Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan.
BioPharmaceuticals Medical - USA, AstraZeneca, Wilmington, Delaware.
Ann Allergy Asthma Immunol. 2021 Jun;126(6):681-689.e1. doi: 10.1016/j.anai.2021.01.024. Epub 2021 Jan 27.
Short-acting β-agonist (SABA) use is one measure reflecting asthma control.
To evaluate the associations between real-world SABA use and severe asthma exacerbations in the United States.
Patients with asthma 12 years of age or older receiving SABA in the IBM MarketScan research databases of US administrative claims from September 30, 2014, to September 30, 2016, were evaluated. Patients with 12 months' continuous eligibility before and after their first SABA claim (index SABA), an asthma diagnosis before through 60 days postindex, and either one additional SABA or at least 1 maintenance fill(s) were included. SABA claims postindex (including index fill) were grouped as follows: low: index only; medium: 2 to 3 canisters per year; and high: 4 or more canisters per year. Differences in SABA exposure with respect to disease severity groups and severe asthma exacerbations (hospitalizations, emergency visits, or outpatient systemic corticosteroids) were analyzed by analysis of variance and χ (significance, P ≤ .05).
A total of 135,540 patients were included: 62.8% women; mean (SD) age, 40.9 (18.3) years; SABA fills per 12-months postindex: 3.0(2.7). Furthermore, 28% of patients filled 1 SABA, 47% 2 to 3, and 25% 4 or more canisters per year. Despite higher maintenance medication possession ratio with increasing SABA (low, 0.53 (0.37); medium, 0.59 (0.35); high, 0.66 (0.32)), annual exacerbation rate per person per year and percent of patients within each SABA group having at least 1 exacerbation rose as SABA fills increased (low, 1.00 (1.45), 45.8%; medium, 1.20 (1.62), 54.3%; high, 1.50 (1.94), 58.7%). Mean SABA fills differed between patients with 0 exacerbation, 2.8 (2.6); 1 exacerbation, 2.9 (2.5); and 2 or more exacerbations, 3.3 (2.9).
Exacerbation risk increased with increasing SABA fills. Management strategies ensuring adequate anti-inflammatory therapy delivered to the airways when symptoms occur may be needed to mitigate asthma morbidity.
短效 β-激动剂（SABA）的使用是反映哮喘控制情况的一个指标。
评估美国真实世界中 SABA 使用与严重哮喘加重之间的关联。
对 2014 年 9 月 30 日至 2016 年 9 月 30 日期间，在美国 IBM MarketScan 研究数据库中接受 SABA 治疗且年龄在 12 岁及以上的哮喘患者进行评估。在首次使用 SABA 之前和之后的 12 个月内（索引 SABA），患者必须有 12 个月的连续资格，并且在索引前 60 天内有哮喘诊断，且至少有 1 次维持性用药或至少 1 次维持性用药。索引后（包括索引填充）的 SABA 要求分为以下几类：低：仅索引；中：每年 2 至 3 个小瓶；高：每年 4 个或更多小瓶。使用方差分析和 χ²检验（差异有统计学意义，P≤0.05）分析疾病严重程度组和严重哮喘加重（住院、急诊就诊或门诊全身皮质类固醇治疗）之间 SABA 暴露的差异。
共纳入 135540 例患者：62.8%为女性；平均（SD）年龄为 40.9（18.3）岁；索引后 12 个月内 SABA 填充次数为 3.0（2.7）。此外，28%的患者使用 1 个 SABA，47%的患者使用 2 至 3 个 SABA，25%的患者使用 4 个或更多 SABA。尽管随着 SABA 用量的增加，维持药物占有率越高（低：0.53（0.37）；中：0.59（0.35）；高：0.66（0.32）），但每人每年的哮喘加重率和每个 SABA 组中至少有 1 次加重的患者比例均呈上升趋势（低：1.00（1.45），45.8%；中：1.20（1.62），54.3%；高：1.50（1.94），58.7%）。无加重的患者的平均 SABA 用量为 2.8（2.6），有 1 次加重的患者为 2.9（2.5），有 2 次或更多次加重的患者为 3.3（2.9）。
随着 SABA 使用量的增加，哮喘加重的风险增加。需要采取管理策略，确保在出现症状时向气道输送足够的抗炎治疗，以减轻哮喘的发病率。
