Altawalbeh Shoroq M, Manoon Nour A, Ababneh Mera A, Basheti Iman A
Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
Department of Clinical Pharmacy & Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan.
J Asthma. 2020 Mar;57(3):231-240. doi: 10.1080/02770903.2019.1568454. Epub 2019 Feb 4.
To evaluate clinical and economic burden associated with respiratory tract infection (RTI)-induced asthma exacerbations and to identify risk factors associated with these exacerbations. Factors associated with these exacerbations are understudied and little information is available about consequent expenditures. In this retrospective case-control study, medical records and pharmacy data in King Abdullah University Hospital in Northern Jordan were reviewed for adults with asthma aged 40 years and older, over the period 2013-2016. Cases of RTI-induced asthma exacerbations were identified, and controls were selected randomly from asthmatic adults who did not experience any RTI-induced asthma exacerbation during the same period. Independent-samples t-tests and chi-square tests were conducted to compare patient characteristics of cases and controls. Predictors of RTI-induced asthma exacerbations and the resultant complications were evaluated using multivariable logistic regression. Multivariable regression on log-transformed charges was used to predict expenditures of these exacerbations. A total of 137 cases and 548 controls were identified. Using inhaled corticosteroid + long-acting beta-agonists (ICS + LABA) was significantly associated with lower odds of RTI-induced asthma exacerbations (OR = 0.4; 95% CI, 0.21-0.77; = 0.006), and lower odds of resultant serious complications (OR = 0.23; 95% CI, 0.07-0.69; = 0.009), compared to being untreated with any asthma maintenance treatment. Asthma severity and co-morbidities were associated with increased susceptibility to these exacerbations. The average charges of RTI-induced asthma admissions and outpatient exacerbations were 1042.9 JD ($1471.0) and 81.1 JD ($114.4), respectively. ICS + LABA, asthma severity and co-morbidities appeared to affect the clinical and economic burden associated with RTI-induced asthma exacerbations. Efforts to prevent these exacerbations in patients with risk factors are warranted.
评估与呼吸道感染（RTI）诱发的哮喘加重相关的临床和经济负担，并确定与这些加重相关的危险因素。与这些加重相关的因素研究不足，关于由此产生的支出的信息也很少。在这项回顾性病例对照研究中，对2013年至2016年期间约旦北部阿卜杜拉国王大学医院40岁及以上哮喘成人的病历和药房数据进行了审查。确定了RTI诱发哮喘加重的病例，并从同期未经历任何RTI诱发哮喘加重的哮喘成人中随机选择对照。进行独立样本t检验和卡方检验以比较病例和对照的患者特征。使用多变量逻辑回归评估RTI诱发哮喘加重及其所致并发症的预测因素。对经对数转换的费用进行多变量回归以预测这些加重的支出。共确定了137例病例和548例对照。与未接受任何哮喘维持治疗相比，使用吸入性糖皮质激素+长效β受体激动剂（ICS+LABA）与RTI诱发哮喘加重的几率显著降低相关（OR = 0.4；95%CI，0.21 - 0.77；P = 0.006），以及所致严重并发症的几率降低相关（OR = 0.23；95%CI，0.07 - 0.69；P = 0.009）。哮喘严重程度和合并症与这些加重的易感性增加相关。RTI诱发哮喘住院和门诊加重的平均费用分别为1042.9约旦第纳尔（1471.0美元）和81.1约旦第纳尔（114.4美元）。ICS+LABA、哮喘严重程度和合并症似乎会影响与RTI诱发哮喘加重相关的临床和经济负担。有必要努力预防有危险因素患者的这些加重情况。
