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目的分析支气管哮喘患者未用吸入型糖皮质激素(ICS)的原因并探讨对策。方法随访2005年1月—2006年1月复旦大学附属华山医院和市东医院诊治的785例支气管哮喘患者,详细询问并记录患者使用ICS的情况及未用原因,并进行健康教育。结果支气管哮喘患者ICS使用率仅为19.1%。支气管哮喘患者未继续使用ICS的主要原因有担心糖皮质激素不良反应(438例,69.0%)、感觉起效不快或效果不显著(324例,51.0%)以及虽使用有效但自认为支气管哮喘已控制或痊愈而停药(87例,13.7%)、费用较高难以承受经济负担(86例,13.5%)。就诊于三级医院及呼吸科专家门诊患者的ICS使用率分别为20.7%和33.3%,明显高于就诊于二级医院及普通门诊患者的11.6%和14.1%(P值均<0.05)。结论应通过进一步提高患者对支气管哮喘和ICS抗炎作用的认知、提供方便且有效的ICS使用方案、降低药物价格等措施,提高患者使用ICS的依从性。
Objective To analyze the causes of uncontaminated inhaled glucocorticoid (ICS) in patients with bronchial asthma and to explore countermeasures. METHODS: Follow-up A total of 785 patients with bronchial asthma diagnosed and treated by Huashan Hospital and Shi Dong Hospital affiliated to Fudan University from January 2005 to January 2006 were asked and recorded in detail about the use of ICS and reasons for unused patients and health education. Results The incidence of ICS in bronchial asthma patients was only 19.1%. The main reasons for the discontinuation of ICS in patients with bronchial asthma are concerns about glucocorticoid adverse reactions (438 patients, 69.0%), unpleasant sensations or insignificant effects (324 patients, 51.0%), and those who are considered effective but who have had bronchial asthma Control or cure (87 cases, 13.7%), the higher the cost is difficult to bear the financial burden (86 cases, 13.5%). The ICS utilization rate of patients attending tertiary hospitals and respiratory specialist clinics was 20.7% and 33.3% respectively, significantly higher than 11.6% and 14.1% of those attending secondary hospitals and general out-patients (P <0.05). Conclusion The measures to improve ICS compliance in patients with ICS should be further improved by further improving patients’ cognition of anti-inflammatory effects of bronchial asthma and ICS, providing convenient and effective ICS regimens and reducing drug prices.