"三位一体"支气管哮喘教育管理模式对支气管哮喘患者病情控制水平的影响

目的 评价"三位一体"支气管哮喘教育管理模式对支气管哮喘患者病情控制水平的影响.方法 由经过培训的北京市6所大型教学医院的呼吸科医生,以面对面的方式连续不加选择地问卷调查各自医院门诊成年支气管哮喘患者病情控制水平,比较以"三位一体"(哮喘专病门诊、哮喘宣教中心、哮喘患者协会)模式系统教育管理的支气管哮喘患者(教育组)与未进行"三位一体"系统教育管理的支气管哮喘患者(对照组)的问卷调查结果.结果 教育组患者100例,对照组患者427例.教育组支气管哮喘控制测试(ACT)评分达20分以上的占85%,显著高于对照组的37%(χ2=74.345,P<0.01);过去1年中教育组因支气管哮喘加重住院、急诊就诊、误工的分别占4%、18%、20%(10/49),显著低于对照组的23%、32%、55%(76/137)(χ2值分别为19.431、7.515、17.853,P值均小于0.01).结论 "三位一体"支气管哮喘教育管理模式可显著提高患者的病情控制水平.     

Factors affecting quality of life of asthma patients in Spain: The importance of patient education

ObjectivesAssessment of demographic and clinical factors that have an impact on the quality of life (QoL) of patients with asthma in Spain.Patients and methodsMulticenter, prospective, observational, cohort study, conducted in 40 Spanish Pneumology Units during a 12-month period. Data on sociodemographic, clinical variables, asthma treatment and QoL were collected in a case report form.Results536 patients (64.6% women, mean age: 54) were recruited. Reported QoL was better for patients from Northern and Central Spain as compared with those from the South and the East (p < 0.001), students and employed patients as compared with housewives and unemployed (p < 0.01), for those who had received asthma information (p < 0.01), for those with milder daytime symptoms (p < 0.01) and for patients with higher level of education (p < 0.05).ConclusionsAmong the factors that have a significant effect on patients’ QoL only symptom control and patient education on asthma control are modifiable. Therefore, all the strategies should be tailored to improve such factors when managing asthma patients.     

支气管哮喘患者与胃食管返流的症状相关性

目的　探讨胃食管返流 (GER)与成人中、重度支气管哮喘的症状相关性 ,了解 2 4h食管pH监测对哮喘合并GER的诊断价值及抗返流治疗对合并GER的哮喘患者症状的影响。方法　对 2 6例常规治疗后仍有顽固性咳嗽等症状的成人哮喘患者进行 2 4h食管pH监测 ,严格记录监测期间患者出现的各种症状 ,每小时记录 1次呼气峰流速 (PEF)。筛选出适当病例分组抗返流治疗并观察疗效。结果　 2 6例中有 15例DeMeester总积分≥ 14 72 ,2例虽DeMeester总积分 <14 72 ,但咳嗽与返流的症状相关概率 (SAP)≥ 95 % ,共筛选出 17例。将 17例患者随机分为治疗组 (9例 )和对照组 (8例 )。经抗返流治疗后 ,治疗组咳嗽、胸闷和胸骨后烧灼感等症状均较对照组有明显改善 ,2 4hPEF波动率治疗前 [(3 8± 8) % ]、后 [(16± 3 ) % ]比较差异有显著性 (P <0 0 5 )。结论　 (1)中、重度支气管哮喘患者具有较高的GER发生率 (5 8% )。 (2 ) 2 4h食管pH监测有助于了解哮喘患者的症状与GER的相关性。 (3 )对于有GER并与哮喘症状密切相关的患者 ,抗返流治疗可显著地改善其症状及PEF波动率     

