臺灣博碩士論文加值系統

本研究目的係探討護理指導對患孩母親氣喘用藥知識、患孩處方遵從率及患孩最大呼氣流速（最大呼氣流速，Peak Expiratory Flow，簡稱PEF）值的影響，及母親氣喘用藥知識、患孩處方遵從率與PEF值的關係。
本研究採類實驗研究設計，於87年1月初至7月底於某醫學中心小兒過敏科門診進行研究，經立意取樣方式選取符合選樣條件之患孩母親為研究對象，採隨機分派方式分為實驗組與控制組，最後有效樣本數共38位，包括實驗組20位，控制組18位。兩組母親與患孩皆被指導吸入性藥物使用技巧、PEF使用技巧、氣喘日記記錄方式並充分解釋配合PEF值應採用的處方，全部個案皆需記錄氣喘日記100天，實驗組患孩母親另接受護理指導（方式：首先指導母親氣喘用藥知識、往後每次回診追蹤時加強母親氣喘用藥知識、討論執行處方時遇到的問題，支持母親協助患孩遵從處方）
研究工具包括『PEF測定器』、『氣喘用藥知識量表』、『氣喘日記』等。研究所收集之資料以SPSS for Windows 7.0版套裝軟體進行次數分配、百分比、平均值、標準差、卡方檢定、t-test、配對t-test、共變項分析、皮爾森積差相關等方法進行統計分析。結果發現：
1.護理指導後，實驗組母親氣喘用藥知識顯著高於控制組
2.實驗期間共三個月，實驗組患孩處方遵從率一直顯著高於控制組
3.實驗組患孩PEF值於實驗期間第一個月顯著高於控制組，但第二、三個月兩組PEF值即無顯著差異
4.母親氣喘用藥知識後測得分與實驗期患孩處方遵從率之相關係數未達統計顯著水準
5.實驗期間第一、二、三個月患孩處方遵從率與PEF值之相關係數
皆未達統計上顯著程度
本研究結果可作為未來推行氣喘教育與研究方面的參考。

The purpose of this study was to explore the effects of nursing instruction for mother’s knowledge of asthma medication, compliance and P.E.F data in asthma children, and the relationships among all of these.
Quasi-experimental design was conducted during January 1998 to July 1998 at the pediatric allergy clinic at a medical center. The sample consisted of 38 mothers and their children by purposive sampling and assigned to two groups by randomization (20 in the experimental group and 18 in the control group). All mothers and children were instructed the technique to record asthma diaries, corporate with prescription, use PEF meter and inhale asthma medication. And their were ought to record their asthma diaries for 100 days. Mothers in the experimental group received nursing instruction (includes teaching asthma medication knowledge, medication knowledge reinforcement as follow up, discussion about problem from compliance, supporting compliance with prescription). “PEF meter”, ” Knowledge of medication questionnaire” and ”asthma diaries” were applied to evaluate the effects of nursing instruction for mother’s knowledge of asthma medication, compliance and P.E.F data in asthma children. Data were analyzed by frequency distribution, percentage, mean, standard deviation, Chi-square test, t-test, paired t-test, one way ANCOVA and Pearson’s correlation through the SPSS for Windows/PC. The major results were as follows:
1.There were significant changes in Mother’s medication knowledge and children’ s compliance（p<.05）following the program.
2.Children’s PEF data increased at a statistically significant level on 1st month, but no significant changes on 2nd and 3rd month.
3.The relationships between Mother’s medication knowledge and children’s compliance and the relationship between children’s compliance and children’s PEF data neither increased at a statistically significant level.
Based on the findings of this study, several recommendations have been submitted with regard to asthma education and further researches.

