Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, Université Grenoble Alpes, Grenoble, France.
Pôle Pharmacie, CHU Grenoble Alpes, Grenoble, France.
Eur Respir J. 2018 Apr 12;51(4). doi: 10.1183/13993003.02114-2017. Print 2018 Apr.
Multimedication related to multimorbidity is common in the elderly with asthma. We aimed at comprehensively characterising medications used by elderly women and assessing how multimedication impacts on asthma prognosis.We performed network-based analyses on drug administrative databases to visualise the prevalence of drug classes and their interconnections among 17 458 elderly women from the Asthma-E3N study, including 4328 women with asthma. Asthma groups sharing similar medication profiles were identified by a clustering method relying on all medications and were studied in association with adverse asthma events (uncontrolled asthma, attacks/exacerbations and poor asthma-related quality of life).The network-based analysis showed more multimedication in women with asthma than in those without asthma. The clustering method identified three multimedication profiles in asthma: "Few multimorbidity-related medications" (43.5%), "Predominantly allergic multimorbidity-related medications" (32.8%) and "Predominantly metabolic multimorbidity-related medications" (23.7%). Compared with women belonging to the "Few multimorbidity-related medications" profile, women belonging to the two other profiles had an increased risk of uncontrolled asthma and asthma attacks/exacerbations, and had lower asthma-related quality of life.The integrative data-driven approach on drug administrative databases identified specific multimorbidity-related medication profiles that were associated with poor asthma prognosis. These findings support the importance of multimorbidity in the unmet needs in asthma management.
多重用药与多种合并症在老年哮喘患者中很常见。我们旨在全面描述老年女性使用的药物,并评估多重用药对哮喘预后的影响。我们对药物管理数据库进行基于网络的分析,以可视化 17458 名来自 Asthma-E3N 研究的老年女性(包括 4328 名哮喘女性)中药物类别的流行情况及其相互关系。通过一种依赖于所有药物的聚类方法,识别出具有相似用药特征的哮喘组,并将其与不良哮喘事件(未控制的哮喘、发作/加重和较差的哮喘相关生活质量)相关联进行研究。基于网络的分析显示,哮喘女性的多重用药比无哮喘女性更为常见。聚类方法在哮喘中识别出三种多重用药特征:“与多种合并症相关的药物较少”(43.5%)、“主要与过敏相关的多种合并症相关的药物”(32.8%)和“主要与代谢相关的多种合并症相关的药物”(23.7%)。与属于“与多种合并症相关的药物较少”特征的女性相比,属于后两种特征的女性未控制的哮喘和哮喘发作/加重的风险增加,且哮喘相关生活质量较低。基于药物管理数据库的综合数据驱动方法确定了与哮喘不良预后相关的特定与多种合并症相关的用药特征。这些发现支持了多种合并症在哮喘管理中未满足需求的重要性。