杭州市社区医生支气管哮喘知识及管理情况问卷调查结果分析

目的 了解杭州市社区内科医生对支气管哮喘(简称哮喘)基本知识的掌握、规范化治疗及接受再教育情况,以及社区卫生服务中心对哮喘患者教育和管理的情况.方法 采用问卷调查方式,共调查杭州市区45家社区卫生服务中心,每个中心随机抽取2～4名西医内科医生,共114名医牛接受调查.结果 87%(99/114)的受调查者回答哮喘的本质是气道炎症性疾病.69%(79/114)的受调查者选择吸入糖皮质激素(简称激素)为持续期哮喘每日规律使用的一线治疗药物.55%(63/114)的受调查者曾阅读哮喘指南.仅有24%(27/114)的受调查者知道中国哮喘联盟组织,曾访问中国哮喘联盟网站的受调查者仪有6%(7/114),受调查的医生均未参加过中国哮喘联盟在全国进行的普及哮喘规范化防治的讲座.调查前1年中,有55%(63/114)的受调查者未参加任何哮喘相关的会议或讲座.97%(111/114)的受调查者表示希望有上级医院的医生进社区医院进行哮喘相关的讲座.45家社区卫生服务中心中,仅有2家有部分哮喘患者的登记资料,其中仅有1家在调查前1年中对哮喘患者进行了健康教育讲座.结论 社区医生需要更多的继续教育机会以掌握规范的哮喘治疗方案,社区医生的教育工作有待加强.     

支气管哮喘规范化管理与教育对哮喘控制的效果评析

目的 评价北京朝阳医院“健康呼吸中心”五年来成人支气管哮喘(简称哮喘)规范化管理与教育对哮喘控制的效果.方法 对就诊“健康呼吸中心”,参加过“哮喘之家”活动的572例患者进行问卷调查,了解其对哮喘的认知水平、长期用药情况、哮喘日记、ACT评分和病情控制水平等,并比较哮喘患者教育前、教育后6个月、教育后1年、教育后3年时...     

What Determines Knowledge of Asthma Among Young People and Their Families?

In this analysis, we sought to determine factors that predicted the level of asthma knowledge in a sample of adolescents with asthma and their parents. Eighty-five young people aged 10-24 years attending tertiary care asthma clinics and 46 of their parents answered validated respiratory and asthma knowledge questionnaires. Older adolescents were more knowledgeable about asthma than were younger adolescents (r=0.36, p=0.001). Young people with severe asthma (p=0.015) scored higher on the asthma knowledge questionnaire than those with mild/moderate asthma. Asthma knowledge among young people was related to that of their mothers (r=0.47, p=0.014), however, only age and the asthma knowledge of fathers significantly predicted adolescent asthma knowledge. Adolescents develop increasing autonomy for asthma self-management as they mature, but parents remain an important source of information about asthma for young people.     

支气管哮喘规范化管理与教育对哮喘控制的效果评析

目的评价北京朝阳医院“健康呼吸中心”五年来成人支气管哮喘（简称哮喘）规范化管理与教育对哮喘控制的效果。方法对就诊“健康呼吸中心”，参加过“哮喘之家”活动的572例患者进行问卷调查，了解其对哮喘的认知水平、长期用药情况、哮喘日记、ACT评分和病情控制水平等，并比较哮喘患者教育前、教育后6个月、教育后1年、教育后3年时的生活质量评分的变化。结果572例被调查哮喘患者的病情控制水平未控制、部分控制、完全控制的分别占46．2％、38．7％和15．1％，其中，了解哮喘发作的诱因占89％，认识哮喘炎症本质占89％，了解哮喘的症状和诊断占72％，认识哮喘的危害并建立起慢性疾病理念占78％，哮喘药物以吸人为主占90％，了解病情的自我监测方法并坚持记录哮喘日记占28％，了解控制水平的分级占38％，了解哮喘临床控制的定义占52％，认识哮喘防治中存在的误区占62％，了解长期治疗的目标占58％，了解哮喘控制测试占68％，近一年内因哮喘急诊就医、住院、因哮喘误工患者分别占9．5％、3．6％和9．6％，定期行肺功能检查者占75．7％。以上结果均显著优于2008年亚太地区哮喘现状研究（AIRIAP）报道的平均水平。572例哮喘患者治疗6个月后，患者的哮喘症状得到较好的控制，活动受限、避免暴露危险因素以及对危险因素的反应均较教育前有所改善（P〈0．05），同时对疾病有了正确的认识，心理情绪、对疾病的担心得到改善，与教育前比较差异均有统计学意义（P〈0．05）；3年后再次评价改善更加明显，与教育后1年比较差异有非常显著统计学意义（P〈0．01）。结论通过“健康呼吸中心”的活动教育哮喘患者，促进患者的规范治疗，增强患者的认知能力和自我监测、自我管理能力，实现医患之间的伙伴式、互动式关系，减少急性发作、住院率及病死率，从而提高哮喘患者的生活质量，并最终达到控制哮喘的目的。     

