哮喘急性发作后早期和晚期采用丙酸氟替卡松/沙美特罗治疗的回顾性比较研究
2011/10/13
摘要
背景：糖皮质激素吸入治疗哮喘的优势已经明确。哮喘急性发作后早期使用吸入性抗炎药物可能对患者有益。
方法：本项回顾性队列研究比较初始哮喘相关急性发作后90天内采用单个吸入器(FSC)吸入丙酸氟替卡松/沙美特罗治疗的患者与哮喘急性发作后后期（晚期治疗）治疗的患者间哮喘相关恶化（住院、急诊就医和/或全身激素治疗）的风险。数据来自于1998年1月至2008年4月间一项大型健康保险理赔数据库。入选患者为第一次哮喘相关恶化≤ 1年内采用FSC治疗≥1次的患者。根据倾向得分，将早期治疗患者与晚期治疗患者进行匹配，基于FSC治疗后的卫生资源使用和开支进行比较。
结果：共计14861患者满足入选标准，10793名患者采用早期治疗，4068名患者采用晚期治疗。匹配后，3555对患者在预处理特征和随访时间上匹配(平均：722 vs. 717天, p =0 .634)。与晚期治疗相比，早期治疗与较长的哮喘相关恶化时间（危险比：0.82, 95% CI 0.75-0.88, p <0.001）、较少的短效β激动剂治疗(3.3 vs. 3.6, p =0.031)、每位患者每年的药物开支较高($1320 vs. $1163, p =0.008)、每年每位患者哮喘相关急诊就诊开支降低($80 vs. $105, p =0.032)相关。总的每年每位患者哮喘相关开支相似($2197 vs. $2064, p =0.203)。
结论：哮喘急性发作后早期使用FSC能减少未来哮喘相关发作，减少缓解药物的使用。
背景：糖皮质激素吸入治疗哮喘的优势已经明确。哮喘急性发作后早期使用吸入性抗炎药物可能对患者有益。
方法：本项回顾性队列研究比较初始哮喘相关急性发作后90天内采用单个吸入器(FSC)吸入丙酸氟替卡松/沙美特罗治疗的患者与哮喘急性发作后后期（晚期治疗）治疗的患者间哮喘相关恶化（住院、急诊就医和/或全身激素治疗）的风险。数据来自于1998年1月至2008年4月间一项大型健康保险理赔数据库。入选患者为第一次哮喘相关恶化≤ 1年内采用FSC治疗≥1次的患者。根据倾向得分，将早期治疗患者与晚期治疗患者进行匹配，基于FSC治疗后的卫生资源使用和开支进行比较。
结果：共计14861患者满足入选标准，10793名患者采用早期治疗，4068名患者采用晚期治疗。匹配后，3555对患者在预处理特征和随访时间上匹配(平均：722 vs. 717天, p =0 .634)。与晚期治疗相比，早期治疗与较长的哮喘相关恶化时间（危险比：0.82, 95% CI 0.75-0.88, p <0.001）、较少的短效β激动剂治疗(3.3 vs. 3.6, p =0.031)、每位患者每年的药物开支较高($1320 vs. $1163, p =0.008)、每年每位患者哮喘相关急诊就诊开支降低($80 vs. $105, p =0.032)相关。总的每年每位患者哮喘相关开支相似($2197 vs. $2064, p =0.203)。
结论：哮喘急性发作后早期使用FSC能减少未来哮喘相关发作，减少缓解药物的使用。
(林江涛 审校)
J Asthma. 2011 Sep;48(7):721-8. Epub 2011 Jul 28.
J Asthma. 2011 Sep;48(7):721-8. Epub 2011 Jul 28.
Retrospective Comparison of Early versus Late Treatment with Fluticasone Propionate/Salmeterol After an Asthma Exacerbation.
Hagiwara M, Delea TE, Stanford RH.
Hagiwara M, Delea TE, Stanford RH.
