Medical Research Institute of New Zealand, Wellington, New Zealand; Capital & Coast District Health Board, Wellington, New Zealand; Division of Respiratory Medicine, School of Clinical Sciences, University of Nottingham, Nottingham, UK.
Clin Exp Allergy. 2013 Oct;43(10):1144-51. doi: 10.1111/cea.12166.
Beta-agonist overuse is associated with adverse outcomes in asthma, however, the relationships between different metrics of salbutamol use and future risk are uncertain.
To investigate the relationship between metrics of salbutamol use and adverse outcome.
In a 24-week randomized controlled trial of 303 asthma patients at risk of severe exacerbations which compared the efficacy and safety of combination budesonide/formoterol inhaler according to a single inhaler regimen (SMART) with a fixed-dose regimen with salbutamol as reliever ('Standard'), actual medication use was measured by electronic monitoring (Australian New Zealand Clinical Trials Registry Number ACTRN12610000515099). A nested cohort study explored the relationship between metrics of baseline salbutamol use over 2 weeks and future severe asthma exacerbations, poor asthma control (ACQ-5 ≥ 1.5) or 'extreme' salbutamol overuse (> 32 salbutamol actuations/24-h period).
Higher mean daily salbutamol use (per two actuations/day) [Odds ratio (OR) (95% CI) 1.24 (1.06-1.46)], higher days of salbutamol use (per 2 days in 2 weeks) [OR 1.15 (1.00-1.31)] and higher maximal 24-h use (per two actuations/day) [OR 1.09 (1.02-1.16)] were associated with future severe exacerbations. Higher mean daily salbutamol use was associated with future poor asthma control [OR 1.13 (1.02-1.26)]. Higher mean daily salbutamol use [OR 2.73 (1.84-4.07)], number of days of use [OR 1.46 (1.24-1.71)], and maximal daily use [OR 1.57 (1.31-1.89)] were associated with an increased risk of future extreme salbutamol overuse.
Electronically recorded frequency of current salbutamol use is a strong predictor of risk of future adverse outcomes in asthma, with average daily use performing the best. These findings provide new information for clinicians considering metrics of salbutamol as predictors of future adverse outcomes in asthma.
β-激动剂的过度使用与哮喘的不良后果有关，然而，不同沙丁胺醇使用指标与未来风险之间的关系尚不确定。
研究沙丁胺醇使用指标与不良结局之间的关系。
在一项为期 24 周、共纳入 303 例有发生严重哮喘加重风险的哮喘患者的随机对照试验中，比较了布地奈德/福莫特罗联合吸入器（根据单吸入器方案[SAMRT]）与沙丁胺醇作为缓解剂的固定剂量方案（“标准”）治疗的疗效和安全性。通过电子监测（澳大利亚新西兰临床试验注册编号：ACTRN12610000515099）测量实际用药情况。一项嵌套队列研究探索了基线 2 周内沙丁胺醇使用指标与未来严重哮喘加重、哮喘控制不佳（ACQ-5≥1.5）或“极端”沙丁胺醇过度使用（＞32 次沙丁胺醇/24 小时）之间的关系。
较高的平均每日沙丁胺醇使用量（每次增加 2 次/天）[比值比（OR）（95%置信区间）1.24（1.06-1.46）]、较高的沙丁胺醇使用天数（每增加 2 天/2 周）[OR 1.15（1.00-1.31）]和较高的最大 24 小时使用量（每次增加 2 次/天）[OR 1.09（1.02-1.16）]与未来严重加重相关。较高的平均每日沙丁胺醇使用量与未来哮喘控制不佳相关[OR 1.13（1.02-1.26）]。较高的平均每日沙丁胺醇使用量[OR 2.73（1.84-4.07）]、使用天数[OR 1.46（1.24-1.71）]和最大每日使用量[OR 1.57（1.31-1.89）]与未来极端沙丁胺醇过度使用的风险增加相关。
当前沙丁胺醇使用频率的电子记录是哮喘未来不良结局的一个强有力的预测指标，其中平均日用量的预测效果最好。这些发现为临床医生考虑沙丁胺醇的使用指标作为预测哮喘未来不良结局的指标提供了新的信息。
