英国哮喘患者吸入器更换为低排放装置的调查分析
基于英国「Life with a Lung Condition」2023年在线调查，分析9960名哮喘患者中谁被建议从压力定量吸入器换为干粉吸入器、谁拒绝更换及谁成功更换。结果显示，53.2%的pMDI使用者曾被建议更换，其中88.5%接受，接受者中64%更换成功。更换成功与哮喘控制较好相关，未成功更换与主客观哮喘控制不佳标志相关。
要点
- 多数使用pMDI的哮喘患者中，仅约一半曾被建议更换为低排放DPI。
- 接受更换者中64%成功，成功者哮喘控制更稳定。
- 对DPI疗效和安全性的担忧是部分患者拒绝或更换失败的原因之一。
核心结论
- 英国大型调查中，超过一半的pMDI使用者曾被建议更换为DPI。
- 多数尝试更换的患者能够成功，但未成功更换与哮喘控制不佳的主客观指标相关。
- 在病情稳定患者的常规随访中整合更换建议更具可行性。
研究设计与样本
- 基于Asthma+Lung UK「Life with a Lung Condition」2023年在线调查的横断面分析。
- 共纳入9960名哮喘应答者，女性占77.9%，平均年龄59.9±13.0岁。
- 分析人口学、经济和临床因素，比较被建议与未被建议更换、接受与拒绝及成功与未成功更换者的特征。
主要发现
- 9960名哮喘应答者中，7059人（87.7%）为pMDI使用者。
- 在pMDI使用者中，3753人（53.2%）曾被建议从pMDI更换为DPI。
- 被建议更换者更了解低排放吸入器选择（72% vs 53.2%，p<0.001）。
- 被建议更换者未控制哮喘比例更高（61% vs 54.1%，p<0.001）。
- 被建议更换者过去一年内接受非计划医疗的比例更高（27.4% vs 21.2%，p<0.001）。
关键数值与推荐
- 7059名pMDI使用者中，3753人（53.2%）曾被建议从pMDI换为DPI。
- 被建议更换者中，432人（11.5%）拒绝更换，3321人（88.5%）接受更换。
- 接受更换者中，2126人（64%）成功更换为DPI。
- 被建议更换者较低排放吸入器知晓率为72%，未建议组为53.2%，p<0.001。
- 被建议更换者未控制哮喘比例为61%，未建议组为54.1%，p<0.001。
临床怎么用
- 对病情稳定的哮喘患者，可在常规随访中主动提出pMDI更换为DPI的建议。
- 更换前应重点评估哮喘控制状态，并回应患者对DPI疗效和安全性的顾虑。
- 对哮喘控制不佳者，应优先优化控制后再考虑吸入器装置更换。
局限性
- 调查为在线自愿应答，存在选择偏倚，结果外推需谨慎。
- 所有数据来自患者自我报告，缺乏客观肺功能或处方记录验证。
- 更换成功的定义来源于患者报告，未提供标准化确认标准。
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
Background The healthcare community recognises the need for lower emission inhaler options; however, in the UK, most inhalers prescribed are pressurised metered dose inhalers (pMDIs) despite dry powder inhalers (DPIs) having a markedly lower carbon footprint as they do not contain propellants. For this reason, UK clinicians have been encouraged to offer switches from pMDIs to DPIs where feasible. Methods Using data from the Asthma+Lung UK’s ‘Life with a Lung Condition’ 2023 online survey, demographic, economic and clinical factors were analysed to determine who had and had not been offered a switch; whose switch had been successful and why some respondents chose not to switch. Results 9960 people with asthma responded (77.9% female; age 59.9±13.0) and 7059 (87.7%) were pMDI users. The 3753 (53.2%) who were offered a pMDI to DPI switch had a greater awareness of lower-emission inhaler options (72% vs 53.2%*), uncontrolled asthma (61% vs 54.1%*), and had required unscheduled healthcare (27.4% vs 21.2%*) or >2 courses oral corticosteroids (27.6% vs 21.6%*) in the last year (all *p<0.001). 432 (11.5%) opted not to change inhaler when offered. 3321 (88.5%) accepted the switch and it was successful in 2126 (64%). Discussion In a large UK survey of people with asthma, over half of those on pMDIs had been offered a switch. It was successful in most who attempted it but unsuccessful switches were associated with subjective and objective markers of poor disease control. Some patients decline the switch because they like their pMDI, but some have ongoing concerns about the efficacy and safety of a DPI and is most feasible when integrated into routine reviews for patients with stable disease, alongside ongoing efforts to optimise asthma outcomes.
引用
- BMJ Open Respiratory Research：Sustainable asthma inhalers: who is offered the option to change, who declines and who successfully switches?
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。