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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2020, Vol. 13 ›› Issue (03) : 302 -306. doi: 10.3877/cma.j.issn.1674-6902.2020.03.003

论著

哮喘患者吸入性糖皮质激素治疗依从性的决定因素分析
翟翠1, 宋旸1, 苏小凡1, 王青婷1, 史文花1, 李满祥1,†()   
  1. 1. 710061　西安，西安交通大学第一附属医院呼吸与危重症医学科
  • 收稿日期:2020-03-04 出版日期:2020-06-25
  • 通信作者: 李满祥
  • 基金资助:
    国家自然科学基金资助项目(81330002；81670051)

Determinants of treatment compliance for inhaled glucocorticoids in asthma patients

Cui Zhai1, Yang Song1, Xiaofan Su1, Qingting Wang1, Wenhua Shi1, Manxiang Li1,†()   

  1. 1. Department of Respiratory and Critical Care Medicine, First Affiliated Hospital, College of Medicine, Xi′an Jiaotong University, Xi′an 710061, China
  • Received:2020-03-04 Published:2020-06-25
  • Corresponding author: Manxiang Li
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引用本文：

翟翠, 宋旸, 苏小凡, 王青婷, 史文花, 李满祥. 哮喘患者吸入性糖皮质激素治疗依从性的决定因素分析[J]. 中华肺部疾病杂志(电子版), 2020, 13(03): 302-306.

Cui Zhai, Yang Song, Xiaofan Su, Qingting Wang, Wenhua Shi, Manxiang Li. Determinants of treatment compliance for inhaled glucocorticoids in asthma patients[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2020, 13(03): 302-306.

目的

探讨支气管哮喘患者吸入性糖皮质激素治疗依从性不佳时关键的因素，明确患者自身对于治疗依从性的理解。

方法

选择西安交通大学第一附属医院呼吸与危重症医学科2017年4月至2018年1月期间门诊年龄>18岁的哮喘患者350例，对选取的患者采用结构化面谈和横断面调查，进行相应的统计分析。

结果

Logistic回归结果显示，使用糖皮质激素治疗有效，认为病情已控制或痊愈[OR＝0.28，95%CI(0.16，0.48)，P<0.01]，哮喘症状加重或急性发作时才用药[OR＝0.26，95%CI(0.15，0.46)，P<0.01]，费用较高难以承受经济负担[OR＝0.36，95%CI(0.17，0.75)，P<0.01]，使用ICS出现不良反应而停用[OR＝0.26，95%CI(0.08，0.81)，P＝0.02]，担心药物不良反应[OR＝1.59，95%CI(0.49，0.95)，P＝0.04]对哮喘患者吸入糖皮质激素治疗依从性的影响有显著性差异。

结论

门诊成人哮喘患者吸入糖皮质激素治疗的依从性不佳与多种因素相关，需采用多种形式的患者教育，提高患者及其家属对哮喘本质及其规范治疗的认识，进而改善患者的哮喘控制水平和临床结局。

关键词: 支气管哮喘, 糖皮质激素, 治疗依从性
Objective

To investigate the determinants of treatment compliance for inhaled glucocorticoids (ICS) in the asthma patients.

Methods

A total of 350 asthma outpatients older than 18 years of age who visited our hospital from 2017 July to 2018 February were selected for this study. Through structured interviews and cross-sectional investigations, the information and relevant data of their inhalation treatment compliance state and responses to determinants were collected to fill out the paper questionnaire, and then inputted into the on-line EQDC system by site investigator(s). And the valid data were taken into statistical analyses.

Results

Logistic regression results showed that the five factors were significantly different in the asthma patients with ICS treatment compliance, as follows, ①some asthma patients with ICS treatment thought that it was effective if the condition was controlled or cured [OR=0.28, 95%CI (0.16, 0.48), P<0.01], ② the symptoms of asthma patients were worsened or acutely exacerbated [OR=0.26, 95%CI (0.15, 0.46), P<0.01], ③ some asthma patients had difficulty in burdening the high cost [OR=0.36, 95%CI (0.17, 0.75), P<0.01], ④ ICS was discontinued due to adverse reactions [OR=0.26, 95%CI (0.08, 0.81), P=0.02], and ⑤ several asthma patients worried about the adverse drug reactions [OR=1.59, 95%CI (0.49, 0.95), P=0.04].

