妊娠期哮喘患者疾病管理及用药情况的调查分析

目的了解妊娠期哮喘患者哮喘控制及药物使用的情况,分析妊娠期哮喘控制不佳的原因。方法通过对41例诊断为哮喘的妊娠期女性进行问卷调查,收集其目前哮喘控制水平、药物使用情况、吸入装置与吸入技巧、用药依从性、对疾病和药物的认识、影响哮喘控制的因素等情况,根据答题结果分析。结果根据哮喘控制问卷评分,"良好控制"占39.0%;"部分控制"+"未控制"占61.0%。在妊娠期间,34.1%患者有过至少1次因哮喘急性发作门/急诊就诊或入院治疗。20.0%患者能正确吸入药物,52.6%患者用药依从性较好。39%患者认为吸入激素对胎儿危害会大于哮喘,61.0%患者分不清楚缓解药和控制药。影响哮喘控制原因中,48%患者担忧激素会对胎儿影响,无患者选择经济因素。结论妊娠期哮喘控制欠佳,药师参与妊娠哮喘患者管理有望提高其控制水平。     

哮喘非急性发作期73例药学监护调查

目的:了解哮喘治疗的药学监护现状,促进药学监护发展.方法:调查73例非急性发作期哮喘患者治疗方案组成和执行情况,并监测临床疗效和药物不良反应.结果:73例患者中使用缓解药物61例(83.6%),控制药物69例(94.52%).能完全区分控制药物和缓解药物35例(47.94%),用药依从性良好的36例(49.31%)、中等的17例(23.49%)、差的20例(27.4%).结论:哮喘患者未能得到足够的药学监护,药学监护应成为哮喘患者综合治疗的一个重要环节.     

43例癌痛患者药学监护效果的研究

目的:了解临床药师在癌痛控制中的作用。方法:对癌痛患者开展药学监护,发现药物治疗中的问题,优化给药方案,开展用药教育。在进行为期1周的药学监护后,比较患者疼痛评分、疼痛缓解程度、生活质量、用药依从性、药品不良反应等方面的改善情况。结果:共纳入43例癌痛患者进行药学监护,药师总计提供了76条药物治疗建议。药学监护后,43例癌痛患者的疼痛评分由(6.9±1.5)分降低为(1.8±1.4)分,较干预前有极显著的降低(P<0.01),其中8例患者的疼痛(18.6%)完全缓解,18例(41.9%)明显缓解,7例(16.2%)中度缓解,8例(18.6%)轻度缓解,2例(4.7%)无缓解,疼痛缓解率76.7%;43例癌痛患者的生活质量(KPS)评分,3例(7%)明显改善,25例(58.1%)有改善,15例(34.9%)达到稳定,无评分下降;患者用药依从性与药学监护前相比有显著性变化(P<0.01)。结论:临床药师参与癌痛控制,可减轻患者疼痛,提高患者生活质量。     

儿童哮喘非急性发作期52例药学监护调查

目的：了解儿童哮喘治疗的药学监护现状，促进儿科药学监护发展。方法： 调查52例非急性发作期哮喘患儿治疗方案组成和执行情况，并监测临床疗效和药物不良反应。结果：52例患儿中用缓解药物45例(86.54%)，控制药物48例(92.31%)。能完全区分控制药物和缓解药物24例(46.15%)。用药依从性好24例(46.15%)，中等11例(21.15%)，差17例(32.69%)。在吸入型药物使用方法中，定量压力气雾剂使用42例，其中使用技术合格8例(19.05%)，不合格34例(80.95%)；干粉剂吸入48例，其中使用技术合格34例(70.83%)，不合格14例(29.17%)。长期吸入糖皮质激素43例中，完全按方案执行15例(34.88%)，执行不规范28例(65.12%)。52例中8例有哮喘日记，正确记录4例。使用峰流速仪11例，用法正确和了解临床意义8例，经常使用5例。定期来哮喘门诊随访11例(21.54%)。调查使用吸入型药物患儿47例，其中对吸入型糖皮质激素药物不良反应了解9例(19.15%)，基本了解20例(42.55%)，错误了解18例(38.30%)。结论： 儿童哮喘未能得到足够药学监护，药学监护应成为儿童哮喘综合治疗的一个重要环节。     