第一章緒論
　第一節研究背景與動機………………………1
　第二節研究目的與研究假設………………………4
　第三節研究架構、名詞界定………………………5
第二章文獻探討
　第一節氣喘概觀………………………9
　第二節氣喘的居家監測………………………14
　第三節預防性藥物治療………………………18
　第四節氣喘藥物遵從情況………………………19
　第五節氣喘藥物指導成效………………………21
第三章研究方法
　第一節研究設計………………………24
　第二節研究對象………………………26
　第三節研究工具………………………27
　第四節研究工具的信效度測定………………………29
　第五節研究過程………………………30
　第六節資料分析處理………………………36
第四章研究結果
　第一節氣喘用藥知識情形………………………38
　第二節患孩處方遵從行為………………………47
　第三節患孩PEF值變化………………………48
　第四節母親氣喘用藥知識與
患孩遵從處方行為之關係………………………50
　第五節患孩處方遵從行為與PEF值之關係………………………50
第五章討論
　第一節母親氣喘用藥知識情形………………………51
　第二節患孩處方遵從行為………………………53
　第三節患孩PEF值變化………………………54
　第四節母親氣喘用藥知識
與患孩處方遵從行為之關係………………………56
　第五節患孩遵從處方行為與PEF值之關係………………………57
第六章結論與建議
　第一節結論………………………59
　第二節研究限制………………………60
　第三節研究建議………………………61
參考資料
中文部份………………………64
英文部份………………………65
　附件1基本資料表
氣喘藥物知識量表………………………84
　附件2處方………………………86
　附件3氣喘日記………………………87
　附件4氣喘藥物教案………………………88
　附件5個別說明………………………92
　附件6專家名單………………………97

一、中文部份
1.王資惠（民85）．護理指導對學齡期氣喘患童使用吸入型藥物的知識及技巧的影響．國立台灣大學護理研究所碩士論文。
2.呂克桓（民84）．避免或控制氣喘病發病的誘因．中華民國微生物及免疫學雜誌，28（4），39-43。
3.周正成、王世叡（民84）．慢性氣喘病的藥物治療．中華民國微生物及免疫學雜誌，28（4），79-90。
4.洪兆嘉（民86）．系統性護理指導對氣喘患童母親協助藥物使用的成效探討．國立台灣大學護理研究所碩士論文
5.陳黛娜（民83）．氣喘學童的疾病知識與相關行為之探討．國防醫學院護理研究所碩士論文
6.葉燦昇（民84）．支氣管過敏性氣喘．當代醫學，22（11），878-883。
7.謝貴雄（民84）．小兒氣喘病之預防和處理．中華民國小兒科醫學雜誌，36（增刊，Ｂ），878-883。
8.台灣省政府衛生處（民84）．台灣省公立醫院出院患者結果統計． 台灣省衛生處（第二輯）
二、英文部份
1.Adelroth, E., & Thompson, S. （1988）Advantages of high-dose inhaled budesonide(letter). Lancet, 1,476.
2.Alessandro, F., Vincenzo, Z.G., Marco, S., Marcello, G., & Enrica, R.（1994）. Compliance with pharmacologic prophylaxis and therapy in bronchial asthma. Annals of Allergy, 73, 135-140.
3.Allen, R.M., Jones, M.P., & Oldenburg, B.（1995）Randomized trial of an asthma self-management program for adults. Throat, 50 731-738.
4.Altounyan, REC.（1980）.Review of clinical activity and mode of action of sodium cromoglycate. Clinical Allergy, supp 10, 481-489.
5.American Thoracic Society （1995）. Standard of spirometry. Journal of American Critical Medical care, 152, 1107-1136.
6.Barnes, P.J.（1995）.Inhaled glucocorticoids for asthma. New England Journal of Medicine, 332, 868-875.
7.Barnes, P.J., Jonsson, B., & Klim, J.B.（1996）. The cost of asthma. European Respiratory Journal, 9（4）, 636-642.
8.Barlett, E.E.（1983）Educational self-help approaches in childhood asthma. Journal of Clinical Immunology, 72, 545-553.
9.Bartholomew, L.K., Parcel, G.S., Swank, P.R. & Czyzewsky, D.I. （1993）. Measuring self-efficacy expectations for the self management of cystic fibrosis. Chest, 103（5）, 1624-629.
