Background: Poor adherence with inhaled corticosteroid (ICS) medication is common in the pediatric population and can result in poor asthma control with increased frequency of asthma-related complications. The purpose of this study was to determine whether or not the initiation of ICS administration twice per day at school/daycare in patients with poor medication adherence at home improves asthma health care outcomes. Methods: We retrospectively selected patients followed by our Pediatric Pulmonology Clinic who had poorly controlled asthma and had been assigned to receive ICS twice daily at school/daycare due to poor adherence with ICS therapy. We analyzed the number of short courses of oral corticosteroids, hospital admissions, emergency department visits, and intramuscular methylprednisolone administrations for asthma exacerbations for the year before and after the intervention. The Wilcoxon signed rank test with continuity correction was used in the primary analysis. Results: Forty-nine patients who met the inclusion criteria were identified, but only 40 actually started the intervention. The number of oral corticosteroid courses per year decreased from 1.35 ± 1.1 before the intervention to 0.68 ± 1.2 (P = 0.008) postintervention, hospital admissions per year decreased from 0.45 ± 0.7 to 0.10 ± 0.3 (P = 0.006), emergency department visits per year decreased from 0.55 ± 0.8 to 0.28 ± 0.6 (P = 0.084), and intramuscular repository methylprednisolone injections per year for asthma exacerbations decreased from 0.20 ± 0.4 to 0.10 ± 0.3 (P = 0.23). Conclusion: These results indicate that school/daycare administration of ICS may be an effective option to improve indicators of asthma exacerbations in children with poor adherence to ICS at home.

中文翻译：

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在学校或托儿所使用的吸入性糖皮质激素对哮喘的直接观察疗法。

背景：吸入式糖皮质激素（ICS）药物依从性差在儿科人群中很常见，可能导致哮喘控制不佳，并增加与哮喘相关的并发症的发生率。这项研究的目的是确定在家中药物依从性差的患者在学校/日托机构中每天两次开始ICS给药是否可以改善哮喘的医疗保健结果。方法：我们回顾性选择了哮喘控制不佳且由于对ICS治疗依从性差而每天两次在学校/托儿所接受ICS的儿科肺科门诊患者。我们分析了口服糖皮质激素短期课程的数量，住院情况，急诊就诊，干预前后的一年中，使用肌肉注射甲基强的松龙和肌肉注射甲基强的松龙。在初步分析中使用了具有连续性校正的Wilcoxon符号秩检验。结果：确定了符合入选标准的49名患者，但实际上只有40名患者开始了干预。每年口服糖皮质激素疗程的数量从干预前的1.35±1.1减少到干预后的0.68±1.2（P = 0.008），每年的住院人数从0.45±0.7降低到0.10±0.3（P = 0.006），急诊就诊次数年从0.55±0.8降至0.28±0.6（P = 0.084），每年因哮喘加重而进行的肌肉内甲基泼尼松龙注射量从0.20±0.4降低至0.10±0.3（P = 0.23）。结论：