北京市各级医院呼吸系病专业医师哮喘基本知识问卷调查结果分析

目的了解各级医院呼吸系病专业医师对哮喘基本知识的掌握情况，作为哮喘防治学组制定工作计划的依据。方法采用问卷调查方式，共调查市级或以上医院、市内区级医院和郊区县医院５５家，对象为呼吸内科或内科呼吸专业组的住院医师和主治医师，总计４３６人。结果无论是哮喘的基本概念，还是吸入治疗、抗炎治疗在哮喘治疗中的地位、峰流速仪的使用价值等，各级医院呼吸系病专业医师均存在不同程度的模糊认识，市级或以上医院医师回答问题情况明显优于市内区级医院和郊区县医院。结论哮喘的医师教育问题是一项非常重要的工作，工作的重点应放在基层医院。     

Relapse Following Treatment of Acute Asthma in the Emergency Department

In this analysis, we sought to determine factors that predicted the level of asthma knowledge in a sample of adolescents with asthma and their parents. Eighty-five young people aged 10–24 years attending tertiary care asthma clinics and 46 of their parents answered validated respiratory and asthma knowledge questionnaires. Older adolescents were more knowledgeable about asthma than were younger adolescents (r=0.36, p=0.001). Young people with severe asthma (p=0.015) scored higher on the asthma knowledge questionnaire than those with mild/moderate asthma. Asthma knowledge among young people was related to that of their mothers (r=0.47, p=0.014), however, only age and the asthma knowledge of fathers significantly predicted adolescent asthma knowledge. Adolescents develop increasing autonomy for asthma self-management as they mature, but parents remain an important source of information about asthma for young people.     

健康教育在哮喘治疗中的临床价值

目的评价健康教育对患者了解哮喘的知识,自我管理及治疗的影响。方法哮喘患者40例,随机分为A、B组,每组各20例。两组均进行哮喘相关知识的问卷调查。A组给予关于哮喘发病机制、治疗、诱发因素、自我管理计划等内容的健康教育;B组给予常规的治疗与护理。6个月后调查,评价患者哮喘相关知识的了解程度,并以激素使用情况作为依从性指标。结果在接受哮喘教育之前,95%患者的哮喘发病机制及治疗知识了解较少。6个月后再调查,A组哮喘相关知识的掌握程度和治疗依从性明显好于对照组(P<0.01)。结论哮喘患者普通存在哮喘知识不足,依从性较差;健康教育对改善患者的治疗依从性和提高疗效有重要价值。     

Systematic review and content analysis of asthma knowledge questionnaires: A focus on the knowledge surrounding acute exacerbation management

Objectives: Asthma education is a key component of asthma management. Asthma education around the management of a person who is having an acute exacerbation of asthma (often referred to as asthma first aid (AFA) training) is important, particularly in a school setting. There is no gold standard assessment of asthma knowledge and also there is no specific tool to measure the knowledge of AFA. Our aim was to identify asthma knowledge questionnaires and perform a content analysis. We were interested in evaluating the number, the type and the format of AFA questions. Method: A literature search was performed to identify the instruments which were able to assess asthma knowledge of people with asthma and/or caregivers of people with asthma. An electronic database search was performed in EMBASE, IPA, MEDLINE and PUBMED. Articles which described the development or psychometric testing of an asthma knowledge questionnaire were included. The content of questions in each instrument was analysed and categorised using the NVivo software, and a secondary analysis was performed to identify knowledge questions relevant to the management of an acute asthma exacerbation. Results: Forty-four papers with 37 different instruments met the inclusion criteria. The majority of the instruments contained a relatively low proportion of questions related to the management of acute asthma, i.e., only 162 of the 780 questions (21%). No questionnaire had sufficient specific emphasis on acute asthma management knowledge to test the impact of AFA training. Conclusion: There is a scope to develop an up-to-date validated acute asthma management knowledge questionnaire for use in research and clinical settings.     

