Regular use of corticosteroids and low use of short-acting β2-agonists can reduce asthma hospitalization
Regular use of corticosteroids and low use of short-acting β2-agonists can reduce asthma hospitalization
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DOI：
10.1378/chest.127.4.1242
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发表时间：
2005-04-01
期刊：
影响因子：
9.6
通讯作者：
Dosman, JA
中科院分区：
文献类型：
--
作者：
Senthilselvan, A;Lawson, JA;Dosman, JA
目的：吸入性皮质类固醇（ICS）和吸入性短效β（2）-激动剂（ISABA）是最常用的哮喘管理药物。在几项研究中，过度使用ISABA会导致哮喘发病率和死亡率增加。在这些研究中，作者使用不同的指标来控制哮喘严重程度的潜在混杂因素。本研究的目的是在控制了几个哮喘严重程度的指标后，确定ICS的使用对ISABA的使用与首次哮喘住院之间的关联的影响。设计：一项使用萨斯喀彻温省健康数据库的初始队列研究。设置：加拿大萨斯喀彻温省。参与者：在1991年至2000年期间，共有29，957名年龄在5至54岁之间的人至少有5次与哮喘相关的就诊。在哮喘严重程度增加的受试者中，通过随访期间每3个月一次或多次哮喘相关医生访视的平均次数表示，当未使用ICS时，高剂量使用ISABA是住院风险因素（率比[RR]，2.16; 95%置信区间[CI]，1.51 - 2.95）。当ICS使用率低（RR，0.65; 95% CI，0.42 - 0.93）或ICS使用率高（RR，0.23; 95% CI，0.12 - 0.41）时，ISABA具有有益作用。在随访期间，平均每3个月不到一次哮喘相关医生就诊的哮喘不太严重的受试者中，当未使用ICS时，高剂量使用ISABA的住院风险更大（RR，10.06; 95%CI，6.99至14.47）。当ICS的使用率较低时，这一比例有所降低，但并未取消（RR，3.24; 95% CI，2.29至4.59），并被ICS的高使用率完全否定（RR，1.10; 95% CI，0.39至3.12）。在严重和不太严重的哮喘组中，在不使用任何ICS的情况下，高剂量使用ISABA与哮喘住院风险增加相关，随着ICS的低剂量和高剂量使用，哮喘住院风险逐渐降低。这一发现与哮喘严重程度无关，可能是由于在哮喘管理中过度依赖ISABA而缺乏控制所致。
Objectives: Inhaled corticosteroids (ICS) and inhaled short-acting beta(2)-agonists (ISABA) are the most commonly used medications for management of asthma. Increased asthma morbidity and mortality have been reported with excess use of ISABA in several studies. In these studies, authors have used different indicators to control for the potential confounding by asthma severity. The objective of this study was to determine the effect of ICS use on the association between use of ISABA and first hospitalization for asthma after controlling for several indicators of asthma severity.Design: An inceptional cohort study using Saskatchewan Health databases.Setting: The Province of Saskatchewan, Canada.Participants: A total of 29,957 persons aged 5 to 54 years who had at least five asthma-related visits to physicians between 1991 and 2000.Results: Among the subjects with increased asthma severity, indicated by one or more average number of asthma-related physician visits per 3 months during the follow-up, high use of ISABA was a risk factor for hospitalization when no ICS were used (rate ratio [RR], 2.16; 95% confidence interval [CI], 1.51 to 2.95). There was a beneficial effect of ISABA when there was low use of ICS (RR, 0.65; 95% CI, 0.42 to 0.93) or high use of ICS (RR, 0.23; 95% CI, 0.12 to 0.41). Among the subjects with less severe asthma, indicated by less than one asthma-related physician visits per 3 months, on average, during the follow-up, the risk of hospitalization was even greater for high use of ISABA when no ICS were used (RR, 10.06; 95% CI, 6.99 to 14.47). This was reduced but not abolished when there was low use of ICS (RR, 3.24; 95% CI, 2.29 to 4.59) and negated altogether by high use of ICS (RR, 1.10; 95% CI, 0.39 to 3.12).Conclusion: Among both severe and less severe asthma groups, high use of ISABA was associated with an increased risk of asthma hospitalization in the absence of any use of ICS, which was progressively reduced with low and high use of ICS. This finding was independent of asthma severity and could result from lack of control through over reliance on ISABA in asthma management.