10.Beasley, R., Burgess, C., Crane, J., Pearce, N., & Roche, W. （1993）. Pathology of asthma and its clinical implications. Journal of Allergy and Clinical Immunology, 92（1 pt 2）, 148-154.
11.Becker, M.H., Maiman, L.A.（1980）Strategies for enhancing patient compliance. Journal of Community Health, 6,113-115.
12.Bernard-Bonnin A-C., Stachenko, S., Bonin, D., Charette, C., and Rousseau, E. （1995）. Self-management teaching programs and morbidity of pediatric asthma: a meta-analysis. Journal of Allergy Clinical Immunology, 95 （1）,34-41.
13.Birkhead, G., Attaway, N.J., Strunk, R.C., Townsend, M.C., and Teutsch, S.（1989）. Investigation of a cluster of deaths of adolescent from asthma: Evidence implicating inadequate treatment and poor patient adherence with medication. Journal of Allergy Clinical Immunology, 84 （1）,481-491.
14.Boulet, L-P（1998）. Perception of the role and potential side effects of inhaled steroids among asthmatic patients. Chest, 113 （3）,587-592.
15.Brand, P.L.P., Duiverman, E.J.,Postma, D.S., Waalkens, H.J., Kerrebijn, E.E.M., van Essen-Zandzliet, & the Dutch CNSLD Study Group.（1997）. Peak flow variation in childhood asthma: relationship to symptoms, atopy, airway obstruction and hyperresponsiveness. European Respiratory Journal, 10, 1242-1247.
16.Brewis, R.A.L. （1991）. Patient education, self management plan and peak flow measurement. Respiratory medicine, 85, 457-462.
17.Brook, U., Mendelberg, A., & Heim, M（1993）Increasing parental knowledge of asthma decreases the hospitalization of the child: a pilot study. Journal of Asthma, 30（1）45-49.
18.Calpine, C., Macarthur, C., Stephens, D., Feldman, W., Parkin, P.C.（1997）. Effectiveness of prophylactic inhaled steroids in childhood asthma: a systematic review of the literature. Journal of Allergy Clinical Immunology, 100 （4）,452-457.
19.Charlton, I., Antoniou, A.G., Atkinson, J.（1994）Asthma at the interface: bridging the gap between general practice and a district general hospital. Arch of Disease Child. 70, 313-318.
20.Charlton, I., Charlton, G., Broomfield, J., Mullee, M.A., （1990）Evaluation of the peak flow and symptoms only self management plans for control of asthma in general practice. British Medicine Journal. 301, 1355-1359.
21.Chandler, M.J., Gammer, L.C., Patterson, R.（1986）Noncompliance and prevarication in life treatment adolescent asthma. New England Reg allergy-Proc. 7(4), 367-370.
22.Cheng-Yeung, M., Chang, G.H., Manfreda, J., Ferguson, A., & Becker, .（1996）Changes in peak flow, symptom score, and the use of medications during acute exacerbations of asthma. American Journal of Respiratory care medicine. 154, 889-893.
23.Clark, N. M., Feldman, C., Hevans, D., Levison, M., Wasilewski, Y & Mellins, R.B. （1986）. The impact of health education on frequency and cost of health care use by low income children with asthma. Journal of Allergy Clinical Immunology, 78 （19）,108-115.
24.Clough, J.B., & Williams, J.D.（1992）Profile or bronchial responsiveness in children with respiratory symptoms. Archives of Disease in Childhood. 67, 574-579.
25.Clough, J.B.（1996）Recommendations for peak flow monitoring in children. Respiratory medicine, 90, 459-461.
26.Cockcroft, D.W. （1991）. Therapy for airway inflammation in asthma. Journal of Allergy Clinical Immunology, 87,914-919.
27.Corchrane, G.M.（1996）. Asthma current perspectives. London: Mosby-Wolfe.
28.Connolly, C.K. （1987）. Is cosinor analysis an appropriate model for diurnal variation in asthma? Thorax, 42, 733.
