Рецепт. 2021; 24: 498-514
Приверженность лечению пациентов с бронхиальной астмой
https://doi.org/10.34883/PI.2021.24.4.007Аннотация
Бронхиальная астма – самое распространенное хроническое заболевание органов дыхания, им болеет более 358 млн человек в мире. Целью лечения пациентов с бронхиальной астмой, согласно Глобальной инициативе по астме (GINA 2021), является достижение и поддержание оптимального контроля заболевания. Одна из причин отсутствия контроля астмы – низкая приверженность лечению. По рекомендациям GINA перед постановкой диагноза и коррекцией фармакотерапии неконтролируемой астмы необходимо оценить приверженность пациентов лечению. В представленном исследовании оценена приверженность 315 пациентов с бронхиальной астмой базисной ингаляционной терапии с помощью Test of Adherence to Inhalers (Тест на приверженность к использованию ингаляторов), определены клинические формы неприверженности. 33,97% из исследуемых пациентов не выполняли врачебные назначения, касающиеся применения ингаляционных препаратов базисной терапии. Отсутствие приверженности лечению выше у длительно болеющих бронхиальной астмой (стаж болезни ≥15 лет – 39,76%), пациентов с аллергической формой – 43,48% и легкой степенью тяжести астмы – 53,38%. Приверженность базисному ингаляционному лечению в значительной степени зависит от лекарственных препаратов, которые назначают пациенту: применение фиксированной комбинации ингаляционного беклометазона дипропионата с формотеролом фуроатом (Фостер) в режиме единого ингалятора уменьшило количество пациентов с отсутствием приверженности до 11,11%. У большинства пациентов снижен неумышленный (непреднамеренный) компонент приверженности. Авторами предложена примерная схема ведения пациента с бронхиальной астмой для обеспечения максимально возможного уровня приверженности лечению.
Список литературы
1. (2017) Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet, vol. 390, no 10100, pp. 1211–1259.
2. Global Initiative for Asthma. GINA 2021 (electronic resource). Available at: https://ginasthma.org/wp-content/uploads/2021/05/GINA-Main-Report-2021-V2-WMS.pdf (accessed 20.07.2021).
3. Bateman E. (2004) Can guideline defined asthma control be achieved? The Gaining Optimal Asthma Control study. Am. J. Resp. Crit. Care Med., vol. 170, pp. 836–844.
4. Anohina T., Belevskij A. (2016) Trudnaya dlya kontrolya bronhial’naya astma: vsegda li eto tyazhelaya forma zabolevaniya? [Hard-to-control bronchial asthma: is it always a severe form of disease?]. Astma i allergiya, 2, pp. 31–36.
5. Arhipov V., Grigorieva E., Gavrishina E. (2011) Kontrol’ nad bronhial’noj astmoj v Rossii: rezul’taty mnogocentrovogo nablyudatel’nogo issledovaniya NIKA [Control over bronchial asthma in Russia: results of a multicenter observational study NIKA]. Pul’monologiya, 6, pp. 87–93.
6. Ruzanov D. (2015) Vozmozhnosti dostizheniya kontrolya nad bronhial’noj astmoj: rezul’taty respublikanskogo mnogocentrovogo issledovaniya RAPIRA [Options of achieving control over bronchial asthma: results of republican multicenter study RAPIRA]. Zdravoohranenie, 9, pp. 32–37.
7. Costa E. (2015) Interventional tools to improve medication adherence: review of literature. Patient Prefer Adherence, 9, pp. 1303–1314.
8. World Health Organization (2003) Adherence to long-term therapies, evidence for action (electronic resource). Available at: http://www.who.int2 (accessed 20.07.2021).
9. Feshchenko YU., YAshina L. (2007) Dostizhenie kontrolya sovremennaya strategiya vedeniya bronhial’noj astmy [Achieving control – modern strategy of management of bronchial asthma]. Astma ta alergiya, 1–2, pp. 5–9.
10. Ernst E. (1998) Complementary therapies in asthma: what patients use. J. Asthma, vol. 35, pp. 667–671.
11. Bender B. (2002) Overcoming barriers to nonadherence in asthma treatment. J. Allergy Clin. Immunol., 109, pp. 554–559.
