怀孕前，孕期中和产后哮喘患者的治疗：一项基于人群的队列研究
2018/06/04
摘要
患有哮喘的女性在孕期可能会有较高的急性加重风险。这项研究的目的是明确加拿大Ontario地区的女性哮喘患者在怀孕期间是否增加了医疗服务利用率（HSU）。在基于人群的哮喘孕妇队列中，计算其哮喘特异性，哮喘相关和非妊娠相关HSU的比例。应用重复测量的Poisson回归来确定与怀孕前一年相比，妊娠期间和产后一年的HSU的调整率比（ARR）和95％置信区间。该队列由103976名女性组成。与怀孕前一年相比，妊娠期间每100人月的哮喘特异性住院率增加30％（95%CI[0.016-0.020]），哮喘相关住院率增加24％（95%CI[0.012-0.015]），非妊娠相关住院率减少37％（95%CI[0.24-0.15]）。怀孕期间，哮喘和哮喘相关急诊就诊率并未显著增加，而哮喘及哮喘相关症状门诊就诊率分别下降19％（95%CI[2.20-1.79]）和10%（95%CI[9.44-8.47]），非妊娠相关症状门诊就诊率增加77％（95%CI[5.64-9.82]）。怀孕期间哮喘和哮喘相关住院率增加，表明与非妊娠相关门诊就诊率的增加可能不能满足哮喘孕妇的初级保健需求。
Asthma Health Services Utilization Before, During, and After Pregnancy: A Population-Based Cohort Study.
To T, et al. Eur Respir J. 2018 Mar 8.
Abstract
During pregnancy, women with asthma may be at higher risk of exacerbation. The objective of this study was to determine whether women with asthma in Ontario, Canada have increased health services utilization (HSU) during pregnancy. Rates of asthma-specific, asthma-related and non-pregnancy-related HSU were calculated in a population-based cohort of pregnant women with asthma. Poisson regression with repeated measures was used to determine adjusted rate ratios and 95% confidence intervals of HSU during and one year after pregnancy, compared to the year before pregnancy.The cohort consisted of 103,976 women. Compared to the year prior to pregnancy, hospitalization rates per 100 person-months during pregnancy increased 30% for asthma (0.016 to 0.020), 24% for asthma-related conditions (0.012 to 0.015) and decreased 37% for non-pregnancy-related conditions (0.24 to 0.15). Emergency department visits for asthma and asthma-related conditions did not significantly increase during pregnancy. During pregnancy, physician office visits decreased 19% for asthma (2.20 to 1.79), 10% for asthma-related conditions (9.44 to 8.47) and increased 77% for non-pregnancy-related conditions (5.64 to 9.82).Hospitalizations for asthma and asthma-related conditions increased during pregnancy, demonstrating that the overall increase in non- pregnancy-related physician office visits may not meet the primary care needs of pregnant women with asthma.
患有哮喘的女性在孕期可能会有较高的急性加重风险。这项研究的目的是明确加拿大Ontario地区的女性哮喘患者在怀孕期间是否增加了医疗服务利用率（HSU）。在基于人群的哮喘孕妇队列中，计算其哮喘特异性，哮喘相关和非妊娠相关HSU的比例。应用重复测量的Poisson回归来确定与怀孕前一年相比，妊娠期间和产后一年的HSU的调整率比（ARR）和95％置信区间。该队列由103976名女性组成。与怀孕前一年相比，妊娠期间每100人月的哮喘特异性住院率增加30％（95%CI[0.016-0.020]），哮喘相关住院率增加24％（95%CI[0.012-0.015]），非妊娠相关住院率减少37％（95%CI[0.24-0.15]）。怀孕期间，哮喘和哮喘相关急诊就诊率并未显著增加，而哮喘及哮喘相关症状门诊就诊率分别下降19％（95%CI[2.20-1.79]）和10%（95%CI[9.44-8.47]），非妊娠相关症状门诊就诊率增加77％（95%CI[5.64-9.82]）。怀孕期间哮喘和哮喘相关住院率增加，表明与非妊娠相关门诊就诊率的增加可能不能满足哮喘孕妇的初级保健需求。
(中国医科大学附属第一医院呼吸与危重症医学科 李文扬 摘译 杨冬 审校)
(To T, et al. Eur Respir J. 2018 Mar 8. )
(To T, et al. Eur Respir J. 2018 Mar 8. )
Asthma Health Services Utilization Before, During, and After Pregnancy: A Population-Based Cohort Study.
To T, et al. Eur Respir J. 2018 Mar 8.
Abstract
During pregnancy, women with asthma may be at higher risk of exacerbation. The objective of this study was to determine whether women with asthma in Ontario, Canada have increased health services utilization (HSU) during pregnancy. Rates of asthma-specific, asthma-related and non-pregnancy-related HSU were calculated in a population-based cohort of pregnant women with asthma. Poisson regression with repeated measures was used to determine adjusted rate ratios and 95% confidence intervals of HSU during and one year after pregnancy, compared to the year before pregnancy.The cohort consisted of 103,976 women. Compared to the year prior to pregnancy, hospitalization rates per 100 person-months during pregnancy increased 30% for asthma (0.016 to 0.020), 24% for asthma-related conditions (0.012 to 0.015) and decreased 37% for non-pregnancy-related conditions (0.24 to 0.15). Emergency department visits for asthma and asthma-related conditions did not significantly increase during pregnancy. During pregnancy, physician office visits decreased 19% for asthma (2.20 to 1.79), 10% for asthma-related conditions (9.44 to 8.47) and increased 77% for non-pregnancy-related conditions (5.64 to 9.82).Hospitalizations for asthma and asthma-related conditions increased during pregnancy, demonstrating that the overall increase in non- pregnancy-related physician office visits may not meet the primary care needs of pregnant women with asthma.
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哮喘患者的黏液栓塞与嗜酸性粒细胞增多和气流阻塞有关
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在症状未控制的持续哮喘患者中吸入性糖皮质激素联合长效毒蕈碱受体拮抗剂与哮喘控制的关系：一项系统性回顾 Meta 分析
