气道靶向药物吸入治疗对有和无潜在气道疾病的澳大利亚原住民成年人肺功能参数下降的影响。
The Effects of Inhaled Airway Directed Pharmacotherapy on Decline in Lung Function Parameters Among Indigenous Australian Adults With and Without Underlying Airway Disease.
机构信息
Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, NT, Australia.
Northern Territory Medical Program - College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
出版信息
Int J Chron Obstruct Pulmon Dis. 2021 Sep 29;16:2707-2720. doi: 10.2147/COPD.S328137. eCollection 2021.
BACKGROUND
The trajectory of lung function decline among Indigenous patients with or without underlying chronic airway disease (COPD and concomitant bronchiectasis) and with use of inhaled pharmacotherapy, including inhaled corticosteroids (ICS), has not been reported in the past.
METHODS
Adult Indigenous Australian patients identified to have undergone at least two or more lung function tests (LFTs) between 2012 and 2020 were assessed for changes in the lung function parameters (LFPs) between the first and last recorded LFTs.
RESULTS
Of the total 1350 patients identified to have undergone LFTs, 965 were assessed to fulfil session quality, 115 (n=58 females) were eligible to be included with two or more LFTs. Among the 115 patients, 49% showed radiological evidence of airway diseases, and 77% were on airway directed inhaled pharmacotherapy. Median time between LFTs was 1.5 years (IQR 0.86,5.85), with no significant differences in LFPs noted between first and last LFT. Overall rate of change (mL/year) showed considerable variation for FVC (median -37.55 mL/year [IQR -159.88,92.67]) and FEV (-18.74 mL/year [-102.49,71.44]) with minimal change in FEV/FVC (0.00 ratio/year [-0.03,0.01]). When stratified by inhaled pharmacotherapy group, however, patients using ICS showed significantly greater rate of FEV decline (-48.64 mL/year [-110.18,62.5]) compared to those using pharmacotherapy with no ICS (15.46 mL/year [-73.5,74.62]) and those using no pharmacotherapy (-5.76 mL/year [-63.19,67.34]) (p=0.022). Additionally, a greater proportion of these patients reached the threshold for excessive FEV decline (64%) compared to those using pharmacotherapy without ICS (44%) and those using no pharmacotherapy (52%).
CONCLUSION
Decline in LFPs occurs commonly among adult Indigenous population, especially, excessive so among those using inhaled pharmacotherapy containing ICS.
背景
过去尚未报道过土著患者（伴有或不伴有潜在慢性气道疾病[COPD 和并发支气管扩张]）在使用吸入性药物治疗（包括吸入性皮质类固醇[ICS]）的情况下肺功能下降的轨迹。
方法
评估了 2012 年至 2020 年间至少进行了两次或更多次肺功能检查（LFT）的成年澳大利亚土著患者的肺功能参数（LFPs）在首次和最后一次记录的 LFT 之间的变化。
结果
在确定进行了 LFT 的 1350 名患者中，有 965 名患者符合会议质量评估标准，其中 115 名（n=58 名女性）有资格进行两次或更多次 LFT。在 115 名患者中，49%的人有气道疾病的放射学证据，77%的人接受了气道导向的吸入性药物治疗。两次 LFT 之间的中位时间为 1.5 年（IQR 0.86，5.85），首次和最后一次 LFT 之间的 LFPs 无显著差异。FVC（中位数-37.55mL/年[IQR-159.88，92.67]）和 FEV（-18.74mL/年[-102.49，71.44]）的总体变化率（mL/年）差异较大，但 FEV/FVC 的变化极小（比值每年增加 0.00[0.03，0.01]）。然而，当按吸入性药物治疗组分层时，与使用无 ICS 药物治疗的患者（15.46mL/年[-73.5，74.62]）和未使用药物治疗的患者（-5.76mL/年[-63.19，67.34]）相比，使用 ICS 的患者的 FEV 下降速度明显更快（-48.64mL/年[-110.18，62.5]）（p=0.022）。此外，与使用无 ICS 药物治疗和未使用药物治疗的患者相比，这些患者中达到过度 FEV 下降阈值的比例更高（64%）（64%）。
结论
在成年土著人群中，LFPs 下降很常见，尤其是在使用含有 ICS 的吸入性药物治疗的人群中。
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