12. Global Strategy for Asthma. Management and Prevention. Revised 2021 (electronic resource). Available at: http://www.ginasthma.org (accessed 21.07.2021)
13. Bender B., Milgrom H., Rand C. (1997) Nonadherence in asthmatic patients: is there a solution to the problem? Ann. Allergy Asthma Immunol., vol. 79, pp. 177–185.
14. Breekveldt-Postma N.S. (2004) Persistence with inhaled corticosteroid therapy in daily practice. Respiratory Medicine, 98, pp. 752–759.
15. Krishnan J.A. (2004) Mortality in Patients Hospitalized for Asthma Exacerbations in the United States. Am. J. Respir. Crit. Care Med., vol. 170, pp. 1281–1285.
16. Williams L.K. (2004) Relationship between adherence to inhaled corticosteroids and poor outcomes among adults with asthma. J. Allergy Clin. Immunol., vol. 114, pp. 1288–93.
17. Ohm R., Aaronson L. (2006) Symptom perception and adherence to asthma controller medications. J. Nurs. Scholarsh., vol. 38, pp. 292–297.
18. Baiardini I. (2006) Adherence to Treatment: Assessment of an Unmet Need in Asthma. J. Investig. Allergol. Clin. Immunol., vol. 16, pp. 218–223.
19. Morisky D., Green L., Levine D. (1986) Concurrent and predictive validity of a self-reported measure of medication adherence. Med. Care, vol. 24, pp. 67–74.
20. Plaza V., López-Vina Antolín, Cosio B.G. (2017) Test of Adherence to Inhalers. Arch Broncopneumol., 53 (7), pp. 360–361.
21. Plaza V. (2016) Validation of the ‘Test of the Adherence to Inhalers’ (TAI) for Asthma and COPD Patients. J. Aerosol Med. Pulm. Drug Deliv., vol. 29, 2, pp. 142–152.
22. Wang G. (2017) Corticosteroid plus β2-agonist in a single inhaler as reliever therapy in intermittent and mild asthma: a proof-of-concept systematic review and meta-analysis. J. Respir. Res., vol. 18, 1, p. 203.
23. Papi A. (2007) BEST Study Group. Rescue use of beclomethasone and albuterol in a single inhaler for mild asthma. N. Engl. J. Med., vol. 356, 20, pp. 2040–2052.
Recipe. 2021; 24: 498-514
Adherence to the Treatment in Bronchial Asthma Patients
https://doi.org/10.34883/PI.2021.24.4.007Abstract
Bronchial asthma is the most common chronic respiratory disease, affecting more than 358 million people in the world. The goal of treating patients with bronchial asthma, according to the Global Asthma Initiative (GINA 2021), is to achieve and maintain optimal control of the disease. One of the reasons for the lack of asthma control is low adherence to treatment. According to the GINA recommendations, patients’ adherence to treatment should be assessed before diagnostics and correction of pharmacotherapy for uncontrolled asthma. In the presented study, the adherence of 315 bronchial asthma patients to basic inhalation therapy was assessed using the Test of Adherence to Inhalers, and clinical forms of non-adherence were identified. 33.97% of the studied patients did not comply with medical prescriptions regarding the use of inhaled drugs for basic therapy. Lack of adherence to treatment is higher in patients with long-term bronchial asthma (disease experience
≥15 years – 39.76%), patients with an allergic form – 43.48%, and in mild asthma – 53.38%. Adherence to basic inhalation therapy largely depends on the drugs that are prescribed to the patient: the use of a fixed combination of inhaled beclomethasone dipropionate with formoterol furoate (Foster) in a“single inhaler” mode reduced the number of non-adherent patients to 11.11%. In most patients, the unintentional component of adherence is reduced. The authors proposed an approximate scheme for managing a patient with bronchial asthma to ensure the highest possible level of adherence to treatment.
References
1. (2017) Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet, vol. 390, no 10100, pp. 1211–1259.
2. Global Initiative for Asthma. GINA 2021 (electronic resource). Available at: https://ginasthma.org/wp-content/uploads/2021/05/GINA-Main-Report-2021-V2-WMS.pdf (accessed 20.07.2021).
3. Bateman E. (2004) Can guideline defined asthma control be achieved? The Gaining Optimal Asthma Control study. Am. J. Resp. Crit. Care Med., vol. 170, pp. 836–844.
