Snyder Laurie, Blanc Paul D, Katz Patricia P, Yelin Edward H, Eisner Mark D
Department of Medicine, University of California, San Francisco, 94117, USA.
Arch Intern Med. 2004 Mar 22;164(6):617-22. doi: 10.1001/archinte.164.6.617.
The introduction of leukotriene modifiers, the first novel class of medications for asthma in more than 2 decades, provided an opportunity to evaluate the clinical context in which patients receive new treatments. Because milder asthma is usually controllable with more familiar medications, we hypothesized that adults with asthma would receive leukotriene modifiers for more severe disease.
We conducted a prospective, longitudinal, 18-month cohort study of 349 patients with asthma. We evaluated the association of baseline self-reported medication use and measures of asthma severity. We also examined the impact of baseline measurement of asthma severity on incident leukotriene modifier use at follow-up.
At baseline, 39 (11%) of 349 patients reported leukotriene modifier use during the previous 2 weeks (95% confidence interval [CI], 8%-15%). Adults with asthma who reported recent use of leukotriene modifiers were more likely to indicate use of other long-term controller medications for asthma, such as inhaled corticosteroids (80% vs 57%;P =.007). Leukotriene modifier use was also associated with poorer severity-of-asthma scores (mean score difference, 3.6 points; 95% CI, 1.7-5.2 points) and asthma-specific health-related quality of life (mean score difference, 8.1 points; 95% CI, 3.4-12.8 points). Leukotriene modifier users were also more likely to indicate a recent emergency department visit (odds ratio [OR], 2.3; 95% CI, 0.9-5.6) or hospitalization for asthma (OR, 4.1; 95% CI, 1.4-11.4). Greater baseline asthma severity was associated with an increased probability of new-onset leukotriene modifier use during 18-month follow-up. Poorer baseline severity-of-asthma scores and asthma-specific quality-of-life scores were related to a greater likelihood of leukotriene modifier use at follow-up (OR per SD-sized score increment, 2.0; 95% CI, 1.4-2.7; OR, 1.8; 95% CI, 1.3-2.5; respectively). Recent hospitalization for asthma at baseline was also associated with a greater likelihood of leukotriene modifier use at follow-up (OR, 4.9; 95% CI, 1.6-14.8).
Adults with asthma who receive leukotriene modifiers have more severe asthma.
白三烯调节剂是20多年来首个用于哮喘治疗的新型药物类别，它为评估患者接受新治疗的临床背景提供了契机。由于症状较轻的哮喘通常使用更为常见的药物即可控制，我们推测哮喘成人患者使用白三烯调节剂是用于治疗更严重的疾病。
我们对349例哮喘患者进行了一项为期18个月的前瞻性纵向队列研究。我们评估了基线时自我报告的药物使用情况与哮喘严重程度指标之间的关联。我们还研究了基线哮喘严重程度测量对随访时白三烯调节剂使用情况的影响。
在基线时，349例患者中有39例（11%）报告在过去2周内使用过白三烯调节剂（95%置信区间[CI]，8%-15%）。报告近期使用过白三烯调节剂的哮喘成人患者更有可能表示使用过其他哮喘长期控制药物，如吸入性糖皮质激素（80%对57%；P = 0.007）。白三烯调节剂的使用还与较差的哮喘严重程度评分（平均评分差异，3.6分；95% CI，1.7-5.2分）以及哮喘特异性健康相关生活质量（平均评分差异，8.1分；95% CI，3.4-12.8分）相关。白三烯调节剂使用者也更有可能表示近期去过急诊科（比值比[OR]，2.3；95% CI，0.9-5.6）或因哮喘住院（OR，4.1；95% CI，1.4-11.4）。更高的基线哮喘严重程度与18个月随访期间开始使用白三烯调节剂的可能性增加相关。较差