An inverse correlation between estimated tuberculosis notification rates and asthma symptoms

BACKGROUND: A recent ecological analysis demonstrated a strong inverse relationship between tuberculosis notification rates and the prevalence of asthma symptoms in 13-14-year-old children as obtained from the International Study of Asthma and Allergies in Childhood (ISAAC). However, the analysis was confined to the 23 countries in which the tuberculosis notification rates were considered to be of sufficient validity. METHODS: A similar analysis was performed using estimated tuberculosis incidence rates obtained from the World Health Organization Global Tuberculosis Programme and asthma symptom prevalence data from ISAAC for both the 6-7 and 13-14 years age groups in 38 and 55 countries, respectively. RESULTS: For the 6-7-year-old children, there was a significant inverse relationship between estimated tuberculosis incidence and the prevalence of key asthma symptoms. However, in the 13-14 year age group, a significant inverse relationship was only demonstrated for 'asthma ever'. CONCLUSION: The present study extends the inverse relationship between tuberculosis rates and asthma prevalence to the 6-7-year-old age group and suggests that the association, if causal, may be stronger at this younger age.     

Internet-based asthma education �C A novel approach to compliance: A case report

Asthma costs Canadians over $1.2 billion per annum and, despite advances, many asthmatic patients still have poor control. An action plan, symptom diary and measurement of peak expiratory flow have been shown to improve clinical outcomes. Effective educational interventions are an important component of good care. However, many rural sites lack not only access to education but physician care as well. It is reasonable, therefore, that an Internet-based asthma management program may be used as an approach. In the present case report, a novel approach that may increase access in these poorly serviced areas is presented. In an Internet-based asthma management program, patients are reviewed by a physician, receive education and are given a unique password that provides program access. Patients record symptoms and peak expiratory flow rates. The present case report shows that a patient can be assisted through an exacerbation, thus averting emergency intervention and stabilizing control, even when travelling on another continent.     

A web-based educational video to improve asthma knowledge for limited English proficiency Latino caregivers

Objectives: To evaluate limited English proficiency (LEP) Latino caregiver asthma knowledge after exposure to an educational video designed for this target group. Methods: A cross-sectional, interventional study was performed. We aimed to evaluate the post-test impact on asthma knowledge from baseline after exposure to a patient-centered, evidence-based, and professionally produced Spanish asthma educational video. Participants included LEP Latino caregivers of children 2–12 years old with persistent asthma. Enrollment was performed during ED encounters or scheduled through a local community organization. Asthma knowledge was measured with a validated Spanish parental asthma knowledge questionnaire. Differences in mean scores were calculated with a paired t-test. Results: Twenty caregivers were enrolled. Participants included mothers (100%) from Puerto Rico (75%), with a high-school diploma or higher (85%), with no written asthma action plan (65%), whose child's asthma diagnosis was present for at least 3 years (80%). Mean baseline asthma knowledge scores improved 8 points from 58.4 to 66.4 after watching the educational video (95% CI 5.3–10.7; t(19) = 6.21, p < 0.01). Knowledge improvements were similar across the ED and community groups. Knowledge gains were observed in the areas of ED utilization, medication usage, and activity limitations. Conclusions: The developed educational video improved caregiver asthma knowledge for a Latino population facing communication barriers to quality asthma care. Dissemination of this educational resource to LEP caregivers has the potential to improve pediatric asthma care in the United States.     

空气污染与哮喘发病的关系

哮喘的发病因素极为复杂，与环境、遗传、免疫、神经内分泌因素都有关系。众多流行病学的调查资料显示：哮喘发病率的上升，与空气污染有着密切的相关性。但是不同的地区，不同的研究得出的结论是不一致的。本文以文献回顾的方式探讨了几种主要空气污染物：臭氧（O3）、二氧化硫（SO2）、二氧化氮（NO2）、可吸入性颗粒物（PM10）对哮喘的影响，以及相关的病理生理学及分子学机制。     

支气管哮喘患者呼出气一氧化氮及诱导痰的相关性研究

目的 分析诱导痰嗜酸粒细胞计数与呼出气一氧化氮水平的相关性,并探讨其对治疗方案调整的意义.方法 收集门诊疑似支气管哮喘(简称哮喘)患者138例(哮喘60例,非哮喘78例),测定呼出气一氧化氮水平;哮喘组查诱导痰嗜酸细胞计数.结果 哮喘组呼出气一氧化氮为(49.73±24.99) ppb,与非哮喘组(31.51±27.43) ppb比较,差异有统计学意义(t=4.19,P＜0.001).诱导痰中EOS计数与呼出气一氧化氮水平呈正相关(P＜0.01).结论 哮喘患者诱导痰嗜酸粒细胞计数和呼出气一氧化氮测定值升高,且两者之间呈正相关.     

