Objective: To compare the effects of the China Children's Asthma Action Plan (CCAAP)-based remote joint management model with traditional management model on the control of childhood asthma. Methods: A retrospective cohort study was conducted to analyze the general data and asthma control assessment data of 219 children with asthma who attended the respiratory department of Guangzhou Women's and Children's Medical Center from April 2021 to October 2021 and were followed up for 1 year or more. According to the follow-up management model, the CCAAP-based remote joint management model was used in the observation group and the traditional management model was used in the control group, and the propensity score matching method was applied to match the data of children in the two management models for comparison. Paired-samples t-test, Wilcoxon signed-rank test, McNemar χ2-test or χ2-test or nonparametric tests were used to compare the general data and asthma control assessment data between the two matched groups of children. Results: Among 219 children with asthma, 145 were male and 74 were female, aged at consultation (7.2±2.4) years. There were 147 cases in the observation group and 72 cases in the control group, and 27 cases in each of the observation and control groups were successfully matched. The number of asthma exacerbation aura, acute exacerbations, and emergency room visits or hospitalizations for asthma exacerbations were lower in the observation group than in the control group after pairing (1 (0, 2) vs. 3 (1, 5) times, 0 (0,0) vs. 0 (0, 1) times, 0 (0,0) vs. 1 (0, 1) times, Z=-3.42, -2.58, -3.17, all P<0.05). The use of peak flowmeters was higher in children aged 5 years and older in the observation group than in the control group after pairing (100% (22/22) vs. 13% (3/23), χ2=54.00,P<0.001). The ratio of actual to predicted 1st second expiratory volume of force after follow-up in the observation group after pairing was higher than that before follow-up in the observation group and after follow-up in the control group ((95±11)% vs. (85±10)%, (95±11)% vs. (88±11)%, t=-3.40, 2.25, all P<0.05). The rate of complete asthma control after follow-up was higher in both the observation and control groups after pairing than before follow-up for 12 months in both groups (93% (25/27) vs. 41% (11/27), 52% (14/27) vs. 41% (11/27), H=56.19, 45.37, both P<0.001), and the rate of complete control of asthma in children in the observation group was higher than that in the control group at 3 and 12 months of follow-up management (56% (15/27) vs. 25% (5/20), 93% (25/27) vs. 52% (14/27), χ2=47.00, 54.00, both P<0.001). The number of offline follow-up visits, inhaled hormone medication adherence scores, and caregiver's asthma perception questionnaire scores were higher in the observation group than in the control group after pairing (6 (4, 8) vs. 4 (2,5), (4.8±0.3) vs. (4.0±0.6) score, (19.3±2.6) vs. (15.2±2.7) score, Z=6.58, t=6.57, 5.61, all P<0.05), and the children in the observation group had lower school absences, caregiver absences, asthma attack visit costs, and caregiver PTSD scores than the control group (0 (0,0) vs.3 (0, 15) d, 0 (0,0) vs. 3 (0, 10) d, 1 100 (0, 3 700) vs. 5 000 (1 000, 10 000) yuan, 1.3 (1.1, 1.9) vs. 2.0 (1.2, 2.7) score, Z=-2.89, -2.30, 2.74, 2.73, all P<0.05). Conclusion: The CCAAP-based joint management model of asthma control is superior to the traditional management model in the following aspects: it can effectively improve asthma control, self-monitoring, and lung function in children; it can improve treatment adherence and caregivers' asthma awareness; and it can reduce the duration of absenteeism from school, the cost of asthma exacerbation visits, and caregiver's negative psychology.
目的： 比较基于中国儿童哮喘行动计划（CCAAP）的远程联合管理模式与传统管理模式对儿童哮喘控制效果的影响。 方法： 回顾性队列研究，分析2021年4月至10月在广州市妇女儿童医疗中心呼吸科就诊且随访1年及以上的219例哮喘患儿的一般资料及哮喘控制评估资料。根据随访管理模式将基于CCAAP远程联合管理模式分为观察组，传统管理模式分为对照组，应用倾向性评分匹配法对两组管理模式的患儿资料进行匹配比较。采用配对样本t检验、Wilcoxon符号秩检验、McNemar χ2检验或χ2检验或非参数检验比较两组患儿匹配后的一般资料及哮喘控制评估资料。 结果： 219例哮喘患儿中男145例、女74例，就诊年龄（7.2±2.4）岁。观察组147例、对照组72例，观察组与对照组匹配成功各27例。配对后的观察组哮喘加重先兆、急性发作及因哮喘发作急诊就诊或住院的次数均低于对照组［1（0，2）比3（1，5）次、0（0，0）比0（0，1）次、0（0，0）比1（0，1）次，Z=-3.42、-2.58、-3.17，均P<0.05］。观察组≥5岁患儿的峰流速仪使用率高于对照组［100%（22/22）与13%（3/23），χ2=54.00，P<0.001］。配对后观察组随访后的第1秒用力呼气容积实际值与预计值比值高于观察组随访前及对照组随访后［（95±11）%比（85±10）%，（95±11）%比（88±11）%，t=-3.40、2.25，均P<0.05］。观察组及对照组随访后12个月的哮喘完全控制率均高于两组随访前［93%（25/27）比41%（11/27）、52%（14/27）比41%（11/27），H=56.19、45.37，均P<0.001］，观察组患儿的哮喘完全控制率在随访管理3、12个月时均高于对照组［（56%（15/27）比25%（5/20）、93%（25/27）比52%（14/27），χ2=47.00、54.00，均P<0.001］。配对后的观察组患儿的线下复诊次数、吸入性激素用药依从性评分、照顾者哮喘认知问卷得分均高于对照组［6（4，8）比4（2，5）次、（4.8±0.3）比（4.0±0.6）分、（19.3±2.6）比（15.2±2.7）分，Z=6.58，t=6.57、5.61，均P<0.05］，配对后的观察组患儿的缺课时间、照顾者的缺勤时间、哮喘发作就诊费用、照顾者的创伤后应激障碍评分均低于对照组［0（0，0）比3（0，15）d、0（0，0）比3（0，10）d、1 100（0，3 700）比5 000（1 000，10 000）元、1.3（1.1，1.9）比2.0（1.2，2.7）分，Z=-2.89、-2.30、2.74、2.73，均P<0.05］。 结论： 基于CCAAP的远程联合管理模式可有效提高儿童哮喘控制水平、自我监测水平、肺功能、治疗依从性与照顾者哮喘认知水平、减少缺课缺勤时间、哮喘发作就诊费用及照顾者负性心理。.