Bronchodilator treatment and deaths from asthma: case-control study
Bronchodilator treatment and deaths from asthma: case-control study
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DOI：
10.1136/bmj.38316.729907.8f
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发表时间：
2005-01-15
影响因子：
--
通讯作者：
Victor, CR
中科院分区：
文献类型：
--
作者：
Anderson, HR;Ayres, JG;Victor, CR
目的探讨支气管扩张剂治疗与哮喘死亡之间的关系。设计病例对照研究。以英国33个卫生当局或卫生委员会为研究对象。研究对象为532例65岁以下死于哮喘的患者和532例因哮喘住院的对照组，研究对象的年龄、年龄、主要结果测量与支气管扩张剂处方和其他治疗相关的哮喘死亡的比值比，敏感性分析校正了发病年龄，既往住院史，结果经过充分调整后，与指数日期前4-12个月内开药的药物无显著相关性。对于1-5年前的处方，死亡率与吸入短效β 2受体激动剂呈正相关（比值比2.05，95%置信区间1.26至3.33），与抗生素呈负相关（0.59，0.39至0.89）。前一种关联似乎仅限于45-64岁的人群，与抗生素的关联在45岁以下的人群中更为明显。在所有时期的显着年龄相互作用表明与口服类固醇仅限于45岁以下年龄组的负相关。与离子作用β（2）激动剂的负相关和与甲基黄嘌呤的正相关在1-5年的时间段内是non-significant.Conclusion没有证据表明吸入长效β（2）激动剂药物的中长期使用对死亡率有不良影响。与短效β 2受体激动剂的相关性有几种解释，其中只有一种可能是直接的不良反应。
Objective To investigate the association between bronchodilator treatment and death from asthma.Design Case-control study.Setting 33 health authorities or health boards in Great Britain.Participants 532 patients under age 65 who died from asthma and 532 controls with a hospital admission for asthma matched for period, age, mid area.Main outcome measures Odds ratios for deaths from asthma associated with prescription of bronchodilators and other treatment, with sensitivity analyses adjusting for age at onset, previous hospital admissions, associated chronic obstructive lung, disease, mid number of other drug categories.Results After full adjustment, there were no significant associations with drugs prescribed in the 4-12 months before the index date. For prescriptions in the 1-5 years before, mortality was positively associated with inhaled short acting beta(2) agonists (odds ratio 2.05, 95% confidence interval 1.26 to 3.33) mid inversely associated with antibiotics (0.59, 0.39 to 0.89). The former association seemed to be confined to those aged 45-64, and the association with antibiotics was more pronounced in those under 45. Significant age interactions across all periods suggested inverse associations with oral steroids confined to the under 45 age group. An inverse association with Ion acting beta(2) agonists and a positive association with methylxanthines in the 1-5 year period were non-significant.Conclusion There was no evidence of adverse effects on mortality with medium to long term use of inhaled long acting beta(2) agonist drugs. The association with short acting beta(2) agonists has several explanations, only one of which may be a direct adverse effect.