2053名丹麦儿童队列中哮喘诊断的有效性及抗哮喘药物使用模式
Validity of asthma diagnoses and patterns of anti-asthmatic drug use in a cohort of 2053 Danish children.
作者信息
Rubak Sune, Høst Arne, Christensen Lotte Brix, Langfrits Mette Sørensen, Thomsen Reimar Wernich
机构信息
Department of Child and Adolescent Health Aarhus University Hospital Skejby Aarhus Denmark.
Department of Pediatrics Odense University Hospital Odense Denmark.
出版信息
Health Sci Rep. 2018 Jul 24;1(9):e77. doi: 10.1002/hsr2.77. eCollection 2018 Sep.
BACKGROUND AND AIMS
When investigating and treating asthma in children, diagnosing must be precise and valid. There is a need for studies researching asthma in children showing how to use registry-based, epidemiological data. We examined the feasibility and validity of using anti-asthmatic drug prescription data to identify children with asthma and assessed medication patterns in children with and without confirmed asthma.
METHODS
We used population-based Danish prescription data and hospital discharge registries to identify all children aged 0 to 14 years who had redeemed at least one prescription for an inhaled anti-asthmatic drug. Individual asthma cases were validated by hospital discharge information and by their treating general practitioners according to international asthma guidelines.
RESULTS
In total, 2053 children, out of a population of 20181, had redeemed at least one prescription of any inhaled anti-asthmatic drug. The positive predictive value (PPV) of having two different asthma medications prescribed in 1 year was 80.2% for presence of true asthma, with a sensitivity of 59%. Corresponding estimates of PPV/sensitivity of at least one prescription for an inhaled corticosteroid (ICS) were 79% and 58%, respectively, while the true asthma PPV with at least one LABA prescription increased to 97%. Among children with confirmed asthma, one-third had not used Beta2-agonist therapy as part of their treatment. Conversely, among children without confirmed asthma, 40% were prescribed a minimum of two prescriptions for any kind of inhaled anti-asthmatic drug, and 12% and 9% used an ICS or Leukotriene receptor antagonist, respectively.
CONCLUSIONS
Anti-asthmatic drug prescription data could be used to identify children with true asthma, with reasonable accuracy. The observed pattern of anti-asthmatic medication usage among children with and without confirmed asthma suggests that there is room for therapeutic improvement.
背景与目的
在对儿童哮喘进行调查和治疗时，诊断必须准确且有效。需要开展研究，以展示如何利用基于登记处的流行病学数据来研究儿童哮喘。我们检验了使用抗哮喘药物处方数据识别儿童哮喘的可行性和有效性，并评估了确诊哮喘和未确诊哮喘儿童的用药模式。
方法
我们利用丹麦基于人群的处方数据和医院出院登记处信息，识别出所有0至14岁且至少兑换过一张吸入性抗哮喘药物处方的儿童。根据国际哮喘指南，通过医院出院信息及其主治全科医生对个体哮喘病例进行验证。
结果
在20181名儿童中，共有2053名儿童至少兑换过一张任何吸入性抗哮喘药物的处方。1年内开具两种不同哮喘药物处方对于确诊哮喘的阳性预测值（PPV）为80.2%，敏感性为59%。吸入性糖皮质激素（ICS）至少一张处方的PPV/敏感性相应估计值分别为79%和58%，而开具至少一张长效β2受体激动剂（LABA）处方的确诊哮喘PPV增至97%。在确诊哮喘的儿童中，三分之一未使用β2受体激动剂治疗作为其治疗的一部分。相反，在未确诊哮喘的儿童中，40%至少开具了两张任何类型吸入性抗哮喘药物的处方，分别有12%和9%使用了ICS或白三烯受体拮抗剂。
结论
抗哮喘药物处方数据可用于以合理的准确性识别真正患有哮喘的儿童。在确诊哮喘和未确诊哮喘儿童中观察到的抗哮喘药物使用模式表明，治疗方面仍有改进空间。
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