4. Anohina T., Belevskij A. (2016) Trudnaya dlya kontrolya bronhial’naya astma: vsegda li eto tyazhelaya forma zabolevaniya? [Hard-to-control bronchial asthma: is it always a severe form of disease?]. Astma i allergiya, 2, pp. 31–36.
5. Arhipov V., Grigorieva E., Gavrishina E. (2011) Kontrol’ nad bronhial’noj astmoj v Rossii: rezul’taty mnogocentrovogo nablyudatel’nogo issledovaniya NIKA [Control over bronchial asthma in Russia: results of a multicenter observational study NIKA]. Pul’monologiya, 6, pp. 87–93.
6. Ruzanov D. (2015) Vozmozhnosti dostizheniya kontrolya nad bronhial’noj astmoj: rezul’taty respublikanskogo mnogocentrovogo issledovaniya RAPIRA [Options of achieving control over bronchial asthma: results of republican multicenter study RAPIRA]. Zdravoohranenie, 9, pp. 32–37.
7. Costa E. (2015) Interventional tools to improve medication adherence: review of literature. Patient Prefer Adherence, 9, pp. 1303–1314.
8. World Health Organization (2003) Adherence to long-term therapies, evidence for action (electronic resource). Available at: http://www.who.int2 (accessed 20.07.2021).
9. Feshchenko YU., YAshina L. (2007) Dostizhenie kontrolya sovremennaya strategiya vedeniya bronhial’noj astmy [Achieving control – modern strategy of management of bronchial asthma]. Astma ta alergiya, 1–2, pp. 5–9.
10. Ernst E. (1998) Complementary therapies in asthma: what patients use. J. Asthma, vol. 35, pp. 667–671.
11. Bender B. (2002) Overcoming barriers to nonadherence in asthma treatment. J. Allergy Clin. Immunol., 109, pp. 554–559.
12. Global Strategy for Asthma. Management and Prevention. Revised 2021 (electronic resource). Available at: http://www.ginasthma.org (accessed 21.07.2021)
13. Bender B., Milgrom H., Rand C. (1997) Nonadherence in asthmatic patients: is there a solution to the problem? Ann. Allergy Asthma Immunol., vol. 79, pp. 177–185.
14. Breekveldt-Postma N.S. (2004) Persistence with inhaled corticosteroid therapy in daily practice. Respiratory Medicine, 98, pp. 752–759.
15. Krishnan J.A. (2004) Mortality in Patients Hospitalized for Asthma Exacerbations in the United States. Am. J. Respir. Crit. Care Med., vol. 170, pp. 1281–1285.
16. Williams L.K. (2004) Relationship between adherence to inhaled corticosteroids and poor outcomes among adults with asthma. J. Allergy Clin. Immunol., vol. 114, pp. 1288–93.
17. Ohm R., Aaronson L. (2006) Symptom perception and adherence to asthma controller medications. J. Nurs. Scholarsh., vol. 38, pp. 292–297.
18. Baiardini I. (2006) Adherence to Treatment: Assessment of an Unmet Need in Asthma. J. Investig. Allergol. Clin. Immunol., vol. 16, pp. 218–223.
19. Morisky D., Green L., Levine D. (1986) Concurrent and predictive validity of a self-reported measure of medication adherence. Med. Care, vol. 24, pp. 67–74.
20. Plaza V., López-Vina Antolín, Cosio B.G. (2017) Test of Adherence to Inhalers. Arch Broncopneumol., 53 (7), pp. 360–361.
21. Plaza V. (2016) Validation of the ‘Test of the Adherence to Inhalers’ (TAI) for Asthma and COPD Patients. J. Aerosol Med. Pulm. Drug Deliv., vol. 29, 2, pp. 142–152.
22. Wang G. (2017) Corticosteroid plus β2-agonist in a single inhaler as reliever therapy in intermittent and mild asthma: a proof-of-concept systematic review and meta-analysis. J. Respir. Res., vol. 18, 1, p. 203.
23. Papi A. (2007) BEST Study Group. Rescue use of beclomethasone and albuterol in a single inhaler for mild asthma. N. Engl. J. Med., vol. 356, 20, pp. 2040–2052.