29.Cote, J., Cartier, A., Robichaud, P, Boutin, H., Malo, J.L., Rouleau, M., Fillion, A., Lavallee, M., Krusky, M., and Boulet, L.P.（1997）. Influence on asthma morbidity of asthma education programs based on self-management plans following treatment optimization. American Journal of Respiratory and Critical Care Medicine, 155（5）, 1509-1514.
30.Couriel, J.M., Demis, T., & Olinsky, A. （1986）. The perception of asthma. Australian Paediatric Journal, 22（1）, 45-47.
31.Creer, T.L.（1980）Self-management behavioral strategies for asthmatics. Behavior Medicine, 14-24.
32.Dompeling, e., Van Grunsven P.M., Van Schayck, C.P., Folgering, H., Molema, J., & Van Weel, C.（1992）. Treatment with inhaled steroids in asthma and chronic bronchitis. Family Practice, 9（2）, 161-166.
33.Donnelly, J.F., Donnelly, W.J., and Thong, Y.H. （1989）Inadequate parental understanding of asthma medications. Annals of Allergy, 62, 337-341.
34.D’Souza, W., Crane, J., Burgess, C.（1994）. Community-based asthma care: trial of a “credit card”asthma self-management plan. European Respiratory Journal, 7, 1260-1265.
35.Fireman, P., Friday, G.A., Gira, C., Viethaler, W.A., & Michals, L., （1981）. Teaching self management skills to asthmatic children and their parents in an ambulatory care setting. Paediatrics, 68（3）, 341-348.
36.Friedman, M., & Walker, S.（1975）Assessment of lung function using a airflow meter. Lancet, i,310-311.
37.Fritz, G.K., McQuaid, E.L., Spirito, A., and Klein, R.B.（1996）Perception in pediatrics Asthma: relationship to functional morbidity and psychological factors. Journal of Academic Child Adolescence Psychiatry, 35（8）, 1033-1041.
38.Garrett, J., Fenwick, J.M., Taylor, G., Mitchell, E., Stewart, J., Rea, H.（1994）Prospective controlled evaluation of a community based education center in a multiracial working class neighborhood. Thorax, 49,976-983.
39.Gergens, P.J., Mullally, D.I., and Evans, R. National survey of prevalence of asthma among children in the United States, 1976 to 1980. Pediatrics, 81（1）,1-7.
Gerrin（1993）
40.Giannini, D., Paggiaro, P.L., Moscato, G., Gherson, G., Bacci, E., Bancalari, L., Dente, F.L., Di Franco, A., Vagaggini, B., and Giuntini, C. （1997）Comparison between peak flow expiratory flow and forced expiratory volume in one second (FEV1) During bronchoconstriction induced by different stimuli. Journal of asthma, 34（2）,105-111.
41.Hanania, N.A., Chapman, K.R., & Kesten, S. （1995）. Adverse effect of inhaled corticosteroids. American Journal of Medicine, 98,196-208.
42.Hand, C.H., Bradley, C.（1996）Health beliefs of adults with asthma: towards an understanding of the difference between symptomatic and preventive use of inhaler treatment. Journal of Asthma, 33,331-38.
43.Hargreave, F.E., Dolorich, J., & Newhouse, M.T. （1990）. The assessment and treatment of asthma: a conference report. Journal of Allergy Clinical Immunology, 85,1098-1111.
44.Henry, R., Sly, P., & Godfrey, S. （1991）. Assessment and treatment of asthma in children. Journal of Paediatrics and Child Health, 27,218-220.
45.Hetzel, M.R., Clark, T.J.M., & Branthwaite, M.R.（1980）Asthma: the normal range of changes in Peak expiratory flow rates: relationship to symptoms and respiratory disease. American Review of Respiratory Disease,143, 323-330.
46.Higgin, B.G., Britton J.R., Chinn, S., Jones, T.D., Jenkinson, D., Burney, P.G.J., & Tottersifled, A.E.（1989）The distribution of peak expiratory variability in a population sample. American Review of Respiratory Disease,140, 1368-1372.