小儿哮喘病与卡介苗疤痕的相关性研究

目的研究卡介苗疤痕（卡疤）与哮喘的相关性。方法观察200例儿童,年龄6—12岁,其中哮喘患儿100例,正常对照100例,测量卡疤纵横直径,取平均值。结果哮喘患儿中卡疤直径大于5mm者有52例,占52％。正常对照组卡疤直径大于5mm者有72例,占72％,两组相比较,差别有显著性。两组儿童在年龄分布和性别构成上差异无显著性。结论卡疤直径可能是哮喘发作的一个有价值的预报因子。     

细胞因子和低亲合力IgE受体水平的变化与外源性哮喘的关系

目的 探讨T,S细胞异常活化在外源性哮喘免疫调节机制中的作用。方法 对30例外源性哮喘患者发作期和缓解期及30例健康成年人的外周血,采用ELISA双抗体夹心法,测定血清可溶性白介素-2受体(Soluble interleukin-2 receptor,sIL-2R)和白介素-4(Interleukin-4,IL-4)水平,用抗人CD_(23)的McAb测定CD_(23)。结果 外源性哮喘发作期血清sIL-2R,IL-4和CD_(23)水平明显升高,与缓解期和对照组有明显差异(P均<0.01),且CD_(23)水平分别与血清sIL-2R和IL-4之间有明显正相关(r=0.85,0.64,P均<0.01)。结论 T,B细胞异常活化是外源性哮喘发病的关键,通过测定细胞因子水平的变化,监测T,B细胞的活化,为今后临床干预哮喘的发生和治疗提供理论基础。     

Prevalence and severity of asthma among Indian school children aged between 6 and 14 years: associations with parental smoking and traffic pollution

Objective: Phase three of the International Study of Asthma and Allergy in Children (ISAAC) was carried out at various sites in India. The prevalence of asthma symptoms in school children and the effect of environmental tobacco smoke and traffic pollution on the occurrence of asthma were analysed. Methods: Two groups of school children, aged 6–7?yr and 13–14?yr, participated according to the ISAAC protocol. Schools were randomly selected and responses to the ISAAC questionnaire were recorded. Results: The prevalence of asthma was 5.35% in the 6–7?yr age group and 6.05% in the 13–14?yr age group. The odds ratios (ORs) for the risk of asthma in children with exposure to mild, moderate and heavy traffic pollution compared with minimal traffic pollution were 1.63 (95% CI: 1.43, 1.85), 1.71 (95% CI: 1.49, 1.96) and 1.53 (95% CI: 1.31, 1.78), respectively, in the younger group. Similarly, in the older group, they were 1.19 (95% CI: 1.04, 1.36), 1.51 (95% CI: 1.31, 1.75) and 1.51 (95% CI: 1.29, 1.76). Asthma was associated with maternal smoking [6–7?yr group: OR?=?2.72 (2.05, 3.6); 13–14?yr group: OR?=?2.14 (1.72, 2.66)] and paternal smoking [6–7?yr group: OR?=?1.9 (1.70, 2.11); 13–14?yr group: OR?=?1.21 (1.09, 1.34)]. Conclusions: The prevalence of asthma was lower in the 6–7 than the 13–14?yr age group. Environmental tobacco smoke and traffic pollution were the factors most strongly associated with asthma in Indian children.     

支气管哮喘发病与HLA-DRB1等位基因关系的研究

目的　探讨山东汉族支气管哮喘 (简称哮喘 )人群中人类白细胞抗原 (HL A) - DRB1基因型的分布 ,明确与哮喘有关的 HL A- DRB1易感基因。方法　选取急性发作期哮喘患者 (哮喘组 ) 5 0例 ,健康献血员 (对照组 )6 0例。应用序列特异性引物聚合酶链反应 (PCR- SSP)方法检测其 HL A- DRB1等位基因。结果　哮喘组 HL A-DRB1* 130 1- 130 2基因频率显著高于对照组 (P<0 .0 1) ,相对危险度 (RR)为 4 .13;其他等位基因频率两组无显著性差异 (P>0 .0 5 )。结论　 HL A- DRB1* 130 1- 130 2基因与哮喘发病相关 ,是山东汉族哮喘人群的易感基因。