Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea.
Lung Research Institute, Hallym University College of Medicine, Chuncheon, Korea.
Ther Adv Respir Dis. 2020 Jan-Dec;14:1753466620963030. doi: 10.1177/1753466620963030.
Long-term corticosteroid (CS) use is associated with increased mortality in patients with asthma, and comorbid bronchiectasis is also associated with frequent asthma exacerbation and increased healthcare use. However, there is limited information on whether bronchiectasis further increases mortality in patients with CS-dependent asthma. This study examined the impact of bronchiectasis on mortality in patients with CS-dependent asthma.
A retrospective cohort of patients with CS-dependent asthma ⩾18 years old was established using records from the Korean National Health Insurance Service database from 2005 to 2015. Patients with CS-dependent asthma with and without bronchiectasis were matched by age, sex, type of insurance, and Charlson comorbidity index. We evaluated the hazard ratio (HR) for all-cause mortality in patients with bronchiectasis compared with those without bronchiectasis.
The study cohort included 754 patients with CS-dependent asthma with bronchiectasis and 3016 patients with CS-dependent asthma without bronchiectasis. Patients with CS-dependent asthma with bronchiectasis had a higher all-cause mortality than those without bronchiectasis (8429/100,000 6962/100,000 person-years, p < 0.001). The adjusted HR for mortality in patients with CS-dependent asthma with bronchiectasis relative to those without bronchiectasis was 1.33 (95% confidence interval, 1.18-1.50), and the association was primarily significant for respiratory diseases (subdistribution HR = 1.65, 95% confidence interval, 1.42-1.92).
Bronchiectasis further increases all-cause mortality in patients with CS-dependent asthma, a trend that was especially associated with respiratory diseases including chronic obstructive pulmonary disease. Strategies to improve treatment outcomes in patients with CS-dependent asthma with bronchiectasis are urgently needed to improve long-term survival.The reviews of this paper are available via the supplemental material section.
长期使用皮质类固醇（CS）与哮喘患者的死亡率增加有关，而合并支气管扩张症也与哮喘频繁加重和增加医疗保健使用有关。然而，关于支气管扩张症是否会进一步增加 CS 依赖型哮喘患者的死亡率，信息有限。本研究检查了支气管扩张症对 CS 依赖型哮喘患者死亡率的影响。
使用 2005 年至 2015 年韩国国家健康保险服务数据库中的记录，建立了年龄 ⩾18 岁的 CS 依赖型哮喘患者的回顾性队列。通过年龄、性别、保险类型和 Charlson 合并症指数对有和没有支气管扩张症的 CS 依赖型哮喘患者进行匹配。我们评估了支气管扩张症患者与无支气管扩张症患者的全因死亡率的风险比（HR）。
研究队列包括 754 例有支气管扩张症的 CS 依赖型哮喘患者和 3016 例无支气管扩张症的 CS 依赖型哮喘患者。有支气管扩张症的 CS 依赖型哮喘患者的全因死亡率高于无支气管扩张症的患者（8429/100000 比 6962/100000 人年，p<0.001）。有支气管扩张症的 CS 依赖型哮喘患者的死亡率相对于无支气管扩张症患者的调整 HR 为 1.33（95%置信区间，1.18-1.50），这种关联主要与呼吸系统疾病显著相关（亚分布 HR=1.65，95%置信区间，1.42-1.92）。
支气管扩张症进一步增加了 CS 依赖型哮喘患者的全因死亡率，这种趋势尤其与包括慢性阻塞性肺疾病在内的呼吸系统疾病有关。迫切需要制定改善有支气管扩张症的 CS 依赖型哮喘患者治疗效果的策略，以提高长期生存率。本文的评审意见可通过补充材料部分查看。