儿童支气管哮喘的药学服务及临床效果分析

目的：探讨药学服务对儿童哮喘知识知晓程度、用药依从性、肺功能和哮喘控制程度的影响,为改善哮喘患儿的药学服务提供依据。方法：将126例哮喘患儿随机分为观察组和对照组, 每组63例, 进行知识知晓、用药依从性、合理用药、肺功能和哮喘控制的调查和测评;对照组进行常规治疗和健康教育等干预;观察组在对照组健康教育干预措施的基础上,接受为期6个月药学服务干预,干预结束后,实施电话或上门随访跟踪调查。结果：两组患儿在哮喘知识知晓程度、用药依从性、合理用药途径、肺功能（FEV1％和PEF％）和儿童哮喘控制测试（C-ACT）等方面比较差异有统计学意义（P<0.05）。观察组儿童哮喘控制率明显提高（P<0.05）,但仍然存在气雾剂使用不正确（23.81%）、控制药使用不当（20.63%）、哮喘日记欠完整（19.05%）、过分担忧药物不良反应等（14.29%）。结论：药学服务能显著有效改善儿童哮喘知识知晓度、用药依从性、合理用药、肺功能和哮喘控制水平,药师应该更多提供和完善药学服务计划。     

哮喘患者的药学监护探讨

目的:探讨哮喘患者药学监护的重点和方向,促进药学监护发展和更好地控制哮喘。方法:从执行正确的治疗方案、正确区分和选择控制类药物与缓解类药物、提高用药依从性、正确使用吸入药物装置、重视疗效考核和了解药品不良反应等方面入手,介绍加强哮喘患者药学监护的方法。结果与结论:加强哮喘患者的药学监护,可提高哮喘的临床疗效。     

药学服务对支气管哮喘患者用药依从性的影响

药师对支气管哮喘患者进行药学服务(用药前教育、药物知识介绍、定期监测血药浓度、指导气雾剂的使用等),以提高患者用药的依从性.与对照组相比,药学服务组的患者用药依从性一个月后从20%提高到40%.     

哮喘患儿吸入治疗装置的使用调查和相关药学服务探讨

目的:调查哮喘患儿使用吸入药物的情况,以明确针对哮喘患儿的药学服务方向。方法:采用问卷方式对101例门诊哮喘患儿及其家长进行调查,并对调查结果进行统计、分析。结果:仅4.0%的患儿和/或家长能认识到哮喘需要长期的控制治疗;36.6%的患儿能完全遵医嘱用药;能正确使用定量气雾剂、都保和准纳器的患儿比例分别为29.4%、35.3%和29.8%;94.1%的患儿及其家长不了解吸入糖皮质激素的不良反应。结论:哮喘患儿对吸入剂的用药依从性、对长期控制治疗的必要性和药品不良反应的了解程度和吸入技术的掌握均有待提高;药师应为哮喘患儿提供更多的相关用药指导。     

儿童哮喘472例吸入疗法技术及辅助吸药装置使用分析

目的分析不同年龄儿童哮喘患者对吸入疗法技术及辅助吸药装置的正确使用情况,旨在指导临床医师正确选择吸入药物、吸药装置以及如何指导病儿正确使用。方法对我院2004年2月至2008年7月哮喘专科门诊病儿使用吸入药物及吸入装置情况进行观察、指导、随访,分为吸药前有哮喘专科医师指导吸药组和无专科医师指导组。结果吸药前选择正确的吸药装置有哮喘专科医师指导吸药组和无专科医师指导组吸药错误率分别为25.54%、88.52%.经X~3检验P<0.05,差别具有显著性意义,经哮喘专科医师指导吸药后,于用药1周、1个月随访观察,两组吸药错误率分别为16.84%、18.33%,6.79%、9.81%,经X~2检验P>0.05,差别无显著性意义。吸药前选择正确的吸药装置有哮喘专科医师指导吸药组与直接用压力定量气雾剂吸药组比较:虽经哮喘专科医师指导吸药,并于1周、1个月随访观察纠正,但直接用压力定量气雾剂吸药组吸药错误率在用药当时、1周、1个月分别为88.38%、79.06%、67.44%,两组比较经÷~2检验,P<0.05差别具有显著性意义。无专科医师指导组:采取有活瓣的带面罩的储雾罐吸入压力定量气雾剂常见错误依次为:储雾罐的口鼻罩仅叩住患儿的口,未罩住患儿的鼻占22%;用药前未振荡气雾剂占18%;压力定量气霉剂未朝上占15.6%;空气压泵霉化吸入溶液常见错误依次为:用空气压泵面罩仅叩住患儿的口未叩住患儿的鼻占16%;使用吸入激素,吸药后未洗脸漱口占12%;未定期清洁储雾罐占9%;准纳器常见错误依次为:将准纳器吸嘴放入口中,不知道用力吸气以保证吸入药物占14%;吸药后屏气时间未达10s以上,或口唇屏气但鼻腔呼气占11%。直接用压力定量气雾剂常见错误依次为:不能在深吸气的同时按下阀门占66%,用药前未振荡气雾剂占16%;吸入激素吸药后未漱口占12%。结论根据患者年龄正确选择吸入药物及装置;使用吸入药物前由哮喘专科医师正确指导,井定期随访纠正错误是保证吸入技术正确及疗效的关键。     

