美国哮喘患者季度性评价短效β2肾上腺素能激动剂的使用是后期卫生资源使用的一个预测因素
2010/09/14
摘要
目的：对哮喘患者每年1次的风险评估并不能解释哮喘变异的特点。本试验旨在研究短效β2肾上腺素能激动剂（SABA）的使用过度（季度性评价）是否与随后一个季度的哮喘恶化有关。
患者与方法：此项回顾性队列分析共计有93604名健康计划项目的参与者入选，年龄为6～56岁，参与该项目至少有2年（2003～2007）。参与者诊断为哮喘，并采用药物治疗。在第一季度，SABA 的使用量（使用计量吸入器或喷雾器）转换为瓶当量（CEs），并将其评分为0、0.5～3、≥3（SABA使用过度）。哮喘恶化风险（随后一个季度的住院、急诊就医或口服激素治疗[OCS]）采用logistic回归分析进行评价。回归模型中的协变量包括年龄、性别、地理区域、共患病、专家咨询、哮喘控制药物使用以及哮喘严重程度。
结果：该队列研究中，33,951名患者年龄为6～17岁（36％），59,653名患者年龄为18～56岁（64％）。64%的患者SABA评分为0 CE；5%的患者SABA评分为>3 CEs。与0 CE 相比，SABA的过度使用（>3 CEs）与住院增加（校正后优势比[OR]: 3.15, 95%CI：1.89-5.27）和急诊就医（校正后OR：3.14, 95% CI: 2.32-4.28）相关。
结论：前一个季度的SABA过度使用与随后季度的哮喘恶化相关。对哮喘患者SABA的使用进行季度性评价有助于鉴别存在哮喘恶化风险的患者。
（陈欣 审校）
J Asthma. 2010 Jul 9. [Epub ahead of print]
Quarterly Assessment of Short-Acting beta(2)-Adrenergic Agonist Use as a Predictor of Subsequent Health Care Use for Asthmatic Patients in the United States
Silver HS, Blanchette CM, Kamble S, Petersen H, Letter M, Meddis D, Gutierrez B.
1Division of Clinical and Outcomes Research, Lovelace Respiratory Research Institute, Albuquerque, New Mexico, U.S.A.
Abstract
Purpose. An annual time frame for risk assessment may not account for the variable course of asthma. The purpose of this study was to determine whether excessive short-acting beta(2)-adrenergic agonist (SABA) dispensed quarterly was associated with asthma exacerbations in the subsequent quarter.
Patients and Methods. This retrospective cohort analysis included 93,604 health plan members aged 6-56 years with >/=2 years of continuous enrollment (2003-2007), an asthma diagnosis, and asthma prescription claims. The amount of SABA dispensed in claims (metered-dose inhaler and nebulized) was converted to canister equivalents (CEs) in the first observation quarter and categorized as 0, 0.5-3, and >/=3 (excessive SABA use). Asthma exacerbation risk (hospitalization, emergency department [ED] visit, or oral corticosteroid [OCS] claim in the subsequent quarter) was assessed using logistic regression. Covariates used in the regression models were age, sex, geographic region, comorbidities, specialist consultation, asthma controller medication use, and asthma severity.
Results. The cohort included 33,951 patients aged 6-17 years (36%) and 59,653 aged 18-56 years (64%); 64% had 0 SABA CE, and 5% had >3 SABA CEs. Compared with 0 CE, excessive SABA use (>3 CEs) was associated with an increased likelihood of hospitalization (adjusted odds ratio [OR]: 3.15, 95% confidence interval [CI]: 1.89-5.27) and an ED/urgent care (UC) visit (adjusted OR: 3.14, 95% CI: 2.32-4.28).
Conclusion: The risk of an asthma exacerbation was associated with excessive SABA use in the previous quarter. Assessment of excessive SABA dispensed during a calendar quarter can be used to identify patients at increased exacerbation risk in the subsequent quarter.
