Division of Pediatric Gastroenterology, Children's Medical Center, Taichung Veterans General Hospital, Taichung City, Taiwan.
Department of Medical Research, Chung Shan Medical University Hospital, Taichung City, Taiwan.
Int J Clin Pract. 2021 Oct;75(10):e14540. doi: 10.1111/ijcp.14540. Epub 2021 Jun 29.
Among respiratory diseases, asthma is one of the most burdensome disorder worldwide. Growing evidence disclose gut dysbiosis may contribute to asthma via the gut-lung axis. Constipation can lead to alteration of the gut microflora. The clinical impact of constipation on asthma has not been researched. Therefore, we aim to assess the risk of asthma in constipated patients by a nationwide population-based cohort study.
We analysed 86 860 constipated patients and 86 860 individuals without constipation between 1999 and 2013 from the Taiwanese National Health Insurance Research Database. Analysis of propensity score was utilised to match age, gender, comorbidities and medications at a ratio of 1:1. Besides, multiple Cox regression analysis was performed to evaluate the adjusted hazard ratio of asthma. Furthermore, sensitivity tests and stratified analysis were conducted.
The incidence of asthma was 10.4 per 1000 person-years in the constipation group, which was higher than the rate of 5.7 per 1000 person-years observed in the non-constipation group. After adjustment for age, gender, urbanisation, comorbidities and medications, constipated patients had a 1.81-fold greater risk of asthma compared with those without constipation (adjusted hazard ratio [aHR]: 1.81, 95% CI: 1.74-1.88). In subgroup analyses, patients aged 20-39 years had a 2.01-fold highest risk of asthma in the constipation cohort (aHR: 2.01, 95% CI: 1.82-2.22). Besides, the severity of constipation is associated with an increased risk of asthma; the aHR was 1.92 (1.84-2.00), 2.07 (1.94-2.21) and 2.10 (1.96-2.25) for ≤ 30 days, 31-120 days and >120 days of laxatives prescription within 1 year after the index date, respectively (P < .001).
Constipation relates to a significantly increased risk of asthma. Physicians should be aware of the possibility of asthma in constipated people. Further research is warranted to investigate the possible pathological mechanisms of this association.
在呼吸系统疾病中，哮喘是全球最具负担的疾病之一。越来越多的证据表明，肠道菌群失调可能通过肺肠轴导致哮喘。便秘可导致肠道微生物群的改变。便秘对哮喘的临床影响尚未得到研究。因此，我们旨在通过一项全国性的基于人群的队列研究，评估便秘患者患哮喘的风险。
我们分析了 1999 年至 2013 年间来自台湾全民健康保险研究数据库的 86860 例便秘患者和 86860 例无便秘患者。采用倾向评分分析以 1:1 的比例匹配年龄、性别、合并症和药物。此外，还进行了多次 Cox 回归分析，以评估哮喘的调整后危险比。此外，还进行了敏感性测试和分层分析。
便秘组的哮喘发生率为每 1000 人年 10.4 例，高于非便秘组的每 1000 人年 5.7 例。调整年龄、性别、城市化程度、合并症和药物后，与无便秘患者相比，便秘患者患哮喘的风险增加 1.81 倍（调整后的危险比[aHR]：1.81，95%置信区间[CI]：1.74-1.88）。在亚组分析中，20-39 岁的患者在便秘队列中患哮喘的风险最高，为 2.01 倍（aHR：2.01，95%CI：1.82-2.22）。此外，便秘的严重程度与哮喘风险增加相关；在索引日期后 1 年内，阿片类药物处方的时间分别为≤30 天、31-120 天和>120 天的 aHR 分别为 1.92（1.84-2.00）、2.07（1.94-2.21）和 2.10（1.96-2.25）（P<0.001）。
便秘与哮喘风险显著增加相关。医生应该意识到便秘患者患哮喘的可能性。需要进一步研究以探讨这种关联的可能病理机制。
