| Objective: To investigate the compliance and influencing factors of inhaled corticosteroids in patients with bronchial asthma,and to study the correlation between compliance and control level,so as to provide theoretical basis for effective prevention and control of bronchial asthma.Methods: Patients with bronchial asthma visiting our hospital from December 2018 to December 2020 were selected,and 240 patients with bronchial asthma who met the bronchial asthma prevention and treatment guidelines formulated by Asthmology,Respiratory Society of Chinese Medical Association in 2016 were included in the study.After obtaining informed consent and signing the informed consent,the questionnaires were filled,history and symptoms were collected,lung function results and medication use situation were recorded.The questionnaire included general information questionnaire,asthma knowledge questionnaire,inhaled corticosteroids adherence scale and asthma control test(ACT Scale).The inhaling skills of patients were observed.The adherence and control levels at the time of inclusion were evaluated,univariate analysis and multivariate analysis were used to analyze the relationship between patient compliance and control levels.Intervention measures such as medication guidance and follow-up management were implemented for patients with poor compliance,and the changes of compliance and control were compared before and after intervention.Results:1.Overall analysis of compliance and control before intervention.The adherence of patients on admission was assessed,and the control intervention program was implemented,and the compliance changes before and after intervention were compared.The results showed that,220 patients completed the study,of which the mean adherence scores at inclusion was(36.40 ± 10.50),which was in the middle level.Among them,69 patients(31.4%)were completely compliant,91 patients(41.4%)were partially compliant,and 60 patients(27.3%)were completely noncompliant.Among these 220 patients with asthma,69(31.4%)were fully controlled at admission,90(40.9%)were partially controlled,and 61(27.7%)were poorly control.Correlation analysis was conducted by using scores of compliance and control level of bronchial asthma patients before intervention,and positive correlation was found between them(r = 0.710,P < 0.01),and control level changed with adherence.2.Influencing factors of adherence to ICS therapy.The factors that were correlated with compliance were education level(r =0.302,P < 0.001),income level(r = 0.230,P = 0.001),disease duration(r =0.193,P = 0.004),lung function injury(r =-0.165,P = 0.015),regular follow-up(r = 0.139,P = 0.039),common knowledge of asthma(r = 0.158,P =0.019),withdrawal of medication after symptom relief(r =-0.133,P = 0.048),trust of medical staff(r = 0.251,P = 0.001),doctor-patient relationship(r =0.203,P = 0.003),psychological state(r =-0.489,P < 0.001),the other options had no statistical significance for compliance(P > 0.05).3.Analysis of other factors influencing bronchial asthma control level.Correlation analysis showed that asthma control level was positively correlated with education level,income level and asthma course.In addition,good doctor-patient relationship and high trust in medical staff were also correlated with good asthma control,while lung function impairment and positive allergen test were negatively correlated with patient control.There was also a strong negative correlation between the presence of psychological diseases(anxiety and depression)and the level of asthma control(r =-0.299,P< 0.001),suggesting that improving the psychological state of patients can help patients achieve a better level of asthma control.Other options were not correlated with asthma control level,and there was no statistical significance(P > 0.05).4.Partial correlation analysis of other factors influencing bronchial asthma control level.With controlling of compliance,partial correlation analysis showed that only long-term alcohol consumption had a weak positive correlation with asthma control level independent of compliance(r = 0.180,P = 0.007).In particular,no correlation independent of adherence between control level and factors associated with asthma control levels in previous analysis which include education level,income level,course of the disease,pulmonary function injury,a positive determination of allergens,regular follow-up,understanding of the common sense of asthma symptoms,alleviate after drug withdrawal,trust to the medical personnel,the doctor-patient relationship,psychological state.It is suggested that the influence of these factors on the level of asthma control might be achieved by influencing the treatment compliance of patients.This further confirms the importance of the effect of inhaled corticosteroids treatment adherence on asthma control levels.5.Comparative analysis of patient compliance before and after intervention151 asthma patients who did not completely comply with inhalation therapy were treated with health education,medication guidance,follow-up management and other interventions,and followed up 3 months later.The mean MARS-A score of the 150 patients before intervention was(31.2 ± 8.6),which was at a low level.After intervention,the mean MARS-A score reached(42.9 ± 5.8),which was at a good level.The MARS-A compliance increased(11.7 ± 0.61)points after intervention,which was statistically significant(P < 0.01).The overall adherence of patients increases after intervention,which indicate that the intervention measures are effective.6.Comparative analysis of control level of patients before and after intervention151 patients enrolled in the phase II study with incomplete compliance were analyzed.Before intervention,22 patients(14.6%)were fully controlled,68 patients(45.0%)with partial control,and 61 patients(40.4%)with poor control.After intervention,67 patients(44.4%)were fully controlled,74patients(49.0)were partially controlled,and 10 patients(6.6%)were not controlled.The percentage of patients with full control increased significantly(P < 0.01).In terms of quantitative analysis,the ACT score of the 151 patients before intervention was(15.6 ± 5.7),and the ACT score after intervention was(20.6 ± 2.2).The paired T-test showed significant difference between the two groups(P < 0.01),indicating that the intervention can significantly improve the adherence of asthma patients,but also significantly improve the control level of asthma.Conclusion:1.The compliance and control of glucocorticoid treatment in patients at admission were not very good,and there was a strong positive correlation between them.2.Asthma control level were correlated with cultural level,income level,length of the course of the disease,pulmonary function injury,a positive determination of allergens,regular follow-up,understanding of the common sense of asthma symptoms,alleviate after drug withdrawal,trust of doctor,the doctor-patient relationship and psychological state of patients.But in partial correlation analysis with the variable control adherence,none of the above factors showed a correlation with the level of control independent of compliance.3.By means including health education,medication guiding,and follow-up management,patients inhaled treatment adherence and control level could be improved significantly.It is indicated that asthma control level could be improved and a better asthma management could be achieved by these means. |
PDF Full Text Request