儿童青少年中重度哮喘远程医疗管理的循证临床推荐
该研究系统综述了远程医疗与创新技术用于儿童、青少年及年轻成人中重度哮喘的证据，共纳入55项研究（38项随机对照试验、17项观察性研究），采用GRADE评估质量并通过多学科小组共识形成推荐。数字健康工具总体可行、接受度高，常与生活质量、症状控制、治疗依从性改善及急性发作和住院减少相关，但肺功能影响不一致，证据质量有限。
要点
- 数字健康工具在中重度儿童哮喘中总体可行且接受度高。
- 远程医疗常与生活质量、症状控制、依从性改善及发作住院减少相关。
- 肺功能影响不一致，证据质量受方法学异质性限制。
核心结论
- 远程医疗可能改善中重度儿童哮喘的依从性并赋能自我管理。
研究设计与样本
- 系统综述与GRADE评估，共纳入55项研究（38项随机对照试验、17项观察性研究）。
主要发现
- 数字健康工具如智能手机应用、在线平台和远程监测设备总体可行且接受度高。
- 常与生活质量、症状控制、治疗依从性改善及急性发作和住院减少相关。
- 对肺功能的影响不一致。
- 部分研究中增加的医疗接触被专家解读为更早识别急性发作而非临床恶化。
关键数值与推荐
- 严重哮喘约占儿科患者的10%，该亚组承受不成比例的临床和经济负担。
- 通过数字平台的教育干预受到专家组高度评价，但支持证据质量低。
- 证据质量受方法学弱点、结局定义不一和远程医疗工具异质性限制，无法进行荟萃分析。
临床怎么用
- 可考虑将远程医疗用于中重度儿童哮喘的远程监测、依从性评估和患者教育。
- 需关注数字接入不平等、提供者培训不足、互操作性差和隐私问题等障碍。
- 实施需考虑成本、设备可及性、提供者工作负荷及社区照护网络支持。
局限性
- 研究设计、人群和干预异质性大，证据质量有限，无法进行荟萃分析。
- 支持教育干预的证据质量低。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Ital J Pediatr. 2026 Apr 27;52(1):105. doi: 10.1186/s13052-026-02219-4. ABSTRACT BACKGROUND: Asthma is among the most common chronic childhood diseases, with inadequate control leading to substantial morbidity, impaired quality of life, and high healthcare costs. Although severe asthma affects only around 10% of pediatric patients, this subgroup bears a disproportionate share of the clinical and economic burden. Long-term disease control relies on regular monitoring and education, yet traditional follow-up in specialist outpatient clinics may not be sufficient. Advances in telemedicine and digital health offer new opportunities for remote monitoring, treatment adherence assessment, and patient education, but evidence for their use in moderate-to-severe pediatric asthma remains fragmented. METHODS: We systematically reviewed evidence on telemedicine and innovative technologies for moderate-to-severe asthma in children, adolescents, and young adults. Using GRADE, we assessed study quality and synthesized findings. A multidisciplinary panel applied a structured consensus process to develop tailored recommendations, considering evidence strength, feasibility, equity, resources, and patient preferences. RESULTS: Of the 27,551 records retrieved, 55 studies met the inclusion criteria (38 randomized controlled trials, 17 observational). Despite substantial heterogeneity in design, populations, and interventions, digital health tools—such as smartphone applications, online platforms, and remote monitoring devices—were generally feasible, well accepted, and often linked to improved quality of life, symptom control, treatment adherence, and reduced exacerbations and hospitalizations. Effects on pulmonary function were inconsistent. Increased healthcare contacts reported in some studies were interpreted by experts as earlier exacerbation recognition rather than clinical deterioration. Educational interventions via digital platforms were strongly valued by the panel, despite low-quality supporting evidence. Overall, evidence quality was limited by methodological weaknesses, varying outcome definitions, and heterogeneity in telemedicine tools, precluding meta-analysis. Sustainability challenges included costs, device access, provider workload, and the need for robust community-based care networks. Key barriers were unequal digital access, limited provider training, poor interoperability, and privacy concerns. CONCLUSION: Telemedicine may enhance adherence, empower self-
引用
- 指南共识 · 哮喘：Evidence-based clinical recommendations on the use of telemedicine for the management of children, adolescents and young adults with moderate-severe asthma
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。