J Asthma. 2010 Jul 9. [Epub ahead of print]
目的：对哮喘患者每年1次的风险评估并不能解释哮喘变异的特点。本试验旨在研究短效β2肾上腺素能激动剂（SABA）的使用过度（季度性评价）是否与随后一个季度的哮喘恶化有关。
患者与方法：此项回顾性队列分析共计有93604名健康计划项目的参与者入选，年龄为6～56岁，参与该项目至少有2年（2003～2007）。参与者诊断为哮喘，并采用药物治疗。在第一季度，SABA 的使用量（使用计量吸入器或喷雾器）转换为瓶当量（CEs），并将其评分为0、0.5～3、≥3（SABA使用过度）。哮喘恶化风险（随后一个季度的住院、急诊就医或口服激素治疗[OCS]）采用logistic回归分析进行评价。回归模型中的协变量包括年龄、性别、地理区域、共患病、专家咨询、哮喘控制药物使用以及哮喘严重程度。
结果：该队列研究中，33,951名患者年龄为6～17岁（36％），59,653名患者年龄为18～56岁（64％）。64%的患者SABA评分为0 CE；5%的患者SABA评分为>3 CEs。与0 CE 相比，SABA的过度使用（>3 CEs）与住院增加（校正后优势比[OR]: 3.15, 95%CI：1.89-5.27）和急诊就医（校正后OR：3.14, 95% CI: 2.32-4.28）相关。
结论：前一个季度的SABA过度使用与随后季度的哮喘恶化相关。对哮喘患者SABA的使用进行季度性评价有助于鉴别存在哮喘恶化风险的患者。
（陈欣 审校）
J Asthma. 2010 Jul 9. [Epub ahead of print]
Quarterly Assessment of Short-Acting beta(2)-Adrenergic Agonist Use as a Predictor of Subsequent Health Care Use for Asthmatic Patients in the United States
Silver HS, Blanchette CM, Kamble S, Petersen H, Letter M, Meddis D, Gutierrez B.
1Division of Clinical and Outcomes Research, Lovelace Respiratory Research Institute, Albuquerque, New Mexico, U.S.A.
Abstract
Purpose. An annual time frame for risk assessment may not account for the variable course of asthma. The purpose of this study was to determine whether excessive short-acting beta(2)-adrenergic agonist (SABA) dispensed quarterly was associated with asthma exacerbations in the subsequent quarter.
Patients and Methods. This retrospective cohort analysis included 93,604 health plan members aged 6-56 years with >/=2 years of continuous enrollment (2003-2007), an asthma diagnosis, and asthma prescription claims. The amount of SABA dispensed in claims (metered-dose inhaler and nebulized) was converted to canister equivalents (CEs) in the first observation quarter and categorized as 0, 0.5-3, and >/=3 (excessive SABA use). Asthma exacerbation risk (hospitalization, emergency department [ED] visit, or oral corticosteroid [OCS] claim in the subsequent quarter) was assessed using logistic regression. Covariates used in the regression models were age, sex, geographic region, comorbidities, specialist consultation, asthma controller medication use, and asthma severity.
Results. The cohort included 33,951 patients aged 6-17 years (36%) and 59,653 aged 18-56 years (64%); 64% had 0 SABA CE, and 5% had >3 SABA CEs. Compared with 0 CE, excessive SABA use (>3 CEs) was associated with an increased likelihood of hospitalization (adjusted odds ratio [OR]: 3.15, 95% confidence interval [CI]: 1.89-5.27) and an ED/urgent care (UC) visit (adjusted OR: 3.14, 95% CI: 2.32-4.28).
Conclusion: The risk of an asthma exacerbation was associated with excessive SABA use in the previous quarter. Assessment of excessive SABA dispensed during a calendar quarter can be used to identify patients at increased exacerbation risk in the subsequent quarter.
J Asthma. 2010 Jul 9. [Epub ahead of print]
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儿童和看护者对哮喘药物使用所陈述和关注的问题
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儿童哮喘联线（Child Asthma Link Line）：联合启动的、基于电话随访的哮喘患儿综合