47.Hilton, S., Salbald, B., Anderson, H.R., & Freeling P.（1986）.Controlled evaluation of the effects of patients education on asthma morbidity in general practice. Lancet, 1, 26-29.
48.Horn, C.R., Clark, T.J.H., & Cochrane, G.M.（1990）. Compliance with inhaled therapy and morbidity from asthma. Respiratory Medicine, 84,67-70.
49.Hoshino, M., Nakamura, Y., Shin, Z., & Fukushima, Y.（1997）. Effects of ketotifen on symptoms and on bronchial mucosa in patients with atopic asthma. Allergy, 52（8）,814-820.
50.Igracio-Gracia, J.M., & Gonzalez-Santos, P.（1997）.Asthma self management education by home monitoring of peak expiratory flow. American Respiratory critical care medicine, 52（8）,814-820.
51.Jackson, A.C.（1995）. Accuracy, reproducibility, and variability of portable peak flow meter. Chest, 107, 648-651.
52.Jones, K.P., Mullee, M.A., Middleton, M., Chapman, E., Holgate, S.T., and The British Thoracic Society Research Committee.（1995）. Peak flow based asthma self-management randomised controlled study in general practice. Thorax, 50, 851-857.
53.Kinsman, R.A., Dirks, J.F., & Pahlem, N.W.（1980）Noncopliance to prescription needed（PRN）medication use in asthma：usage pattern and patients characteristic. Journal of Psychosomatic Research, 24, 97-107.
54.Kelly, C.A. and Gibson, G.J.（1988）Relationship between FEV1 and PEF in patients with chronic airflow obstruction. Thorax, 43, 335-336.
55.Kleiger, J.H., & Dirks, J.F.（1979）Medication compliance in chronic asthma patients. Journal of Asthma Research, 16, 93-196.
56.Kolbe, J., Vamos, M., Fergusson, W., Elkind. G., and Garrett, J.（1996）. Self-management knowledge and self-management behavior in acute severe asthma. Chest, 110, 1463-1468.
57.Konig, P., & Rejent, A.（1982）. Subjective and objective means of assessing cystic fibrosis and asthma. Annals of Allergy, Asthma and immunology, 49, 86-92.
58.Konig, P., & Shaffer, J.（1996）. The effect of drug therapy on long-term outcome of childhood asthma: a possible review of international guidelines. Journal of Allergy Clinical Immunology, 98（6 pt1）, 1103-1111.
59.Kotses, H., Stout, C., Wigal , J.K., Carlson, B., Creer, T.L., & Lewis. P.（1991）.Individualized self management: a beginning. Journal of Asthma, 28, 287-289.
60.Lahdensuo, A., Haahtela, T., Herrala, J., Kava, T., Kuusisto., P., Peramaki., E., Poussa., T., Saarelainen., & S.Svahn, T.（1996）.Randomized comparison of guided self management and traditional treatment of asthma over one year. British Medical Journal, 312, 748-752.
61.Lai, C.K.W., Douglass, C., & Hoss, S.S.（1996）. Asthma epidemiology in the far east. Clinical Experimental Allergy, 26, 5-12.
61.LeSon, S. and Gershwin, M.E. （1995）Risk factors for asthma patients requiring intubation.Ⅰ.Observations in children. Journal of Asthma, 32（4）,285-294.
62.LeSoulf, P.N., La Fortune, B.C. & Landau, L.I.（1986）. Spirometric assessment of asthmatic children aged two to six years. Australian New Zealand Journal of Medicine, 16, 625.
63.Leung, R., Bishop, J., & Robertson, C.（1994）. Prevalence of asthma and wheeze in Hong Kong school children. European Respiratory Journal, 7（2）, 46-49.
64.Leung, R., Wong, G., Ho, A., Chan, J.K., Choy, D., Douglass, C., & Lai, C.K.（1997）. Prevalence of asthma and allergy in Hong Kong. European Respiratory Journal, 10（2）, 354-360.