Conclusion

Inadequate compliance with ICS in the outpatients with adult asthma is associated with various factors. Multiple forms of patient education are needed to improve the patients′and their family members′awareness of the nature of asthma and its standardized treatment, thereby improving the compliance and clinical outcomes of asthma.

Key words: Bronchial asthma, Glucocorticoids, Treatment compliance
表1 哮喘患者ICS治疗依从性的单因素Logistic回归结果
项　目 B SE Wald OR P值 95%CI
性　别 -0.391 0.245 2.548 0.676 0.110 0.419～1.093
年龄(岁) -0.335 0.478 3.951 0.715 0.057 0.013～1.475
病程(年) 0.065 0.125 0.273 1.067 0.602 0.836～1.363
表2 哮喘患者ICS治疗依从性差的主要原因
项　目 分类 例数 [n(%)]
使用有效，认为病情已控制或痊愈 是 185 52.9
  否 165 47.1
病重时或发作时才用药 是 160 45.7
  否 190 54.3
担心药物不良反应 是 106 30.3
  否 244 69.7
因各种原因遗忘 是 88 25.1
  否 262 74.9
费用较高难以承受经济负担 是 53 15.1
  否 297 84.9
吸入药物使用完后未及时补充新药 是 43 12.3
  否 307 87.7
与医生沟通差，没能掌握足够的用药信息 是 42 12.0
  否 308 88.0
使用ICS出现不良反应而停用 是 41 11.7
  否 309 88.3
使用ICS起效不快或效果不显著 是 35 10.0
  否 315 90.0
感觉吸入装置操作繁琐或麻烦 是 34 9.7
  否 316 90.3
表3 哮喘患者ICS治疗依从性的多元Logistic回归结果
危险因素 B SE Wald OR P值 95%CI
担心药物不良反应 0.466 0.296 2.481 1.594 0.044 0.492～0.947
使用ICS起效不快或效果不显著 -0.315 0.488 0.417 0.730 0.519 0.218～1.898
使用ICS出现不良反应而停用 -1.358 0.587 5.345 0.257 0.021 0.081～0.813
使用有效，认为病情控制或痊愈 -1.283 0.280 20.934 0.277 0.000 0.160～0.480
病重时或发作时才用药 -1.349 0.295 20.889 0.260 0.000 0.146～0.463
费用较高难以承受经济负担经 -1.022 0.377 7.338 0.360 0.007 0.172～0.754
感觉吸入装置操作繁琐或麻烦 -0.756 0.531 2.025 0.469 0.155 0.166～1.330
与医生沟通差，没能掌握足够的用药信息 -0.373 0.499 0.560 0.689 0.454 0.259～1.830
吸入药物用完后未及时补充新药 0.157 0.542 0.084 1.170 0.772 0.405～3.381
各种原因遗忘 -0.027 0.380 0.005 0.943 0.973 0.462～2.048
表4 不同年龄阶段组哮喘患者ICS治疗依从性的多元Logistic回归结果
危险因素 分类 B SE Wald OR P值 95%CI
各种原因遗忘 18～30岁 0.941 1.001 0.885 2.564 0.347 0.361～18.229
  31～45岁 -1.124 0.617 3.316 0.325 0.043 0.102～0.914
  46～60岁 -1.400 1.070 1.711 0.247 0.191 0.030～2.010
  >60岁 -0.098 0.462 0.045 0.907 0.832 0.367～2.242
与医生沟通差，没能掌握足够的用药信息 18～30岁 29.656 3 720.503 0.000 - 0.994 -
  31～45岁 0.353 0.720 0.241 1.424 0.624 0.347～5.839
  46～60岁 19.665 0.000 - - - -
  >60岁 -1.241 0.553 5.033 0.298 0.025 0.098～0.855
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