACT评分为(14.31±2.39)分,总体哮喘控制水平不佳。支气管哮喘患儿的SPBS评分与C-ACT评分呈负相关(r=-0.810,P<0.001)。结论支气管哮喘患儿自我感受负担状况与哮喘控制水平具有密切关系。

肺通气功能正常的儿童支气管哮喘控制情况及急性发作随访的研究

目的探讨学龄期肺通气功能正常的支气管哮喘(简称“哮喘”)患儿病情控制情况及随访1年内急性发作情况。方法回顾性分析2021年4—9月327例6~14岁肺通气功能正常哮喘患儿临床资料。根据一秒率实测值,分为≥80%组(267例)和<80%组(60例),比较两组肺通气功能、哮喘控制水平差异,以及随访1年急性发作情况。结果<80%组基线肺通气功能低于≥80%组,小气道功能障碍比例高于≥80%组(P<0.05);规范治疗1年后,<80%组小气道功能指标均改善,但仍低于≥80%组(P<0.05)。入组时哮喘未完全控制率为34.6%(113/327),<80%组哮喘控制水平低于≥80%组(P<0.05);规范治疗1年后,<80%组哮喘控制水平仍低于≥80%组,且哮喘急性发作比例高于≥80%组(P<0.05)。结论学龄期哮喘患儿在肺通气功能正常时,仍有约1/3为哮喘未完全控制,其中一秒率实测值低于80%的患儿哮喘急性发作风险增加,需密切随访,强化哮喘管理。

益生菌对支气管哮喘患儿疾病控制及Th1、Th2的影响

目的:探究益生菌对支气管哮喘患儿疾病控制及Th1、Th2的影响。方法:选取2021年5月—2023年2月三明市中西医结合医院收治的80例支气管哮喘患儿,根据随机数表法分为两组,各40例。对照组进行常规支气管哮喘治疗,观察组在对照组的基础上加用益生菌。比较两组哮喘控制总有效率、症状体征消失时间、生存质量[哮喘患儿生命质量量表(PAQLQ量表)]、Th1类细胞因子[γ干扰素(IFN-γ)及白细胞介素-2(IL-2)]及Th2类细胞因子[白细胞介素-4(IL-4)、白细胞介素-5(IL-5)及白细胞介素-6(IL-6)]。结果:观察组哮喘控制总有效率显著高于对照组,症状体征消失时间显著短于对照组,差异有统计学意义(P<0.05)。治疗前两组PAQLQ量表评分、Th1类细胞因子及Th2类细胞因子比较,差异无统计学意义(P>0.05);治疗2周、4周后,两组PAQLQ量表评分及Th1类细胞因子均显著高于治疗前,且观察组高于对照组,Th2类细胞因子显著低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。结论:益生菌可有效改善支气管哮喘患儿的疾病状态,且对Th1、Th2失衡的改善效果更好。