Zusammenfassung
Das Asthma bronchiale ist eine chronische Erkrankung, die ab dem Schwergrad 2 eine
Dauertherapie erfordert. Entscheidend für einen guten Therapieerfolg ist neben der
richtigen Medikamentenauswahl und der leitliniengerechten Therapie die korrekte Patientenmitarbeit,
die im Mittel allerdings nur ca. 50 % beträgt. Typischer Weise ist die Mitarbeit der
Patienten mit Asthma bronchiale bei der Bedarfsmediation (reliever) besser als bei
der Dauertherapie (controller). Eine schlechte Mitarbeit ist meist mit einer Untertherapie
und in der Folge mit einer schlechten Behandlung assoziiert. Höheres Patientenalter,
Frauen, höherer Ausbildungsstandard und sozio-öknomischer Status, Krankheitsverständnis
und Kenntnisse über das Asthma sowie die Therapieprinzipien, geringere Medikamentenmenge
(inkl. inhalativer Kombinationspräparate) und ein gutes Patienten-Arzt-Verhältnis
sind die wichtigsten die Patientenmitarbeit positiv beeinflussenden Faktoren. Es gibt
keinen goldenen Standard zur sicheren Quantifizierung der Patientenmitarbeit. Meistens
wurden in Compliance-/Adherence-Studien die Einlösung von Rezepten oder mit elektronischem
Chip-ausgerüstete Inhalationsgeräte bzw. Tablettendöschen verwendet. Die Selbstbeurteilung
durch den Patienten, das Wiegen der Dosieraerosole und die Einschätzung durch den
Arzt erwiesen sich dabei als besonders fehleranfällige und ungenaue Verfahren. In
dieser Übersicht erfolgt eine Bestandsaufnahme der die Patientenmitarbeit positiv
oder negativ beeinflussenden Faktoren und der zur Verfügung stehenden Messinstrumente.
Summary
Asthma is a chronic disease requiring regular use of controller medication (e.g. inhaled
corticosteroids at step 2 of treatment guidelines) to improve symptoms and prevent
exacerbations. However, inadequate patient adherence/compliance to prescribed treatment
regimens is a major cause of poor clinical outcome. Adherence rates in these patients
are generally about 50%. Typically, adherence with reliever medication is better than
with controller medications. Poor compliance most often results in infrequent and
lower than prescribed taking of medication. While older age or female gender are fixed
factors, some modifiable characteristics which can achieve better adherence include
formal education, higher socioeconomic status, belief that asthma is a serious illness,
fewer concerns about the side effects of their medication, shortened and simple treatment
regimens (including the prescription of inhaled fixed-combination devices), patient-oriented
devices for inhalation therapy, and good patient-physician relationship. There is
no gold standard for quantifying patient adherence. In general, direct measures of
assessing patient behavior, such as direct observation or electronic inhaler monitoring,
give a more accurate, valid indication than indirect methods such as patient diaries,
self-reporting, weighting of inhaler devices or doctors' judgment. An understanding
of the barriers that impede guideline adherence, described in this article, is necessary
before programs are designed to initiate changes in the practices of the treating
doctor.
Schlüsselwörter
Asthma - Patientenmanagement - Arzt-Patient-Beziehung - Applikationsform - Compliance
- Adhärenz
Key words
Asthma - patient management - adherence - compliance - application form
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Prof. Dr. med. Adrian Gillissen
Robert Koch-Klinik, Thoraxzentrum des Klinikums St. Georg
Nikolai-Rumjanzew-Straße 100
04207 Leipzig
Telefon: 0341/4231202
Fax: 0341/4231203
URL: http://Internet: www.rkk-leipzig.de
