Thiazolidinediones and the risk of asthma exacerbation among patients with diabetes: a cohort study.
Thiazolidinediones and the risk of asthma exacerbation among patients with diabetes: a cohort study.
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DOI：
10.1186/1710-1492-10-34
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Liu CF
中科院分区：
文献类型：
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作者：
Rinne ST;Feemster LC;Collins BF;Au DH;Perkins M;Bryson CL;O'Riordan TG;Liu CF
噻唑烷二酮是一种口服糖尿病药物，它选择性地激活过氧化物体增殖物激活的受体伽马，并具有强大的抗炎特性。虽然一些研究发现接触噻唑烷二酮可以改善肺功能，但还没有关于它们对哮喘恶化的影响的研究。我们的目标是评估接触噻唑烷二酮类药物是否与降低哮喘恶化风险有关。我们对2005年10月1日至2006年9月30日期间被诊断为哮喘并服用口服糖尿病药物的糖尿病退伍军人进行了一项队列研究。在2006年10月1日至2007年9月30日期间，比较了服用噻唑烷二酮类药物的患者和服用替代口服糖尿病药物的患者的哮喘恶化和口服类固醇使用的风险。多变量Logistic回归和负二项回归分析被用来描述这种风险。进行了敏感性分析，将我们的评估限制在坚持糖尿病治疗的患者。我们确定了2178名服用噻唑烷二酮的患者和10700名没有服用的患者。暴露于噻唑烷二酮类药物可显著降低哮喘恶化的风险(OR = 为0.79，95%CI为0.62~0.99)和口服类固醇处方(OR = 为0.73，95%CI为0.63~0.84)。在坚持服用糖尿病药物的患者中，哮喘恶化的风险(OR = 为0.64，95%CI为0.47-0.85)和口服类固醇处方的风险(OR = 为0.68，95%CI为0.57-0.81)显著降低。通过预防哮喘加重和减少口服类固醇的使用，噻唑烷二酮类药物可能为哮喘治疗提供一种新的抗炎方法。
Thiazolidinediones are oral diabetes medications that selectively activate peroxisome proliferator-activated receptor gamma and have potent anti-inflammatory properties. While a few studies have found improvements in pulmonary function with exposure to thiazolidinediones, there are no studies of their impact on asthma exacerbations. Our objective was to assess whether exposure to thiazolidinediones was associated with a decreased risk of asthma exacerbation. We performed a cohort study of diabetic Veterans who had a diagnosis of asthma and were taking oral diabetes medications during the period of 10/1/2005 – 9/30/2006. The risk of asthma exacerbations and oral steroid use during 10/1/2006 – 9/30/2007 was compared between patients who were prescribed thiazolidinediones and patients who were on alternative oral diabetes medications. Multivariable logistic regression and negative binomial regression analyses were used to characterize this risk. A sensitivity analysis was performed, restricting our evaluation to patients who were adherent to diabetes therapy. We identified 2,178 patients who were on thiazolidinediones and 10,700 who were not. Exposure to thiazolidinediones was associated with significant reductions in the risk of asthma exacerbation (OR = 0.79, 95% CI, 0.62 – 0.99) and oral steroid prescription (OR = 0.73, 95% CI 0.63 – 0.84). Among patients who were adherent to diabetes medications, there were more substantial reductions in the risks for asthma exacerbation (OR = 0.64, 95% CI 0.47 – 0.85) and oral steroid prescription (OR = 0.68, 95% CI 0.57 – 0.81). Thiazolidinediones may provide a novel anti-inflammatory approach to asthma management by preventing exacerbations and decreasing the use of oral steroids.