65.Lewis, C.E., Rechelefsky, G., Lewis, M.A., de la sorta, A., & Kaplan, M.A.（1984）. Randomized trial of A.C.T.（asthma care training）for kids. Pediatrics, 74, 478-486.
66.Lite, I.F., and Crisky, W.R.（1980）Compliance with regimens during adolescence. Clinical North American, 27 3-15.
67.Madage, P., McColl, J., & Paton, J. （1997）Impact of a nurse-led home management training program in children admitted to hospital with acute asthma: a randomized controlled study. Thorax, 52,223-228.
68.Matthews, K.A.（1977）Caregiver-child interactions and the type A coronary-prone behavior pattern. Child Development, 48（4）,1752-1756.
69.Mayo, P.H., Richman, J., & Harris, W., （1990）Results of a program to reduce admissions for adult asthma. Annual Internal Medicine, 112,864-871.
70.Mazon, A., Nieto, A., Nieto, J., Menendez, R., Boquete, M., Brines, J.（1994）Prognostic factors in childhood asthma: a logistic regression analysis. Annals of Allergy, 72,455-461.
71.Mazzuka, S.A. （1986）.Does patient edaucation in chronic disease have therapeutic value . Journal of Chronic Disease, 35, 226-228.
72.McFadden, E.R., Klaser, R., & DeGroot, W.J.（1973）. Acute bronchial asthma: relationship between clinical and physiological manifestations. New England Medical Journal, 288, 221.
73.Meijer, R.J., Kerstjens, H.A.M., & Postma, D.S.（1997） . Comparison of guideline and self-management plans in asthma. European Respiratory Journal, 10（7）, 1163-1172.
74.Mendoza, G.R.（1991）. Peak flow monitoring. Journal of asthma, 28（3）, 161-177.
75.Mesters, L., Meerten, S.R., & Mosterd, N.（1991）. Multidisciplinary cooperation in primary care for asthmatic children. Social Science Medicine, 32（1）, 65-70.
76.Milgrom, H., Bender, B., Ackerson, L., Bowry, P., Smith, B., & Rand, C.（1996）. Noncompliance and treatment failure in children with asthma. Journal of Allergy Clinical Immunology, 98, 1051-1057.
77.Mitchell, E.A, Ferguson, V., and Norwood, M. （1986）Asthma education by community child health nurses. Archives of Disease in Childhood, 61, 1184-1189.
78.Moffitt, J.E., Gearhart, J.G., & Yates, A.B.（1994）Measurement of asthma in children . American Family Physician, 50,1039-1041.
79.Moldofsky, H., Broder, I., Davies, G., amd Leznon, A.（1979）A videotape educational program for people with asthma. Canada Medicine Association Journal, 120, 669-672.
80.Muhlhauser, I., Richter, B., Kraut, D., Weske, G., Worth, H., Berger, M. （1991）Evaluation of a structured treatment and teaching program on asthma. Journal of international Medicine, 230,157-164.
81.Newacheck, P.W. & Taylor, W.R.（1992）.Childhood chronic illness: Prevalence, severity, and impact. American Journal of Public Health, 82（3）, 364-371.
82.Nicklas, R.A.（1989）.Perspective on asthma mortality-1989. Annals of Allergy, 63, 578-584.
83.Ninan, T.K., and Russell, G.（1992）Respiratory symptoms and atopy in Aberden schoolchildren: evidence from two surveys 25 years apart. British Medical Journal, 304（6831）,873-875.
84.Nishima, S.（1993）.A study on the prevalence of bronchial asthma in school children in western districts of Japan─comparison between the study in 1982 and in 1992 with the same methods and same districts. The study of the prevalence of Bronchial asthma, the Western Japan Study Group of Bronchial Asthma. Arerugi - Japanese Journal of Allergology, 42（3 pt 1）, 192-204.
85.O’Linna（1996）. Spirometry, bronchodilator test or symptom scoring for the assessment of childhood asthma. Acta Pediatric, 85, 564-569.
