短效β2-激动剂处方与哮喘的不良临床结果有关：多国、横断面SABINA Ⅲ 研究
2022/06/17
摘要
背景：为了获得关于短效β2-激动剂（SABA）处方和哮喘患者相关的临床结果的全球视角，我们评估了五大洲24个国家的初级卫生数据。
方法：SABINA Ⅲ 是一项横断面研究，在研究访问（初级或专家护理）时采用电子病例报告表，记录过去12个月内哮喘患者（≥12岁）的处方药、非处方药（OTC）SABA购买情况和临床结果。对于有≥1个SABA处方的患者中，使用多变量回归模型分析了SABA与哮喘症状控制和严重恶化的关系。
结果：在招募的8351名患者中（n=6872，专科；n=1440，初级保健），76.5%有中度至重度哮喘，45.4%在过去12个月中经历了≥1次严重恶化。38%的患者获得了≥3个SABA装置的处方；18.0%的患者购买了OTC SABA，其中76.8%的患者也获得了SABA处方。（与1-2个相比）开具3-5、6-9、10-12和≥13个SABA装置的处方与哮喘控制率或部分控制率的越来越低相关（调整后的OR分别为 0.64（95% CI 0.53-0.78）、0.49（95% CI 0.39-0.61）、0.42（95% CI 0.34-0.51）和0.33（95%CI 0.25-0.45）；n=4597），且与较高的严重恶化率相关（调整后的发病率比分别为1.40（95%CI 1.24-1.58），1.52（95%CI 1.33-1.74），1.78（95%CI 1.57-2.02）和1.92（95%CI 1.61-2.29）；n=4612）。
结论：这项研究表明，在广泛的国家、医疗环境和哮喘严重程度中，SABA的高处方与不良的临床结果之间存在关联，为通过减少SABA的过度依赖来改善哮喘发病率的倡议提供参考依据。
Short-acting β 2-agonist prescriptions are associated with poor clinical outcomes of asthma: the multi-country, cross-sectional SABINA III study.
Bateman, E. D., Price, D. B., Wang, H. C., Khattab, A., Schonffeldt, P., Catanzariti, A., van der Valk, R., & Beekman, M
Abstract
BACKGROUND：To gain a global perspective on short-acting β2-agonist (SABA) prescriptions and associated asthma-related clinical outcomes in patients with asthma, we assessed primary health data across 24 countries in five continents.
METHODS：SABINA III was a cross-sectional study that employed electronic case report forms at a study visit (in primary or specialist care) to record prescribed medication(s), over-the-counter (OTC) SABA purchases and clinical outcomes in asthma patients (≥12 years old) during the past 12 months. In patients with ≥1 SABA prescriptions, associations of SABA with asthma symptom control and severe exacerbations were analysed using multivariable regression models.
RESULTS：Of 8351 patients recruited (n=6872, specialists; n=1440, primary care), 76.5% had moderate-to-severe asthma and 45.4% experienced ≥1 severe exacerbations in the past 12 months. 38% of patients were prescribed ≥3 SABA canisters; 18.0% purchased OTC SABA, of whom 76.8% also received SABA prescriptions. Prescriptions of 3-5, 6-9, 10-12 and ≥13 SABA canisters (versus 1-2) were associated with increasingly lower odds of controlled or partly controlled asthma (adjusted OR 0.64 (95% CI 0.53-0.78), 0.49 (95% CI 0.39-0.61), 0.42 (95% CI 0.34-0.51) and 0.33 (95% CI 0.25-0.45), respectively; n=4597) and higher severe exacerbation rates (adjusted incidence rate ratio 1.40 (95% CI 1.24-1.58), 1.52 (95% CI 1.33-1.74), 1.78 (95% CI 1.57-2.02) and 1.92 (95% CI 1.61-2.29), respectively; n=4612).
CONCLUSION：This study indicates an association between high SABA prescriptions and poor clinical outcomes across a broad range of countries, healthcare settings and asthma severities, providing support for initiatives to improve asthma morbidity by reducing SABA overreliance.
