Laforest Laurent, Licaj Idlir, Devouassoux Gilles, Eriksson Irene, Caillet Pascal, Chatte Gérard, Belhassen Manon, Van Ganse Eric
Pharmacoepidemiology Lyon, UMR 5558 CNRS - Claude Bernard University, Lyon, France.
Respiratory Medicine, Croix Rousse University Hospital, Lyon, France.
BMC Fam Pract. 2015 Apr 14;16:49. doi: 10.1186/s12875-015-0265-2.
Inhaled corticosteroids (ICS) are the cornerstone of asthma therapy. The ICS-to-total-asthma-medication ratios, calculated from claims data, indicate potentially risky disease management in asthma. Our aim was to assess the utility of ICS-to-total-asthma-medication ratios from primary care electronic medical records (EMRs) in detecting patients at risk of asthma exacerbation, as approached by prescription of oral corticosteroids and/or antibiotics.
Retrospective cohort studies were identified, using the Health Improvement Network general practice database (THIN, United Kingdom) and the Cegedim Longitudinal Patient Data (France). We selected asthma patients aged 16-40 years, with ≥ 4 prescriptions for asthma medications in 2007 and ≥ 1 prescription in 2008. For each country, three groups were defined according to ratio value in 2008: 0% (non-ICS users), <50% (low-ICS-ratio group) and ≥ 50% (high-ICS-ratio group). Outcomes were marker of asthma exacerbations: systemic corticosteroids and antibiotics. They were compared between groups in each country.
Among 38,637 British and 4,587 French patients, higher numbers of prescriptions per patient of systemic corticosteroids, antibiotics and total asthma medications were observed in the low-ICS-ratio groups compared to other groups (p < 0.0001 for each outcome in both countries). Likewise, low-ICS-ratio patients had more medical contacts (p < 0.0001 in both countries), suggesting poorly controlled asthma. ICS-treated patients had lower risks of receiving systemic corticosteroids in 2008 in the high-ICS-ratio group, compared to the low-ICS-ratio group: RR = 0.54, 95%CI = [0.50-0.57] and RR = 0.78, 95%CI = [0.67-0.91] in the UK and France, respectively.
Patients with high ICS-to-total-asthma-medication ratios presented fewer asthma-related outcomes. The low ICS-to-total-asthma-medication ratio calculated with EMRs data reflects insufficient prescribing of ICS relative to all asthma medications, which may lead to deteriorated asthma control.
吸入性糖皮质激素（ICS）是哮喘治疗的基石。根据索赔数据计算得出的ICS与哮喘总用药量之比，表明哮喘疾病管理可能存在风险。我们的目的是评估从基层医疗电子病历（EMR）中获取的ICS与哮喘总用药量之比，在检测有哮喘加重风险患者方面的效用，评估方法是通过口服糖皮质激素和/或抗生素的处方情况。
利用健康改善网络全科医疗数据库（英国的THIN）和Cegedim纵向患者数据（法国）开展回顾性队列研究。我们选取了年龄在16至40岁之间、2007年有≥4次哮喘用药处方且2008年有≥1次处方的哮喘患者。对于每个国家，根据2008年的比值将患者分为三组：0%（未使用ICS者）、<50%（低ICS比值组）和≥50%（高ICS比值组）。观察指标为哮喘加重的标志物：全身性糖皮质激素和抗生素。对每个国家的不同组之间进行比较。
在38637名英国患者和4587名法国患者中，与其他组相比，低ICS比值组患者的全身性糖皮质激素、抗生素及哮喘总用药量的人均处方数更多（两国各观察指标的p值均<0.0001）。同样，低ICS比值组患者有更多的医疗接触（两国的p值均<0.0001），提示哮喘控制不佳。与低ICS比值组相比，高ICS比值组中接受ICS治疗的患者在2008年接受全身性糖皮质激素治疗的风险更低：在英国，RR = 0.54，95%CI = [0.50 - 0.57]；在法国，RR = 0.78，95%CI = [0.67 - 0.91]。
ICS与哮喘总用药量比值高的患者出现的哮喘相关结局较少。根据EMR数据计算出的低ICS与哮喘总用药量比值反映出相对于所有哮喘药物而言，ICS的处方不足，这可能导致哮喘控制恶化。
