临床联合药物治疗未完全控制的轻度哮喘患者的哮喘发作频率：探索性析因分析
2009/05/22
背景：接受吸入性糖皮质激素（ICS）、长效β受体激动剂（LABA）和孟鲁司特（MON）（ICS/LABA/MON）联合治疗的哮喘患者与接受ICS/MON 联合治疗的哮喘患者在哮喘发作频率方面可能存在差异。
方法：本项分析是对检测前后的回顾性队列研究进行的析因分析。轻度持续性哮喘和过敏性鼻炎患者除接受MON常规治疗外，还接受ICS单独治疗或与LABA联合治疗。开始治疗后12个月内比较两组患者哮喘和过敏性鼻炎的发作频率。哮喘发作定义为与哮喘有关的住院治疗、急诊就诊或口服激素治疗。
结果：在344名患者中，有181名（53％）患者接受ICS/MON治疗，其余163名（47%）患者接受ICS/LABA/MON治疗，平均治疗时间分别为10.5个月和11.4个月（P<0.05）。ICS/MON组74.6％患者接受短效β受体激动剂治疗，而ICS/LABA/MON组为71.8%（P>0.05）。ICS/MON组和ICS/LABA/MON组的哮喘发作频率分别为4.4%和6.8%（P>0.05）。ICS/LABA/MON组与ICS/MON组相比，哮喘发作频率的校正后优势比为1.24（95％CI，0.35-4.44）。
结论：本文对轻症持续性哮喘和过敏性鼻炎患者的药物治疗进行了观察性研究，在1年的观察期内，LABA/ICS/MON联合治疗与ICS/MON联合治疗对哮喘发作频率无明显差异。
（林江涛 审校）
Dal Negro RW, et al. BMC Pulm Med. 2009 Mar 30;9(1):10. [Epub ahead of print]
Rates of asthma attacks in patients with previously inadequately controlled mild asthma treated in clinical practice with combination drug therapy: an exploratory post-hoc analysis.
BACKGROUND: Differences could exist in the likelihood of asthma attacks in patients treated with inhaled corticosteroid (ICS), long-acting beta-agonist (LABA), and montelukast (MON) (ICS/LABA/MON) and patients treated with an inhaled corticosteroid (ICS) and montelukast (MON) (ICS/MON).
METHODS: This was a post-hoc analysis of a pretest-posttest retrospective cohort study. Patients with mild persistent asthma and allergic rhinitis, who were taking an ICS either alone or in combination with a LABA, started concomitant MON treatment as part of their routine care. Rates of asthma- and allergic rhinitis-related medical resource use in the 12-months after the initial (index) MON prescription were compared in the ICS/MON and ICS/LABA/MON groups. An asthma attack was defined as an asthma-related hospitalization, ER visit, or use of an oral corticosteroid.
RESULTS: Of the total of 344 patients, 181 (53%) received ICS/MON and 163 (47%) received ICS/LABA/MON in the post-index period for means of 10.5 and 11.4 months, respectively, (P<0.05). Short-acting beta-agonists were used by 74.6% in the ICS/MON and 71.8% in the ICS/LABA/MON groups (P>0.05). An asthma attack occurred in 4.4% of the ICS/MON group and 6.8% of the ICS/LABA/MON group (P>0.05). The adjusted odds of an asthma attack in the post-index period in the ICS/LABA/MON group relative to the ICS/MON group was 1.24, 95% confidence interval 0.35-4.44.
CONCLUSIONS: In this observational study of combination drug treatment of mild persistent asthma and allergic rhinitis, no difference was observed between LABA/ICS/MON combination therapy and the ICS/MON combination without LABA use, for the rate of asthma attacks over one year.
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