Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas, USA.
Department of Pediatrics, Section of Pulmonology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.
Pharmacoepidemiol Drug Saf. 2021 Nov;30(11):1520-1531. doi: 10.1002/pds.5336. Epub 2021 Aug 8.
Opioid analgesics are frequently dispensed in children despite its known risk in children with a compromised airway function. The objectives of the study were to assess the prevalence of opioid analgesic dispensing in children with current asthma and to identify patient and prescriber factors associated with the dispensing of opioid versus non-opioid analgesics.
Children <18 years of age, having current asthma and receiving an incident analgesic prescription were identified from a large Medicaid Managed Care Plan during years 2013 through 2018. Current asthma was defined as both receiving an asthma diagnosis and filling an anti-asthmatic medication during the 12-month period prior to the analgesic medication initiation. A scoring algorithm was applied to associate analgesic prescription with procedures and diagnoses according to perceived need for analgesia and time proximity.
Of the 9529 children meeting the inclusion criteria, 2681 (28.1%) received an opioid prescription. Opioid analgesic dispensing was most common among children who had an outpatient surgery/procedure (29.4%), trauma (19.4%) dental procedure (18.4%), and respiratory infection (10.6%). Multivariable analysis indicated that non-Hispanic Black (AOR: 0.39[0.3-0.5]) and Hispanic (AOR: 0.51[0.4-0.6]) children were less likely to receive an opioid analgesic compared to their non-Hispanic White counterparts. Children with prior history of asthma-related emergency department visit (AOR: 1.24[1.0-1.5]) and short acting beta agonist overuse (AOR: 1.33[1.1-1.7]) were more likely to fill an opioid analgesic prescription than those without.
Opioid analgesics are frequently dispensed to children with asthma. A higher dispensing rate was observed among non-Hispanic White children and among those with a history of uncontrolled asthma.
尽管已知气道功能受损的儿童存在风险，但阿片类镇痛药仍常被开给儿童。本研究的目的是评估目前患有哮喘的儿童中阿片类镇痛药的配药情况，并确定与开阿片类与非阿片类镇痛药相关的患者和处方者因素。
从一个大型医疗补助管理式医疗计划中，确定了 2013 年至 2018 年期间年龄在 18 岁以下、目前患有哮喘且接受新开具的镇痛药处方的儿童。目前患有哮喘的定义是在开始使用镇痛药的前 12 个月内，既接受哮喘诊断又开具了抗哮喘药物。应用评分算法根据对疼痛缓解的需求和时间接近程度，将镇痛药处方与程序和诊断联系起来。
在符合纳入标准的 9529 名儿童中，有 2681 名（28.1%）开具了阿片类药物处方。阿片类镇痛药的配药最常见于门诊手术/程序（29.4%）、外伤（19.4%）、牙科手术（18.4%）和呼吸道感染（10.6%）的儿童。多变量分析表明，与非西班牙裔白人相比，非西班牙裔黑人（AOR：0.39[0.3-0.5]）和西班牙裔（AOR：0.51[0.4-0.6]）儿童不太可能开具阿片类镇痛药。有哮喘相关急诊科就诊史（AOR：1.24[1.0-1.5]）和短效β激动剂滥用史（AOR：1.33[1.1-1.7]）的儿童比无此类病史的儿童更有可能开具阿片类镇痛药处方。
阿片类镇痛药经常被开给哮喘儿童。非西班牙裔白人儿童和未控制哮喘史的儿童配药率更高。