抚顺地区50例非急性发作期哮喘病人药学监护报告

目的：了解哮喘病人药学监护的现状。方法：调查研究50例初诊非急性发作期门诊哮喘病人治疗方案的组成和执行情况。结果：20％(10／50)病人治疗方案中有缓解药并首选雾化吸入剂；10％(5／50)有控制药。80％(40／50)用药依从性差：90％(45／50)不能区分控制药与缓解药。无1例病人记哮喘日记和根据峰流速(PEF)来评价疗效；5例吸入糖皮质激素中1例对不良反应有了解。结论：病人未得到足够的药学监护。因此，药学监护应成为哮喘综合治疗的重要环节。     

支气管哮喘住院患者的药学监护实践

目的:探讨哮喘患者的药学监护模式。方法:结合哮喘治疗研究进展,为哮喘住院患者制定个体化的药学监护计划并实施全程药学监护,介绍哮喘患者药学监护的主要内容。结果与结论:对哮喘患者实施药学监护,可及时发现患者的药物治疗问题,避免严重后果的出现,促进临床合理用药,提高哮喘控制率。     

Asthma: a provincial study

To identify factors contributing to increased mortality and morbidity we prospectively evaluated 200 consecutive adult (greater than 17 years) asthmatic presentations (105 patients) referred to Gisborne Hospital over a 28 month period between 1985 and 1987 using a modified protocol adapted from previous national studies. In the moderate asthmatic group (113 presentations, 56%), 6% failed to use beta agonists prior to admission and 43% were not on regular steroid inhaler therapy. No patient had a crisis plan although 45 (22.5%) had received oral steroid therapy before admission. Poor drug compliance was twice as common in the Maori. Fifty-eight percent of patients were on regular long term oral theophylline whereas 48 (43%) patients with moderate and severe asthma were not on corticosteroid inhalers. We conclude that patient education and more liberal use of steroid inhalers have the greatest potential for improving morbidity and mortality.     

妊娠期合并哮喘患者药学监护要点

目的 探索临床药师在病区对妊娠期合并哮喘患者实施药学监护的要点.方法 从文献分析中,得出妊娠期哮喘特点,通过临床实践及案例分析,总结出适合妊娠期合并哮喘患者的药学监护要点.结果 临床药师通过对妊娠期哮喘特点的学习,并对患者实施药学监护,可增加患者依从性,使哮喘得到有效控制,体现临床药师的专业价值.结论 对妊娠期合并哮喘患者实施药学监护是临床药师参与临床工作的重要内容,临床药师应掌握药学监护要点,有效开展工作.     

PHARMAC and Ventolin in New Zealand

Recently, PHARMAC undertook an unfortunate experiment on asthma sufferers when it fundamentally changed its funding support for reliever medications. Ventolin metered dose inhaler (MDI), the backbone of asthma relief for over 30 years, was dropped in favour of Salamol, a post-patent salbutamol in a device which, within the first few weeks of use, has been found to be ineffective by many patients, and thus potentially dangerous. PHARMAC has agreed to reconsider its decision, but how was this decision reached in the first place?     

Budesonide/formoterol maintenance and reliever therapy: a new treatment approach for adult patients with asthma

ABSTRACT

Background: An inhaled corticosteroid (ICS) or an ICS/long-acting β₂-agonist (LABA) combination plus short-acting β₂-agonist (SABA) as needed for symptom relief is recommended for persistent asthma. Additionally, budesonide/formoterol maintenance and reliever therapy (Symbicort SMART, AstraZeneca, Sweden) has been approved for adults in the European Union. This option is well tolerated and offers greater reductions in asthma exacerbations together with similar improvements in daily symptom control, at a lower overall steroid load, compared with fixed-dose ICS/LABA plus SABA.

Scope: Two large clinical trials investigated the use of budesonide/formoterol as maintenance and reliever compared with medium or high doses of an ICS/LABA combination as controller plus SABA as reliever in adults (aged ≥ 12 years). COMPASS was a 6-month, double blind, randomized trial while COSMOS was a 1?year, dose titration study which reflected routine clinical practice. The current review focuses on the findings in both studies, among adult patients only (aged ≥ 18 years).

