基于传感器的电子监测哮喘：随机对照试验
2021/10/20
摘要
背景：尽管基于传感器的每日吸入糖皮质激素ICSs和短效β激动剂药物的监测可能会改善哮喘的结局，但这些干预措施对不同儿童人群的有效性尚不清楚。
方法：将照顾者和儿童一起随机分配接受吸入器传感器，允许护理人员和临床医生对药物进行电子监测。结局包括哮喘控制测试分数（≥19表示哮喘控制）和哮喘相关保健使用。同时评估照顾者的生活质量（QoL）和儿童ICS的依从性。采用多水平模型评估从基线时调整后的变化。
结果：分组为对照（n=127）组或干预（n=125）组。在结局，干预组的哮喘控制测试平均分数从19.1（SE=0.3）增加到21.8（SE=0.4），在对照组中由19.4（SE=0.3）增加到19.9(SE=0.4)(干预-控制的差值=2.2；SE=0.6；P＜0.01)。与对照组相比，在结局时，经调整的急诊就诊率和住院率在干预组中显著增加（急诊科发生率比值=2.2；SE=0.5；P＜0.01；医院发病率比值=3.4；SE=1.4；P＜0.01）。与对照组相比，在研究结束时干预组的照顾者生活质量评分Qol较高（干预-对照的差值=0.3；SE=0.2；P=0.01）。
结论：研究结果表明，基于传感器的吸入器监测与临床反馈可以改善不同人群的哮喘控制和照顾者QoL。相对于对照组，在干预组参与者中观察到较高的保健使用，表明需要进一步完善。
Sensor-Based Electronic Monitoring for Asthma: A Randomized Controlled Trial
Ruchi S Gupta, Jamie L Fierstein , Kathy L Boon, Madeleine K Kanaley, Alexandria Bozen, Kristin Kan, Deneen Vojta, Christopher M Warren
Abstract
Background: Although sensor-based monitoring of daily inhaled corticosteroids (ICSs) and short-acting β-agonist medications may improve asthma outcomes, the effectiveness of these interventions in diverse pediatric populations remains unclear.
Methods: Caregiver and child dyads were randomly assigned to receive inhaler sensors that allowed for caregiver and clinician electronic monitoring of medications. End points included Asthma Control Test scores (≥19 indicated asthma control) and asthma health care use. Caregiver quality of life (QoL) and child ICS adherence were also assessed. Multilevel models were used to estimate adjusted changes from baseline.
Results: Dyads were assigned to the control (n = 127) or intervention (n = 125) arms. At the end line, the mean Asthma Control Test score increased from 19.1 (SE = 0.3) to 21.8 (SE = 0.4) among the intervention and from 19.4 (SE = 0.3) to 19.9 (SE = 0.4) among the control (Δintervention-control = 2.2; SE = 0.6; P < .01). Adjusted rates of emergency department visits and hospitalizations among the intervention were significantly greater (incidence rate ratioemergency department = 2.2; SE = 0.5; P < .01; incidence rate ratiohospital = 3.4; SE = 1.4; P < .01) at endline than the control. Caregiver QoL was greater among the intervention at the endline (Δintervention-control = 0.3; SE = 0.2; P = .1) than the control.
Conclusions: Findings suggest that sensor-based inhaler monitoring with clinical feedback may improve asthma control and caregiver QoL within diverse populations. Higher health care use was observed among the intervention participants relative to the control, indicating further refinement is warranted.
背景：尽管基于传感器的每日吸入糖皮质激素ICSs和短效β激动剂药物的监测可能会改善哮喘的结局，但这些干预措施对不同儿童人群的有效性尚不清楚。
方法：将照顾者和儿童一起随机分配接受吸入器传感器，允许护理人员和临床医生对药物进行电子监测。结局包括哮喘控制测试分数（≥19表示哮喘控制）和哮喘相关保健使用。同时评估照顾者的生活质量（QoL）和儿童ICS的依从性。采用多水平模型评估从基线时调整后的变化。
结果：分组为对照（n=127）组或干预（n=125）组。在结局，干预组的哮喘控制测试平均分数从19.1（SE=0.3）增加到21.8（SE=0.4），在对照组中由19.4（SE=0.3）增加到19.9(SE=0.4)(干预-控制的差值=2.2；SE=0.6；P＜0.01)。与对照组相比，在结局时，经调整的急诊就诊率和住院率在干预组中显著增加（急诊科发生率比值=2.2；SE=0.5；P＜0.01；医院发病率比值=3.4；SE=1.4；P＜0.01）。与对照组相比，在研究结束时干预组的照顾者生活质量评分Qol较高（干预-对照的差值=0.3；SE=0.2；P=0.01）。
结论：研究结果表明，基于传感器的吸入器监测与临床反馈可以改善不同人群的哮喘控制和照顾者QoL。相对于对照组，在干预组参与者中观察到较高的保健使用，表明需要进一步完善。
(中日友好医院呼吸与危重症医学科 张清 摘译 林江涛 审校)
(Pediatrics. 2021 Jan;147(1):e20201330. doi: 10.1542/peds.2020-1330.)
(Pediatrics. 2021 Jan;147(1):e20201330. doi: 10.1542/peds.2020-1330.)
Sensor-Based Electronic Monitoring for Asthma: A Randomized Controlled Trial
Ruchi S Gupta, Jamie L Fierstein , Kathy L Boon, Madeleine K Kanaley, Alexandria Bozen, Kristin Kan, Deneen Vojta, Christopher M Warren
Abstract
Background: Although sensor-based monitoring of daily inhaled corticosteroids (ICSs) and short-acting β-agonist medications may improve asthma outcomes, the effectiveness of these interventions in diverse pediatric populations remains unclear.
Methods: Caregiver and child dyads were randomly assigned to receive inhaler sensors that allowed for caregiver and clinician electronic monitoring of medications. End points included Asthma Control Test scores (≥19 indicated asthma control) and asthma health care use. Caregiver quality of life (QoL) and child ICS adherence were also assessed. Multilevel models were used to estimate adjusted changes from baseline.
Results: Dyads were assigned to the control (n = 127) or intervention (n = 125) arms. At the end line, the mean Asthma Control Test score increased from 19.1 (SE = 0.3) to 21.8 (SE = 0.4) among the intervention and from 19.4 (SE = 0.3) to 19.9 (SE = 0.4) among the control (Δintervention-control = 2.2; SE = 0.6; P < .01). Adjusted rates of emergency department visits and hospitalizations among the intervention were significantly greater (incidence rate ratioemergency department = 2.2; SE = 0.5; P < .01; incidence rate ratiohospital = 3.4; SE = 1.4; P < .01) at endline than the control. Caregiver QoL was greater among the intervention at the endline (Δintervention-control = 0.3; SE = 0.2; P = .1) than the control.
Conclusions: Findings suggest that sensor-based inhaler monitoring with clinical feedback may improve asthma control and caregiver QoL within diverse populations. Higher health care use was observed among the intervention participants relative to the control, indicating further refinement is warranted.
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过敏性哮喘的预防与过敏原避免措施和暴露的作用
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确定持续性哮喘和COPD的最佳药物依从性
