哮喘或慢性阻塞性肺疾病患者使用沙丁胺醇吸入器有或者没有集成的剂量计数器的比较效益的历史性队列研究
2016/10/09
摘要
背景：使用定量吸入器（MDI）超出标记数量的行为可能会导致不适当的用药剂量，从而导致较差的临床结果。本研究比较在哮喘患者、慢性阻塞性肺疾病患者、或两者使用沙丁胺醇气雾定量吸入器与无剂量计数器时的呼吸相关急救部门（ED）的住院率。
方法：本次回顾性研究采用美国索赔数据来确定使用沙丁胺醇气雾定量吸入器或不完整的剂量计数器的哮喘、慢性阻塞性肺疾病，或两者均有的患者（年龄4-64岁）。这项研究包括对病人的表征和混杂因素描述的一年基线期，以及第一次沙丁胺醇处方后的一年结果期的研究。主要终点是呼吸相关的急诊就诊率，使用减少的零膨胀泊松回归模型进行比较。我们还比较了严重的恶化率和救援药物的使用。
结果：总共有93980例患者进行了研究，其中67251例（72%）在剂量计数器队列，26729例（28%）在非剂量计数器队列。队列在基线大致相同（55069 [ 59% ]女性患者，平均年龄，37岁）。呼吸系统发病率相关的急诊就诊率在结果年期间，剂量计数器组较非剂量计数器组降低了45%（调整比率：0.55；95%置信区间：0.47-0.64）。队列之间，恶化率和短效的β-受体激动剂的使用率是相似的。
结论：这些研究结果表明，剂量计数器集成到沙丁胺醇吸入器中与降低急诊就诊率有关。在救援吸入器上集成剂量计数器可以帮助患者在疾病加重期间避免使用空的或接近空的吸入器，从而确保其缓解症状的药物可得。救援吸入器上集成剂量计数器代表了一个简单有效的工具，可在疾病发作期间提高临床疗效，具有为卫生保健系统节约成本的潜力。
关键词：沙丁胺醇；哮喘；慢性阻塞性肺疾病；剂量计数器；效益；吸入器
（杨冬 审校）
JAsthmaAllergy.2016Aug26;9:145-54.doi:10.2147/JAA.S111170.eCollection 2016.
Historical cohort study examining comparative effectiveness of albuterol inhalers with and without integrated dose counter for patients with asthma or chronic obstructive pulmonary disease.
Price DB1, Rigazio A2, Buatti Small M3, Ferro TJ3.
Author information
Abstract
BACKGROUND:Using a metered-dose inhaler (MDI) beyond the labeled number of actuations may result in inadequate dosing of medication, which can lead to poor clinical outcomes. This study compared respiratory-related emergency department (ED) visit rates in patients with asthma, chronic obstructive pulmonary disease, or both when they used albuterol MDIs with versus without dose counters.
METHODS:This retrospective study used US claims data to identify patients (ages 4-64 years) with asthma, chronic obstructive pulmonary disease, or both, using albuterol MDIs with or without an integrated dose counter. The study comprised a 1-year baseline period for patient characterization and confounder definition and a 1-year outcome period following the first albuterol prescription. The primary end point was the incidence rate of respiratory-related ED visits, compared using a reduced zero-inflated Poisson regression model. We also compared severe exacerbation rates and rescue medication use.
RESULTS:A total of 93,980 patients were studied, including 67,251 (72%) in the dose counter cohort and 26,729 (28%) in the non-dose-counter cohort. The cohorts were broadly similar at baseline (55,069 [59%] female patients; median age, 37 years). The incidence rate of respiratory-related ED visits during the outcome year was 45% lower in the dose counter cohort than in the non-dose-counter cohort (adjusted rate ratio: 0.55; 95% confidence interval: 0.47-0.64). Exacerbation rates and short-acting β-agonist use were similar between cohorts.
CONCLUSION:These findings suggest that dose counter integration into albuterol MDIs is associated with decreased ED visit rates. The presence of integrated dose counters on rescue inhalers can help patients avoid using an empty or near-empty inhaler during exacerbations, thereby ensuring available medication for relief of their symptoms. Integrated dose counters on rescue MDIs could represent a simple and effective tool to improve clinical outcomes during exacerbations, with a potential for cost savings to health care systems.
KEYWORDS:albuterol; asthma; chronic obstructive pulmonary disease; dose counter; effectiveness; inhaler
JAsthmaAllergy.2016Aug26;9:145-54.doi:10.2147/JAA.S111170.eCollection 2016.
上一篇：
使用漂白剂进行家庭清洁的妇女患非过敏性哮喘的风险增加
下一篇：
哮喘患儿在牙科治疗时用水合氯醛镇静