Source
Policy Analysis Inc. (PAI) , Brookline, MA , USA.
Policy Analysis Inc. (PAI) , Brookline, MA , USA.
Abstract
BACKGROUND： The benefits of inhaled corticosteroids in asthma are well established. Early use of inhaled anti-inflammatories following and exacerbation could be beneficial.
METHODS： A retrospective observational cohort study compared the risk of asthma-related exacerbations [hospitalization, emergency department visit, and/or treatment with systemic corticosteroid] in patients receiving treatment with fluticasone propionate/salmeterol in a single inhaler (FSC) within 90 days following an initial asthma-related exacerbation (early treatment) versus patients receiving the treatment subsequently (late treatment). Data were from a large health insurance claims database spanning from January 1998 to April 2008. Subjects included patients with ≥1 prescription for FSC ≤ 1 year after first asthma-related exacerbation. Patients with early treatment were matched to those with late treatment by propensity score and compared in terms of healthcare utilization and costs after initiation of FSC.
RESULTS： A total of 14,861 patients met study inclusion criteria, including 10,793 early and 4068 late treatment patients. After matching, 3555 pairs were well matched on all pretreatment characteristics and duration of follow-up (mean 722 vs. 717 days, p = .634). Early versus late treatment was associated with longer time to first asthma-related exacerbation (hazard ratio = 0.82, 95% CI 0.75-0.88, p < .001), fewer short-acting β-agonists prescriptions (3.3 vs. 3.6, p = .031), higher outpatient yearly per patient pharmacy costs ($1320 vs. $1163, p = .008), and lower yearly per patient asthma-related emergency department visit costs ($80 vs. $105, p = .032). Total yearly per patient asthma-related costs were similar ($2197 vs. $2064, p = .203).
CONCLUSIONS： Earlier use of FSC following an asthma exacerbation was associated with reduced risk of future asthma-related exacerbation and lower use of rescue medications.
BACKGROUND： The benefits of inhaled corticosteroids in asthma are well established. Early use of inhaled anti-inflammatories following and exacerbation could be beneficial.
METHODS： A retrospective observational cohort study compared the risk of asthma-related exacerbations [hospitalization, emergency department visit, and/or treatment with systemic corticosteroid] in patients receiving treatment with fluticasone propionate/salmeterol in a single inhaler (FSC) within 90 days following an initial asthma-related exacerbation (early treatment) versus patients receiving the treatment subsequently (late treatment). Data were from a large health insurance claims database spanning from January 1998 to April 2008. Subjects included patients with ≥1 prescription for FSC ≤ 1 year after first asthma-related exacerbation. Patients with early treatment were matched to those with late treatment by propensity score and compared in terms of healthcare utilization and costs after initiation of FSC.
RESULTS： A total of 14,861 patients met study inclusion criteria, including 10,793 early and 4068 late treatment patients. After matching, 3555 pairs were well matched on all pretreatment characteristics and duration of follow-up (mean 722 vs. 717 days, p = .634). Early versus late treatment was associated with longer time to first asthma-related exacerbation (hazard ratio = 0.82, 95% CI 0.75-0.88, p < .001), fewer short-acting β-agonists prescriptions (3.3 vs. 3.6, p = .031), higher outpatient yearly per patient pharmacy costs ($1320 vs. $1163, p = .008), and lower yearly per patient asthma-related emergency department visit costs ($80 vs. $105, p = .032). Total yearly per patient asthma-related costs were similar ($2197 vs. $2064, p = .203).
CONCLUSIONS： Earlier use of FSC following an asthma exacerbation was associated with reduced risk of future asthma-related exacerbation and lower use of rescue medications.
J Asthma. 2011 Sep;48(7):721-8. Epub 2011 Jul 28.
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瑜伽是否有利于哮喘治疗？随机临床试验的系统综述
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使用活性沙丁胺醇、安慰剂和假针灸或无干预措施来治疗哮喘
