Outcomes after periodic use of inhaled corticosteroids in children.
Outcomes after periodic use of inhaled corticosteroids in children.
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DOI：
10.1080/02770900802468517
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发表时间：
2009-06
期刊：
影响因子：
--
通讯作者：
Lieu TA
中科院分区：
文献类型：
--
作者：
Wu AC;Li L;Miroshnik I;Glauber J;Gay C;Lieu TA
许多患有持续性哮喘的儿童定期使用吸入性皮质类固醇。成人临床试验表明，定期使用吸入性皮质类固醇可能对轻度持续性哮喘患者有效。然而，关于哮喘儿童在现实环境中定期使用吸入性皮质类固醇的临床结果的信息很少。这项前瞻性队列研究比较了在为期12个月的随访期间，患有持续性哮喘的儿童的临床结果，这些儿童的父母认为他们应该在研究开始时(a)定期或(b)全年每天使用吸入类固醇。研究的临床结果是(1)哮喘相关的急诊（ED）就诊或住院，(2)基于卫生保健和药物使用的未控制哮喘，以及(3)哮喘门诊就诊。研究人群包括来自两个健康计划的患有持续性哮喘的儿童，他们的父母在基线电话采访中报告他们正在使用吸入性皮质类固醇。访谈收集了儿童父母是否认为他们应该定期或每天使用吸入皮质类固醇的信息，以及基线哮喘症状状态、社会人口统计学和行为变量。我们使用计算机数据库来确定每个孩子在基线访谈后12个月内的临床事件。未控制的哮喘被定义为任何与哮喘相关的ED就诊或住院，在12个月内服用两次或两次以上口服类固醇处方，或服用四次或更多β激动剂。我们使用逻辑回归分析比较了周期性和每日吸入皮质类固醇使用者之间的这些结果。我们进行了(1)传统的逻辑回归分析，其中我们通过纳入协变量，如年龄，哮喘身体状况，社会人口统计学和行为变量，以及访谈前一年哮喘相关医疗保健使用史来调整选择偏差；(2)使用倾向得分进行分析，以更充分地调整选择偏差。在这项研究的476名儿童中，55%的父母认为他们的孩子应该定期使用吸入皮质类固醇，45%的父母认为他们的孩子应该全年每天使用这些药物。在基线时，定期吸入皮质类固醇使用者的哮喘严重程度低于每日服用者，包括在儿童哮喘健康调查中更好的哮喘身体状况评分（平均87±16.0比81±17.4,p = < 0.0001）。在基线访谈前的一年中，与每日服用者相比，定期服用者就诊或住院的可能性更小（10%对23%，p = 0.0001），服用过5次或更多沙丁胺醇处方的可能性更小（13%对31%，p < 0.0001）。在随访的一年中，那些认为吸入类固醇是周期性使用的患者比那些认为吸入类固醇是日常使用的患者更不可能因哮喘而去ED就诊或住院（or 0.36, 95% CI: 0.18-0.73），即使在调整了基线哮喘状态和其他协变量之后也是如此。同样，那些认为吸入类固醇是周期性使用的人不太可能有不受控制的哮喘，OR为0.38 （95% CI: 0.24-0.62）。分析使用倾向得分调整产生类似的结果，逻辑回归分析。父母认为孩子应该定期使用吸入性皮质类固醇的孩子在基线时的哮喘严重程度要低于那些父母认为孩子应该每天使用类固醇的孩子。在1年的随访中，定期服用者比每日服用者发生不良哮喘结果的可能性要小。这表明临床医生可以通过选择哮喘不太严重的患者进行周期性吸入皮质类固醇治疗来应用适当的选择标准。
Many children with persistent asthma use inhaled corticosteroids on a periodic basis. Clinical trials in adults suggest that periodic use of inhaled corticosteroids may be effective for patients with mild persistent asthma. However, scant information exists on the clinical outcomes of children with asthma who are using inhaled corticosteroids on a periodic basis in real-world settings. This prospective cohort study compared clinical outcomes during a 12-month follow-up period between children with persistent asthma whose parents believed that they were supposed to use inhaled steroids either (a) periodically or (b) daily year-round at the start of the period. The clinical outcomes studied were (1) asthma-related emergency department (ED) visits or hospitalizations, (2) uncontrolled asthma based on health care and medication use, and (3) outpatient visits for asthma. The study population included children with persistent asthma from two health plans whose parents reported that they were using inhaled corticosteroids during a baseline telephone interview. The interviews collected information on whether the children’s parents believed they were supposed to use inhaled corticosteroids on a periodic or daily basis, as well as baseline asthma symptom status, sociodemographic, and behavioral variables. We used computerized databases to identify clinical events for each child during the 12 months after their baseline interview. Uncontrolled asthma was defined as any asthma-related ED visit or hospitalization, two or more oral steroid prescription fills, or four or more beta-agonists canisters filled during the 12-month period. We compared these outcomes between the periodic versus daily users of inhaled corticosteroids using logistic regression analyses. We conducted both (1) a traditional logistic regression analysis in which we adjusted for selection bias by including covariates such as age, asthma physical status, sociodemographic and behavioral variables, and history of asthma-related health care use during the year before interview and (2) an analysis using propensity scores to more fully adjust for selection bias. Of a total of 476 children in the study, 55% of parents believed their children were supposed to be using inhaled corticosteroids on a periodic basis and 45% believed their children were supposed to be using them daily year-round based on the baseline parent interview. At baseline, periodic inhaled corticosteroid users had less severe asthma than daily users based on several measures including better asthma physical status scores on the Children’s Health Survey for Asthma (mean 87 ± 16.0 vs. 81 ± 17.4, p = < 0.0001). During the year before the baseline interview, periodic users compared with daily users were less likely to have an ED visit or hospitalization (10% vs. 23%, p = 0.0001) and less likely to have had five or more albuterol prescription fills (13% vs. 31%, p < 0.0001). During the follow-up year, those who believed inhaled steroids were for periodic use were less likely than those who believed inhaled steroids were for daily use to have an ED visit or hospitalization for asthma (OR 0.36, 95% CI: 0.18–0.73), even after adjusting for baseline asthma status and other covariates. Similarly, those who believed inhaled steroids were for periodic use were less likely to have uncontrolled asthma, OR 0.38 (95% CI: 0.24–0.62). Analyses using propensity score adjustment yielded similar results to the logistic regression analyses. Children whose parents believed they were supposed to use inhaled corticosteroids on a periodic basis had less severe asthma at baseline than those whose parents believed they were supposed to be using them daily. Periodic users were less likely than daily users to have adverse asthma outcomes during 1-year follow-up. This suggests that clinicians may be applying appropriate selection criteria by choosing patients with less severe asthma for periodic inhaled corticosteroid regimens.
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影响因子：
158.5
作者：
Boushey, HA;Sorkness, CA;Israel, E
通讯作者：
Israel, E
影响因子：
3.7
作者：
ROSENBAUM, PR;RUBIN, DB
通讯作者：
RUBIN, DB
影响因子：
--
作者：
Cabana, MD;Rand, CS;Rubin, HR
通讯作者：
Rubin, HR
DOI：
10.1016/j.ambp.2007.10.007
发表时间：
2008-03-01
期刊：
AMBULATORY PEDIATRICS
影响因子：
--
作者：
Wu, Ann Chen;Smith, Lauren;Lieu, Tracy A.
通讯作者：
Lieu, Tracy A.
影响因子：
8
作者：
Asmussen, L;Olson, LM;Weiss, KB
通讯作者：
Weiss, KB