86.Ordonez, G.A., Phelan, P.D., Olinsky, A., & Robertson, C.F.（1998）. Preventable factors in hospital admissions for asthma. Archives of Disease Child, 78, 143-147.
87.Osman, L.M., Russel, I.T., Friend, J.A., Legge, J.A., & Douglas, J.G.（1993）. Predicting patient to asthma medication. Thorax, 48, 827-830.
88.Parcel, G.S., Tiernan, K., Nader, P.R. & Weiner, L.（1979）. Teaching myself about asthma. Louis: CV Mosby
89.Peat, J.K., van den Berg R.H., Green, W.F., Mellis, C.M., Leeder, S.R., and Woolcock, A.J.（1994）. Changing prevalence of asthma in Australia children. British Medical Journal, 308（6944）, 1591-1596.
90.Persaud, D.I., Barnett, S.E., Weller, S.C., Baldwin, C.D., Niebuhr, V., & McCormic, D.P.（1996）. An asthma self-management program for children, including instruction in peak flow monitoring by school nurse. Journal of Asthma, 33（1）, 37-43.
91.Pretet, S., Perdrizet, S., Poisson, N., Paulet, J.C., & Marsac, J.（1989）. Treatment compliance and self-medication in France. European Respiratory Journal, 2, 303-307.
92.Quanjer, phH., et al.（eds）（1997）. Peak expiratory flow: conclusions and recommendations of a working party of the European Respiratory Society. . European respiratory Journal, 10（suppl 24）, 2s-8s.
93.Redline, S., Wright, E.C., Kattan, M., Kercsmar, C., & Weiss, K.（1996）. Short-term compliance with peak flow monitoring: result from a study of inner city children with asthma. Pediatric Pulmonology, 21, 203-210.
94.Reed, C.E.（1988）.Basic mechanisms of asthma. Role of inflammation. Chest, 94（1）, 175-177.
95.Reinberg, A., and Gervais, P.（1972）.Circadian rhythms in respiratory function, with special reference to human chronophysiology and chronopharmacology. Bulletin European Physiopathology Respiratory, 8, 663-675.
96.Revsbech, P., and Anderson, G.（1989）. Diurnal variation in peak expiratory flow rate grain elevator workers. British Journal of Internal Medicine, 46, 566-569.
97.Rourke, M.H., Hock, R.A., Pursell, J.S., Johnes, D., and Spock, A.（1981）The news media and the doctor-patient relationship: Sounding boards. New England Journal, 305, 1278-1280.
98.Ryan, G., Dolovich, M.B., and Hargreave, F.E.（1982）.Bronchial responsiveness to histamine: relationship to diurnal variation of peak flow rate, improvement after bronchodilator, and airway caliber. Thorax, 37, 423-429.
99.Sackeet, D.L, Gibson, E.S., Taylor, D.W., Hayes, R.B., Hazlett, B.C., Roberts, R.S., and Johnson, A.L. （1975）Randomised clinical trial of strategies for improving medical compliance in primary hypertension. Lancet, 1, 1205-1207.
100.Sears, M.R.（1988）.Increasing asthma mortality-fact or artifact?. Journal of Annals Clinical Immunology, 82, 957-960.
101.Sheffer, A.L., & Adinoff, M.D.（1992）.International consensus report on diagnosis and treatment of asthma. Clinical Experimental Allergy, 22（supp1）, s1-s72.
102.Shibutani, S., and Iwagaki, K.（1990）.Self-management programs for childhood asthma developed and instituted at the Nishinara-Byoin National Sanatorium in Japan. Journal of Asthma, 27（6）, 359-374.
103.Silverman, M.（1995）.Childhood asthma and wheezing disease
104.Sly, R.M.（1975）Evaluation of a sound-slide program for patient education. Annals of Allergy, 34, 94-97.
105.Sly, P.D., & Hibbert, M.E.（1989）.Childhood asthma following hospitalization with acute viral bronchitis in infancy. Pediatric Pulmonary, 7, 153-158.
106.Sly, P.D. （1996）Peak expiratory flow monitoring in pediatric asthma: is there a role? Journal of Asthma, 33（5）, 277-287.
