Punekar Yogesh Suresh, Sharma Sheetal, Pahwa Ankit, Takyar Jitender, Naya Ian, Jones Paul W
Health Outcomes, ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK.
PAREXEL® Access Consulting, PAREXEL® International, Chandigarh, India.
Respir Res. 2017 May 8;18(1):86. doi: 10.1186/s12931-017-0566-1.
Reducing rescue medication use is a guideline-defined goal of asthma treatment, however, little is known about the validity of rescue medicine use as a marker of symptoms in chronic obstructive pulmonary disease (COPD). To improve patient outcomes, greater insight is needed into the relationship between rescue medication use and alternative COPD outcomes.
A systematic search of electronic databases (Embase®, MEDLINE® and Cochrane CENTRAL) was conducted from database start to 26 May, 2015. Studies of bronchodilator therapy with a duration of ≥24 weeks were included if they reported either mean change from baseline (CFB) in rescue medication use in puffs/day or % rescue-free days (%RFD), and at least one other COPD endpoint. Correlation and meta-regression analyses were undertaken to test the association between rescue medication use and other COPD outcomes using weighted means (weights proportional to the sample size of the treatment group) and unweighted means (equal weight for each treatment group). Each association was assessed at 6 months and study end.
Forty-six studies involving 46,531 patients provided mean data from 145 treatment groups for evaluation. Changes in both measures of rescue medication use were correlated with changes in trough forced expiratory volume in one second ([FEV]; Pearson correlation coefficients |r| ≥ 0.63; p < 0.0001) and with St George's Respiratory Questionnaire (SGRQ) score (|r| ≥ 0.70; p < 0.0001) at study end. Change in rescue medication use in puffs/day during the study correlated with annualized rates of moderate/severe exacerbations at 6 months and study end (both r = 0.66; p ≤ 0.0028). CFB in puffs/day was not well correlated with Transition Dyspnoea Index (TDI), but %RFD did correlate with TDI score at 6 months and study end (both r = 0.69; p < 0.0001). The values for CFB in puffs/day corresponding to the proposed minimal clinically important differences for trough FEV and SGRQ score were -1.3 and -0.6 puffs/day, respectively. A -1.0 puffs/day CFB in rescue use corresponded to a change of 0.26 events/patient-year in moderate/severe exacerbations.
This analysis provides clear evidence of associations at a patient group level between rescue medication use and other clinically important COPD outcomes.
减少急救药物的使用是哮喘治疗指南中明确的目标，然而，对于急救药物的使用作为慢性阻塞性肺疾病（COPD）症状指标的有效性知之甚少。为改善患者预后，需要更深入了解急救药物使用与其他COPD预后之间的关系。
对电子数据库（Embase®、MEDLINE®和Cochrane CENTRAL）进行系统检索，检索时间从数据库建立至2０15年5月26日。纳入支气管扩张剂治疗持续时间≥24周的研究，这些研究需报告每日急救药物使用量（按吸数计算）相对于基线的平均变化（CFB）或无急救药物天数百分比（%RFD），以及至少一项其他COPD终点指标。采用加权均值（权重与治疗组样本量成比例）和非加权均值（各治疗组权重相等）进行相关性和Meta回归分析，以检验急救药物使用与其他COPD预后之间的关联。在6个月和研究结束时评估每种关联。
46项研究涉及46531例患者，提供了145个治疗组的平均数据用于评估。在研究结束时，急救药物使用量的两种测量指标的变化均与一秒用力呼气容积（[FEV]）谷值的变化相关（Pearson相关系数|r|≥0.63；p＜0.0001），并与圣乔治呼吸问卷（SGRQ）评分相关（|r|≥0.70；p＜0.0001）。研究期间每日急救药物使用量的变化与6个月和研究结束时中度/重度急性加重的年化率相关（r均为0.66；p≤0.0028）。每日急救药物使用量的CFB与过渡性呼吸困难指数（TDI）相关性不佳，但%RFD在6个月和研究结束时与TDI评分相关（r均为0.69；p＜0.0001）。对应于FEV谷值和SGRQ评分的最小临床重要差异建议值，每日急救药物使用量的CFB值分别为-1.3和-0.6吸/天。急救药物使用中CFB为-1.0吸/天相当于中度/重度急性加重患者每年发生0.26次变化。
该分析提供了明确证据，表明在患者群体水平上急救药物使用与其他重要的COPD临床预后之间存在关联。
