哮喘联盟

   摘要
   背景：很少有关于哮喘急性发作随时间的自然病程数据。
   目的：在一项成人持续性哮喘大型队列研究中，旨在评估为期超过5年的哮喘急性发作事件的频率和危险因素。
   方法：纳入来自Truven健康市场扫描数据库的医疗保险索赔的2543例患者，在2006～2011年具有全部医疗和药物索赔。这些患者在指数年(2006年)未同时患有慢性阻塞性肺部疾病，且在指数年接受至少120天的高剂量吸入糖皮质激素和长效β2受体激动剂治疗(高强度治疗)。本回顾性分析旨在评估随时间的重度急性发作(接受医疗保健和激素冲击治疗)模式及其与其它健康状况处理措施的相关性。
   结果：尽管接受了高强度的哮喘治疗，但哮喘急性发作的总发生率随时间仅有很小的下降；而对于哮喘住院患者，发生率则无显著的时间趋势。过去一年中一次急性发作可增加8倍的急性发作风险(比值比7.8 [95% CI, 7.1-8.6])。急性发作风险增加50%(比值比1.5 [95% CI, 1.4-1.6])与整个研究期间持续高强度治疗相关。在指数年后伴有慢性阻塞性肺部疾病患者急性发作风险增加60%。
   结论：本研究显示在真实世界机构中哮喘患者急性发作率随时间仍然保持相对稳定，且持续高强度治疗与大幅度降低急性发作风险并无关联性。
 

（林江涛 审校）
JAllergyClinImmunolPract.2014Sep-Oct;2(5):570-574.e1.doi:10.1016/j.jaip.2014.05.002. Epub 2014 Jul 3.


 

Asthma exacerbation rates in adults are unchanged over a 5-year period despite high-intensity therapy.
 

Schatz M1, Meckley LM2, Kim M3, Stockwell BT3, Castro M4.
 

Abstract
BACKGROUND: Few data exist regarding the natural history of asthma exacerbations over time.
OBJECTIVE: To evaluate the frequency and risk factors of asthma exacerbation occurrence over a 5-year period in a large cohort of adult patients with persistent asthma.
METHODS: Health insurance claims from the Truven Health MarketScan database were analyzed for 2543 patients who had full medical and drug claims for years 2006 to 2011, did not have co-occurring chronic obstructive pulmonary disease in the index year (2006), and were treated with high-dose inhaled corticosteroids and long-acting β2-agonists for at least 120 days ("high intensity" therapy) in the index year. A retrospective analysis was conducted to assess the pattern of severe exacerbations (encounter with health care system and steroid burst) over time and their associations with the other measures of health status.
RESULTS: Despite the use of high-intensity asthma therapy, there was only a small decrease in total asthma exacerbations over time, but no significant time trend for asthma hospitalizations. An exacerbation in the prior year increased the risk for exacerbations almost 8-fold, (odds ratio 7.8 [95% CI, 7.1-8.6]). A 50% increase in exacerbation risk (odds ratio 1.5 [95% CI, 1.4-1.6]) was associated with continued high-intensity treatment for the duration of the study. Patients with encounters of chronic obstructive pulmonary disease after the index year were at 60% increased risk of an exacerbation.
CONCLUSIONS: This study showed that exacerbation rates for patients with asthma in a real-world setting remained relatively constant over time, and continuous high treatment intensity was not associated with a substantially lower risk of exacerbations.
 

JAllergyClinImmunolPract.2014Sep-Oct;2(5):570-574.e1.doi:10.1016/j.jaip.2014.05.002. Epub 2014 Jul 3.