107.Sockrider, M.M., Wolle, J.M.（1996）Helping patients better adhere to treatment regimen. Journal of Respiratory Disease, 17,204-216.
108.Spykerboer, J.E., Donnelly, W.J., & Thong, Y.H.（1986）.Parental misconceptions about asthma. Social Science Medicine, 22, 553-558.
109.Spector, S.L., Kinsman, R., Mawhinney, H.（1986）Compliance of patients with asthma with an experimental aerosolized medication: implications for controlled trials. Journal of Allergy Clinical Immunology, 77,65-70.
110.Stephens, M.A., Franks, M.M., Townsend, A.L.（1994）. Stress and rewards in women’s multiple role: the case of woman in the middle. Psychology and Aging, 9（1）, 45-52.
111.Taaggart, V.S., Zuckerman, A.E., Lucas, S., & Acty-Lindsey, A.（1987）.Adapting a self-management education program for asthma for use in an outpatient clinic. Annals of Allergy, 58, 173-178.
112.Tettersell, M.J.（1993）.Asthma patients’ knowledge in relation to compliance with drug therapy. Journal of Advanced Nursing, 18, 103-113.
113.Toelle, B.G., Peat, J.K., Mellis, C.M., & Woolcock, A.J.（1995）.The cost of children asthma to Australian families. Pediatric Pulmonology, 19, 330-335.
114.Townsend, M., Feeny, D.H., Guyatt, G.H., Furlong, W.J., Seip, A.E., & Dolovich, J.（1991）.Evaluation of the burden of illness for paediatric asthmatic patients and their parents. Annals of allergy, 67（4）, 403-408.
115.Van der Palen, J., Klein, J.J., and Rovers, M.M.（1997）. Compliance with inhaled medication and self-treatment guidelines following a self-management program in adult asthmatics. European Respiratory Journal, 10, 652-657.
116.Varsano, I., Volovitz, B., Soferman, R., Tal, A., Schlessinger, M., Rotchild, M., and Tabachnik, E.（1993）. Multicenter study with ketotifen （Zaditen）oral drop solution in the treatment of wheeze children aged 6 months to 3 years. Pediatric Allergy and Immunology, 4（1）, 45-50.
117.Vaughan, T.R., Weber, R.W., Tipton, W.R., and Nelson. H.S.（1989）.Comparison of PEFR and FEV1 in patients with varying degrees of airway obstruction: effect of modest altitude. Chest, 95, 558-562.
118.Weinberger, M., Hendeles, L., and Ahrens, R.（1981）Clinical pharmacology of drugs used for asthma. Pediatric Clinical North American, 28（1）, 47-75.
119.Weiss, K., Gergen, P., & Hodgson, T.（1992）.An economics evaluation of asthma in the United States, 1982-1992. New England Journal of Medicine, 326, 862-868.
120.White, M.S.（1982）.Construct for public nursing. Nursing Outlook, 30, 527-530.
121.Wilson-Pessano, S.R., & McNabb, W.L.（1985）.The role of patient education in the management of childhood asthma. Preventive Medicine, 14, 670-687.
122.Williams, P.D., Williams, A.R., and Griggs, C.（1990）. Children at home on mechanical assistive devices and their families: a retrospective study. Maternal-Child Nursing Journal, 19（4）, 297-311.
123.Wilson, S.R.P, Seaagas, D.F., German, G.F., Hughes, L., S., and Stamatiki, C.（1993）. A controlled trial of two forms of self-management education for adults with asthma. American Journal of Medicine, 94, 564-576.
124.Yeung, M.M., O’Connor, S.A., Parry, D.T., Cochrane, G.M.（1994）Compliance with prescribed drug therapy in asthma. Respiratory Medicine, 88,31-35.
125.Yoon, R., Mckenzie, D.K., Bauman, A., & Miles, D.A.（1993）.Controlled trial evaluation of an asthma education program for adults. Thorax, 48, 1110-1116.