Findings: Among adults, the studies confirmed a 21–39% reduction in severe exacerbations in patients treated with budesonide/formoterol maintenance and reliever therapy compared with titrated salmeterol/fluticasone plus SABA (COSMOS) or fixed higher budesonide/formoterol or salmeterol/fluticasone plus SABA (COMPASS), respectively. Similar levels of daily asthma control were achieved with budesonide/formoterol maintenance and reliever therapy at a significantly lower overall steroid load compared with salmeterol/fluticasone or budesonide/formoterol plus SABA. Budesonide/formoterol maintenance and reliever therapy was as well tolerated as combination therapies.

Conclusions: In adult patients, budesonide/formoterol maintenance and reliever therapy is a safe and simplified approach to asthma management, using a single inhaler, which reduces severe exacerbations and maintains similar daily asthma control at a lower drug load compared with the traditional strategy of ICS/LABA plus SABA.     

Budesonide/formoterol: a review of its use as maintenance and reliever inhalation therapy in asthma

The use of combination budesonide/formoterol dry powder inhaler (Symbicort Turbuhaler) for both daily maintenance therapy and as-needed relief of breakthrough symptoms using a single inhaler is a new approach to asthma management that is indicated in patients with persistent asthma not adequately controlled by conventional regimens using reliever therapy with a short-acting beta(2)-adrenoceptor agonist alone. The administration of additional corticosteroid with each reliever inhalation in response to symptoms is expected to provide improved control of airway inflammation.Budesonide/formoterol maintenance and reliever therapy reduced the risk of severe asthma exacerbations compared with conventional regimens using a short-acting beta(2)-adrenoceptor agonist alone as reliever therapy in the majority of trials, while providing similar or better daily asthma control than higher fixed maintenance doses of budesonide or inhaled corticosteroid/long-acting beta(2)-adrenoceptor agonist combination therapy in patients with generally moderate to severe, uncontrolled, persistent asthma. The strategy offers the convenience of a single inhaler and simplifies treatment by providing immediate additional anti-inflammatory medication in response to asthma symptoms and immediate step-down when symptoms abate. The improved efficacy, with respect to exacerbation prevention, observed with budesonide/formoterol maintenance and reliever therapy in all double-blind comparative trials was achieved with a lower mean daily dose of inhaled corticosteroid or with fewer daily inhalations of reliever medication. Budesonide/formoterol maintenance and reliever therapy was well tolerated with an incidence of adverse events similar to that with conventional regimens. Therefore, it offers a new approach to therapy in patients with uncontrolled, persistent asthma; providing improved efficacy with a lower overall drug load.     

Combination therapy in asthma--fixed or variable dosing in different patients?

The introduction of combination products, for the coadministration of an inhaled corticosteroid (ICS) with a long-acting beta2-agonist in a single inhaler, has greatly simplified asthma therapy. The two combination inhalers currently available, Symbicort (budesonide/formoterol in a single inhaler) and Seretide (salmeterol/fluticasone), comply with Step 3 of international guidelines that recommend the addition of a long-acting beta2-agonist to ICS in patients who are inadequately controlled on ICS alone. Importantly, combination inhalers ensure that patients cannot neglect their ICS maintenance therapy in favour of the long-acting beta2-agonist--which may improve adherence and overall asthma control. In vitro experiments suggest that ICS and long-acting beta2-agonists may interact beneficially when they are administered via one inhaler. The efficacy and tolerability of budesonide/formoterol and salmeterol/fluticasone have been demonstrated. There are currently two approaches for treating asthma using combination therapy--fixed and adjustable dosing. Fixed dosing with budesonide/formoterol or salmeterol/fluticasone provides effective asthma control in line with guideline goals. However, given the inherent variability of asthma, there is increasing evidence that adjusting the dose of ICS according to fluctuations in symptoms is beneficial. Findings from a series of studies comparing fixed and adjustable symptom-guided dosing regimens demonstrate that adjustable dosing may improve asthma control at an overall lower steroid dose. Ultimately, if adjustable dosing proves to be an effective treatment option, it may be possible to use budesonide/formoterol for both maintenance therapy and symptom relief, thereby overcoming the need for a separate reliever inhaler. This is because formoterol has a more rapid onset and greater dose-related effects than salmeterol in salmeterol/fluticasone. Given that all patients are different, with different disease severities and treatment preferences, both fixed and adjustable dosing strategies are likely to be important in the long-term management of asthma. It is possible that different treatment options will be used for different patients, depending on their disease severity, personality and ability to adhere to therapy.