中醫整合型健康照護計畫對氣喘患童與主要照顧者的影響:前瞻性觀察型研究

Impact of an Integrative Healthcare Quality Improvement Program for Asthmatic Children and Primary Care-Givers: A Hospital-Based Observational Preliminary Report

氣喘在台灣是常見的過敏性疾病之一，盛行率逐年增加。為了提供氣喘患童更全面性的治療來加強氣喘控制，本院自2006年施行健保給付小兒氣喘中醫整合型健康照護計畫，此計畫實施已久但仍缺乏實際臨床客觀的療效評估，本研究目的在評估此計畫之療效成果，對患童氣喘的控制程度、患童與主要照顧者的生活品質是否有幫助。本研究為前瞻性觀察型研究，於2013年2月～2013年12月收入43位年紀4-11歲氣喘患童接受此健康照護計畫，進入計畫後共接受治療療程三個月。介入前、進入療程後第1,2,3個月後使用兒童氣喘控制測驗(C-ACT)評估患童哮喘控制程度，另外使用簡式小兒氣喘生活品質量表(ITG-CASF)與主要照顧者生活品質量表(PACQLQ)評估生活品質改善程度。最後共有33位患童完成治療療程，接受治療各個月的平均C-ACT分數與治療前相比較均有顯著增加(p<0.05)、且治療第1,2個月平均C-ACT分數與前月份相比較亦有顯著增加(p<0.05)。患童生活品質在活動受限與白天症狀部分較治療前顯著改善(P<0.05)。主要照顧者生活品質在活動與情緒部分較治療前必較亦有顯著改善(P<0.05)。中醫整合型健康照護計畫可助患童的氣喘控制與改善患童與主要照顧者生活品質。未來將進行更大規模並有隨機對照組之前瞻性臨床療效試驗。

Asthma has been a common allergic disorder with increasing prevalence and morbidity in Taiwan. To provide a comprehensive management integrating Traditional Chinese Medicine, we initiated a government-sponsored Integrative Healthcare Quality Improvement Program (IHQIP) for children with asthma in 2006. However, the clinical objective evaluation for the impact of IHQIP on asthmatic children is still lacking. The aim of this study was to investigate the impact of this program on asthma control and quality of life among asthmatic children and their care-givers. Forty-three children aged 4-11 years, who were diagnosed with asthma and had acute asthma exacerbation over the past 6 months were enrolled since February 2013 to December 2013. The study subjects received the IHQIP for 3 months. The Childhood Asthma Control Test (C-ACT) was used to evaluate the asthma control before treatment and monthly for 3 months. Two questionnaires, the Integrated Therapeutics Group Child Asthma Short Form (ITG-CASF) and the Pediatric Asthma Caregiver’s Quality of Life Questionnaire (PACQLQ) were used to assess the quality of life of patients and caregivers before and after treatment. Overall, 33 children completed the study. The mean score of C-ACT had significantly increased on each month (P<0.05) and significantly increased in 1 and 2 month compared to previous month (P<0.05). Asthmatic children had significant improvement in functional limitation (P<0.05) and daytime symptoms (P<0.05) in ITG-CASF. Primary caregivers had significant improvement in activity (P<0.005) and emotion (P<0.005) in PACQLQ. None of the patients complained of severe adverse effects. Integration with Traditional Chinese Medicine ameliorated symptoms of childhood asthma and improved quality of life in asthmatic children and caregivers. Further randomized controlled clinical trial is warranted.