A COHORT ANALYSIS OF EXCESS MORTALITY IN ASTHMA AND THE USE OF INHALED BETA-AGONISTS
A COHORT ANALYSIS OF EXCESS MORTALITY IN ASTHMA AND THE USE OF INHALED BETA-AGONISTS
复制标题
DOI：
10.1164/ajrccm.149.3.8118625
复制
发表时间：
1994-03-01
影响因子：
24.7
通讯作者：
SPITZER, WO
中科院分区：
文献类型：
--
作者：
SUISSA, S;ERNST, P;SPITZER, WO
吸入-激动剂的使用与哮喘死亡和濒死风险之间的关联此前已有报道。该研究基于一项巢式病例对照研究，从1980年至1987年随访的12301例哮喘药物使用者中选出129例病例和655名对照受试者。在本文中，我们研究哮喘和非哮喘死亡率的问题使用数据从整个队列的12,301哮喘患者。该队列中有46例哮喘死亡和134例非哮喘死亡，随访47,842人年。哮喘总死亡率为每年每10,000名哮喘患者中有9.6人死亡。这一比率根据过去12个月使用非诺特罗、沙丁胺醇或口服皮质类固醇以及过去2年哮喘住院次数的不同而有显著差异。在控制了其他四个风险因素的影响后，这一比率显著下降，在研究期间，每年每10,000名哮喘患者中有0.6人死于哮喘。所有受体激动剂的使用也显著增加，非诺特罗比沙丁胺醇增加更多，尽管这种差异部分是由于两种药物的剂量不相等造成的。变化点剂量-反应曲线显示，当每月吸入约1.4罐（每罐20,000 μ g） β受体激动剂时，哮喘死亡的风险开始急剧上升，这是推荐的限值。对于非哮喘死亡，每年每10,000名哮喘患者中有28人死亡的总体比率与吸入β受体激动剂的使用无关。我们的结论是，吸入-受体激动剂的使用与哮喘死亡率之间的强烈关联主要局限于这些药物的使用超过推荐限度。非哮喘死亡率，包括由心血管原因引起的死亡率，与吸入-受体激动剂的使用无关。
The association between the use of inhaled beta-agonists and the risk of death and near-death from asthma has previously been reported. It was based on a nested case-control study of 129 cases and:655 control subjects selected from a cohort of 12,301 users of asthma drugs followed during the period 1980 through 1987. In this paper we examine the question of asthma and non-asthma mortality using data from the entire cohort of 12,301 asthmatics. There were 46 asthma and 134 non-asthma deaths in this cohort, for which there were 47,842 person-years of follow-up. The overall rate of asthma death was 9.6 per 10,000 asthmatics per year. This rate varied significantly according to the use of fenoterol, albuterol, or oral corticosteroids in the prior 12 months and the number of asthma hospitalizations in the prior 2 years. The rate decreased significantly, by 0.6 asthma deaths per 10,000 asthmatics per year over the study period, after controlling for the effect of the four other risk factors. It also increased significantly with the use of all beta-agonists, and more so for fenoterol than for albuterol, although this difference was partly explained by the dose inequivalence of the two drugs. Change-point dose-response curves showed that the risk of asthma death began to escalate drastically at about 1.4 canisters (of 20,000 mu g each) per month of inhaled beta-agonist, the recommended limit. For non-asthma death, the overall rate of 28 deaths per 10,000 asthmatics per year was not related to the use of inhaled beta-agonists. We conclude that the strong association between the use of inhaled beta-agonists and asthma mortality is confined primarily to the use of these drugs in excess of recommended limits. Non-asthma mortality, including that from cardiovascular causes, is not associated with the use of inhaled beta-agonists.