经支气管热成形术治疗成人哮喘急性发作的减少
2023/05/25
摘要
背景：支气管热成形术（BT）在随机对照试验中被证明是有效的，该试验针对的是那些通过大剂量吸入皮质类固醇联合支气管扩张剂未能实现疾病控制的严重哮喘患者。然而，BT在现实世界临床环境中的有效性，尤其是在亚洲人群中的有效率尚未确定。
目的：利用全国数据库评估BT的有效性。
方法：使用日本诊断程序组合数据库中的住院和门诊数据，我们应用自我控制的病例系列设计来评估BT 1年前后住院和急诊的综合结果以及全身皮质类固醇剂量的变化。我们还根据患者的情况进行了亚组分析。
结果：在2014年9月至2020年3月期间接受BT治疗的561名哮喘患者中，分析了102名至少有一种结果的患者。BT与入院和急诊综合结果的改善显著相关（发病率比为0.53；95%置信区间为0.44-0.64）。BT治疗后全身皮质类固醇使用减少（1931.5[1341.2-3725.3]mg至641.3[1342.2-1691.1]mg/人年（p＜0.001））。在亚组分析的综合结果中，BT在年龄>65岁的老年人和体重指数较高（>25 kg/m2）的人中往往效果较差。
结论：目前使用真实世界数据的研究表明，BT可以改善哮喘控制，但BT的有效性可能因患者基线情况而异。
Reduced asthma exacerbations in adult patients treated with bronchial thermoplasty
Tomohiro Akaba, Taisuke Jo, Masao Iwagami, Yohei Hashimoto, Hiroki Matsui, Kiyohide Fushimi, Etsuko Tagaya, Hideo Yasunaga
Abstract
Background: Bronchial thermoplasty (BT) has been shown to be effective in randomized controlled trials of patients with severe asthma who failed to achieve disease control with high-dose inhaled corticosteroids combined with bronchodilators. However, the effectiveness of BT in real-world clinical settings, especially among the Asian population has not been determined.
Objective: To evaluate the effectiveness of BT using a nationwide database.
Methods: Using the inpatient and outpatient data from the Japanese Diagnosis Procedure Combination database, we applied a self-controlled case series design to evaluate changes in the composite outcome of hospital admissions and emergency department visits, as well as systemic corticosteroid dose, between 1 year before and after BT. We also conducted subgroup analyses based on patients' profiles.
Results: Among the 561 patients with asthma who underwent BT treatment between September 2014 and March 2020, 102 patients with at least one outcome were analyzed. BT was significantly associated with an improvement in the composite outcome of hospital admission and emergency department visits (incidence rate ratio, 0.53; 95% confidence interval, 0.44-0.64). Systemic corticosteroid use was reduced after BT sessions (1931.5 [1341.2-3725.3] mg to 641.3 [134.2-1691.1] mg per person-year (p<0.001)). Although all groups showed a significant improvement in the composite outcome in the subgroup analyses, BT tended to be less effective among older people aged > 65 years and those with higher body mass index (> 25 kg/m2).
Conclusion: The present study using real-world data suggests that BT may improve asthma control, however the effectiveness of BT can vary depending on patient baseline profiles.
背景：支气管热成形术（BT）在随机对照试验中被证明是有效的，该试验针对的是那些通过大剂量吸入皮质类固醇联合支气管扩张剂未能实现疾病控制的严重哮喘患者。然而，BT在现实世界临床环境中的有效性，尤其是在亚洲人群中的有效率尚未确定。
目的：利用全国数据库评估BT的有效性。
方法：使用日本诊断程序组合数据库中的住院和门诊数据，我们应用自我控制的病例系列设计来评估BT 1年前后住院和急诊的综合结果以及全身皮质类固醇剂量的变化。我们还根据患者的情况进行了亚组分析。
结果：在2014年9月至2020年3月期间接受BT治疗的561名哮喘患者中，分析了102名至少有一种结果的患者。BT与入院和急诊综合结果的改善显著相关（发病率比为0.53；95%置信区间为0.44-0.64）。BT治疗后全身皮质类固醇使用减少（1931.5[1341.2-3725.3]mg至641.3[1342.2-1691.1]mg/人年（p＜0.001））。在亚组分析的综合结果中，BT在年龄>65岁的老年人和体重指数较高（>25 kg/m2）的人中往往效果较差。
结论：目前使用真实世界数据的研究表明，BT可以改善哮喘控制，但BT的有效性可能因患者基线情况而异。
(中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校)
(J Allergy Clin Immunol Pract. 2023 May 9;S2213-2198(23)00480-4. doi: 10.1016/j.jaip.2023.04.036.)
(J Allergy Clin Immunol Pract. 2023 May 9;S2213-2198(23)00480-4. doi: 10.1016/j.jaip.2023.04.036.)
Reduced asthma exacerbations in adult patients treated with bronchial thermoplasty
Tomohiro Akaba, Taisuke Jo, Masao Iwagami, Yohei Hashimoto, Hiroki Matsui, Kiyohide Fushimi, Etsuko Tagaya, Hideo Yasunaga
Abstract
Background: Bronchial thermoplasty (BT) has been shown to be effective in randomized controlled trials of patients with severe asthma who failed to achieve disease control with high-dose inhaled corticosteroids combined with bronchodilators. However, the effectiveness of BT in real-world clinical settings, especially among the Asian population has not been determined.
Objective: To evaluate the effectiveness of BT using a nationwide database.
Methods: Using the inpatient and outpatient data from the Japanese Diagnosis Procedure Combination database, we applied a self-controlled case series design to evaluate changes in the composite outcome of hospital admissions and emergency department visits, as well as systemic corticosteroid dose, between 1 year before and after BT. We also conducted subgroup analyses based on patients' profiles.
Results: Among the 561 patients with asthma who underwent BT treatment between September 2014 and March 2020, 102 patients with at least one outcome were analyzed. BT was significantly associated with an improvement in the composite outcome of hospital admission and emergency department visits (incidence rate ratio, 0.53; 95% confidence interval, 0.44-0.64). Systemic corticosteroid use was reduced after BT sessions (1931.5 [1341.2-3725.3] mg to 641.3 [134.2-1691.1] mg per person-year (p<0.001)). Although all groups showed a significant improvement in the composite outcome in the subgroup analyses, BT tended to be less effective among older people aged > 65 years and those with higher body mass index (> 25 kg/m2).
Conclusion: The present study using real-world data suggests that BT may improve asthma control, however the effectiveness of BT can vary depending on patient baseline profiles.
上一篇：
高强度间歇训练对哮喘患者吸入糖皮质激素剂量的影响：一项随机对照试验
下一篇：
按需使用SABA单药治疗的哮喘患者的小气道功能障碍:一场完美风暴
