Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada2Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada3Department of Medicine, University of Toronto, Toronto, Ontario, Canada4The Hospital for Sick Children.
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
JAMA. 2014 Sep 17;312(11):1114-21. doi: 10.1001/jama.2014.11432.
Chronic obstructive pulmonary disease (COPD), a manageable respiratory condition, is the third leading cause of death worldwide. Knowing which prescription medications are the most effective in improving health outcomes for people with COPD is essential to maximizing health outcomes.
To estimate the long-term benefits of combination long-acting β-agonists (LABAs) and inhaled corticosteroids compared with LABAs alone in a real-world setting.
DESIGN, SETTING, AND PATIENTS: Population-based, longitudinal cohort study conducted in Ontario, Canada, from 2003 to 2011. All individuals aged 66 years or older who met a validated case definition of COPD on the basis of health administrative data were included. After propensity score matching, there were 8712 new users of LABA-inhaled corticosteroid combination therapy and 3160 new users of LABAs alone who were followed up for median times of 2.7 years and 2.5 years, respectively.
Newly prescribed combination LABAs and inhaled corticosteroids or LABAs alone.
Composite outcome of death and COPD hospitalization.
The main outcome was observed among 5594 new users of LABAs and inhaled corticosteroids (3174 deaths [36.4%]; 2420 COPD hospitalizations [27.8%]) and 2129 new users of LABAs alone (1179 deaths [37.3%]; 950 COPD hospitalizations [30.1%]). New use of LABAs and inhaled corticosteroids was associated with a modestly reduced risk of death or COPD hospitalization compared with new use of LABAs alone (difference in composite outcome at 5 years, -3.7%; 95% CI, -5.7% to -1.7%; hazard ratio [HR], 0.92; 95% CI, 0.88-0.96). The greatest difference was among COPD patients with a codiagnosis of asthma (difference in composite at 5 years, -6.5%; 95% CI, -10.3% to -2.7%; HR, 0.84; 95% CI, 0.77-0.91) and those who were not receiving inhaled long-acting anticholinergic medication (difference in composite at 5 years, -8.4%; 95% CI, -11.9% to -4.9%; HR, 0.79; 95% CI, 0.73-0.86).
Among older adults with COPD, particularly those with asthma and those not receiving a long-acting anticholinergic medication, newly prescribed LABA and inhaled corticosteroid combination therapy, compared with newly prescribed LABAs alone, was associated with a significantly lower risk of the composite outcome of death or COPD hospitalization.
慢性阻塞性肺疾病（COPD）是一种可管理的呼吸系统疾病，是全球第三大致死原因。了解哪些处方药物在改善 COPD 患者的健康结果方面最有效对于最大限度地提高健康结果至关重要。
在真实环境中估计联合长效β激动剂（LABAs）和吸入皮质类固醇与单独使用 LABA 在长期内的益处。
设计、地点和患者：在加拿大安大略省进行的基于人群的纵向队列研究，时间为 2003 年至 2011 年。所有符合基于健康管理数据的 COPD 验证病例定义的 66 岁或以上的个体均被纳入研究。经过倾向评分匹配后，有 8712 名新使用 LABA-吸入皮质类固醇联合治疗的患者和 3160 名新使用 LABA 的患者，分别随访中位数时间为 2.7 年和 2.5 年。
新处方的联合 LABA 和吸入皮质类固醇或单独的 LABA。
死亡和 COPD 住院的复合结局。
主要结局发生在 5594 名新使用 LABA 和吸入皮质类固醇的患者（3174 例死亡[36.4%]；2420 例 COPD 住院[27.8%]）和 2129 名新使用 LABA 的患者中（1179 例死亡[37.3%]；950 例 COPD 住院[30.1%]）。与单独使用 LABA 相比，新使用 LABA 和吸入皮质类固醇与死亡或 COPD 住院的复合风险略有降低（5 年时复合结局的差异，-3.7%；95%CI，-5.7%至-1.7%；风险比[HR]，0.92；95%CI，0.88-0.96）。最大的差异是在伴有哮喘合并症的 COPD 患者中（5 年时复合结局的差异，-6.5%；95%CI，-10.3%至-2.7%；HR，0.84；95%CI，0.77-0.91）和未接受吸入长效抗胆碱能药物治疗的患者中（5 年时复合结局的差异，-8.4%；95%CI，-11.9%至-4.9%；HR，0.79；95%CI，0.73-0.86）。
在患有 COPD 的老年人中，特别是那些患有哮喘和未接受长效抗胆碱能药物治疗的老年人中，与单独使用 LABA 相比，新处方的 LABA 和吸入皮质类固醇联合治疗与死亡或 COPD 住院的复合结局风险显著降低相关。
