哮喘联合治疗的有效性：一项观察性研究
2009/03/02
背景：哮喘指南建议，对于低到中等剂量激素吸入仍未完全控制的哮喘患者，可将长效β受体激动剂纳入其治疗方案。我们比较了临床实际应用的两套联合治疗方案的有效性.
方法：我们从临床上选取2001年5月以后开始采用布地奈德/福莫特罗或氟替卡松/沙美特罗治疗的哮喘患者。比较了患者次年的哮喘药物治疗和健康保健情况。
结果：第一次使用布地奈德/福莫特罗和氟替卡松/沙美特罗的患者分别为6918例和16157例。随访发现，两组在哮喘的住院治疗(23和25次/1000每年)和就诊次数上无明显差异。在病情加重、或需要不同的或额外的抗炎治疗之前，这段时间定义为治疗有效的持续时间，两组在持续时间上相似，约为8.6个月。布地奈德/福莫特罗组的平均持续治疗时间较对应组长13％(95％可信区间11-16％)，布地奈德/福莫特罗联合治疗组患者的开药次数较对应组少11％(95％可信区间9-13％)。氟替卡松/沙美特罗使用者较少进行专家咨询。
结论：我们发现布地奈德/福莫特罗和氟替卡松/沙美特罗联合用药治疗哮喘具有相似的有效性。该结论基于相对低剂量的布地奈德/福莫特罗联合激素吸入治疗。
（刘国梁审校）
Suissa S, et al. Pulm Pharmacol Ther. 2008 Nov 28. [Epub ahead of print]
Effectiveness of combination therapies in asthma: An observational study.
Suissa S, Dell’aniello S, Ernst P.
McGill Pharmacoepidemiology Research Unit, McGill University Health Centre, Montreal, Canada.
BACKGROUND: Asthma guidelines suggest that a long-acting beta-agonist be added to the treatment regimen of patients not adequately controlled on a low to moderate dose of inhaled corticosteroids. We compared the effectiveness in a real world setting of two such combinations available in a single inhaler.
METHODS: We identified patients initiating therapy with either budesonide/formoterol or fluticasone/salmeterol after May 2001 in a clinical database. We compared asthma medication and health care utilisation over the subsequent year.
RESULTS: There were 6918 first-time users of budesonide/formoterol and 16,157 of fluticasone/salmeterol. Overall, there were no differences between the two treatment groups in hospitalisations for asthma (23 and 25 per 1000 per year) or visits to the physician during follow-up. Duration of treatment success defined as the time to occurrence of an exacerbation or the need for different or additional anti-inflammatory therapy was also similar in both groups at approximately 8.6months. The mean duration of persistent treatment was 13% longer with budesonide/formoterol (95% CI 11-16%), during which budesonide/formoterol subjects received 11% less prescriptions for their combination therapy (95% CI 9-13%). Fluticasone/salmeterol users were less likely to require referral to a specialist.
CONCLUSION: We found similar effectiveness for the budesonide/formoterol and fluticasone/salmeterol combinations. Such equivalence appears to be obtained at lower relative doses of inhaled corticosteroids with the budesonide/formoterol combination.