背景：为了获得关于短效β2-激动剂（SABA）处方和哮喘患者相关的临床结果的全球视角，我们评估了五大洲24个国家的初级卫生数据。
方法：SABINA Ⅲ 是一项横断面研究，在研究访问（初级或专家护理）时采用电子病例报告表，记录过去12个月内哮喘患者（≥12岁）的处方药、非处方药（OTC）SABA购买情况和临床结果。对于有≥1个SABA处方的患者中，使用多变量回归模型分析了SABA与哮喘症状控制和严重恶化的关系。
结果：在招募的8351名患者中（n=6872，专科；n=1440，初级保健），76.5%有中度至重度哮喘，45.4%在过去12个月中经历了≥1次严重恶化。38%的患者获得了≥3个SABA装置的处方；18.0%的患者购买了OTC SABA，其中76.8%的患者也获得了SABA处方。（与1-2个相比）开具3-5、6-9、10-12和≥13个SABA装置的处方与哮喘控制率或部分控制率的越来越低相关（调整后的OR分别为 0.64（95% CI 0.53-0.78）、0.49（95% CI 0.39-0.61）、0.42（95% CI 0.34-0.51）和0.33（95%CI 0.25-0.45）；n=4597），且与较高的严重恶化率相关（调整后的发病率比分别为1.40（95%CI 1.24-1.58），1.52（95%CI 1.33-1.74），1.78（95%CI 1.57-2.02）和1.92（95%CI 1.61-2.29）；n=4612）。
结论：这项研究表明，在广泛的国家、医疗环境和哮喘严重程度中，SABA的高处方与不良的临床结果之间存在关联，为通过减少SABA的过度依赖来改善哮喘发病率的倡议提供参考依据。
(中日友好医院呼吸与危重症医学科 沈焜路 摘译 林江涛 审校)
(Eur Respir J. 2022 May 5;59(5):2101402. DOI: 10.1183/13993003.01402-2021)
(Eur Respir J. 2022 May 5;59(5):2101402. DOI: 10.1183/13993003.01402-2021)
Short-acting β 2-agonist prescriptions are associated with poor clinical outcomes of asthma: the multi-country, cross-sectional SABINA III study.
Bateman, E. D., Price, D. B., Wang, H. C., Khattab, A., Schonffeldt, P., Catanzariti, A., van der Valk, R., & Beekman, M
Abstract
BACKGROUND：To gain a global perspective on short-acting β2-agonist (SABA) prescriptions and associated asthma-related clinical outcomes in patients with asthma, we assessed primary health data across 24 countries in five continents.
METHODS：SABINA III was a cross-sectional study that employed electronic case report forms at a study visit (in primary or specialist care) to record prescribed medication(s), over-the-counter (OTC) SABA purchases and clinical outcomes in asthma patients (≥12 years old) during the past 12 months. In patients with ≥1 SABA prescriptions, associations of SABA with asthma symptom control and severe exacerbations were analysed using multivariable regression models.
RESULTS：Of 8351 patients recruited (n=6872, specialists; n=1440, primary care), 76.5% had moderate-to-severe asthma and 45.4% experienced ≥1 severe exacerbations in the past 12 months. 38% of patients were prescribed ≥3 SABA canisters; 18.0% purchased OTC SABA, of whom 76.8% also received SABA prescriptions. Prescriptions of 3-5, 6-9, 10-12 and ≥13 SABA canisters (versus 1-2) were associated with increasingly lower odds of controlled or partly controlled asthma (adjusted OR 0.64 (95% CI 0.53-0.78), 0.49 (95% CI 0.39-0.61), 0.42 (95% CI 0.34-0.51) and 0.33 (95% CI 0.25-0.45), respectively; n=4597) and higher severe exacerbation rates (adjusted incidence rate ratio 1.40 (95% CI 1.24-1.58), 1.52 (95% CI 1.33-1.74), 1.78 (95% CI 1.57-2.02) and 1.92 (95% CI 1.61-2.29), respectively; n=4612).
CONCLUSION：This study indicates an association between high SABA prescriptions and poor clinical outcomes across a broad range of countries, healthcare settings and asthma severities, providing support for initiatives to improve asthma morbidity by reducing SABA overreliance.
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过敏原免疫疗法有效降低季节性和常年性过敏性哮喘急性加重和下呼吸道感染的风险：一项全国性流行病学研究
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