Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston TX.
Department of Pediatrics, Section of Pulmonology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, and Medical Affairs, Texas Children's Health Plan, Houston, TX.
J Manag Care Spec Pharm. 2022 Mar;28(3):325-335. doi: 10.18553/jmcp.2022.28.3.325.
In the United States, asthma occurs in a vast proportion of children and adolescents. Asthma exacerbation is an acute episodic event typically characterized by difficulty in breathing, chest tightness, coughing, or wheezing. Severe asthma exacerbation can be life-threatening and lead to service utilizations such as hospitalizations and emergency department (ED) visits. Opioid analgesic use can trigger an asthma exacerbation through 2 pharmacological mechanisms. Despite the potential mechanisms, there is lack of empirical evidence to determine the risk of asthma exacerbation and its association with opioid use. To evaluate the risk of asthma exacerbation in children with current asthma receiving an opioid vs a nonopioid analgesic. Eligible individuals aged under 18 years with current asthma and receiving an incident analgesic prescription were identified from a large Medicaid managed care database during 2013-2018. Current asthma was defined as receipt of an asthma diagnosis and an antiasthmatic medication in the 12 months before analgesic medication initiation. Asthma exacerbation was defined as a hospitalization or ED visit with asthma as either the primary or secondary diagnosis within 3 days of receipt of an analgesic prescription. A weighted multivariable logistic regression using inverse probability treatment weighting was performed to test the association between use of analgesic medication and risk of asthma exacerbation. This study included 13,359 children with current asthma who filled either an incident opioid (n = 5,363, 40.1%) or nonopioid analgesic (n = 7,996, 59.9%) prescription. Asthma exacerbation was observed in 24 (0.5%) opioid analgesic recipients and 22 (0.3%) nonopioid analgesic recipients within 3 days of analgesic initiation. Weighted logistic regression results showed that children receiving opioid analgesics (adjusted odds ratio = 1.6, 95% CI = 0.9-2.9) did not have a statistically significantly higher risk of asthma exacerbation than their nonopioid analgesic recipient counterparts in the propensity score-weighted multivariable analysis. Asthma exacerbation associated with analgesic use in children with current asthma was an uncommon event, and the risk was comparable among children receiving opioid vs nonopioid analgesics. This study was supported and funded by the Agency for Healthcare Research and Quality (AHRQ), Project Number: 1R03HS026790-01A1. The study content was solely the responsibility of the authors, and AHRQ had no role in the design and conduct of the study. The authors have nothing to disclose.
在美国，哮喘发生在很大比例的儿童和青少年中。哮喘恶化是一种急性发作性事件，通常表现为呼吸困难、胸闷、咳嗽或喘息。严重的哮喘恶化可能危及生命，并导致住院和急诊部（ED）就诊等服务的利用。阿片类镇痛药的使用可以通过两种药理学机制引发哮喘恶化。尽管存在潜在机制，但缺乏确定哮喘恶化风险及其与阿片类药物使用相关的经验证据。 评估目前患有哮喘的儿童在接受阿片类药物与非阿片类药物镇痛时哮喘恶化的风险。 从 2013 年至 2018 年期间，从一个大型医疗补助管理式护理数据库中确定了年龄在 18 岁以下、目前患有哮喘并接受新处方镇痛药物的合格个体。目前患有哮喘定义为在接受镇痛药物治疗前的 12 个月内接受哮喘诊断和抗哮喘药物治疗。哮喘恶化定义为在接受镇痛药物处方后 3 天内因哮喘作为主要或次要诊断而住院或急诊就诊。使用逆概率治疗加权法进行加权多变量逻辑回归，以测试镇痛药物使用与哮喘恶化风险之间的关联。 这项研究包括 13359 名目前患有哮喘的儿童，他们分别服用了新的阿片类药物（n=5363，40.1%）或非阿片类药物（n=7996，59.9%）。在开始镇痛治疗后的 3 天内，有 24 名（0.5%）阿片类镇痛药接受者和 22 名（0.3%）非阿片类镇痛药接受者出现哮喘恶化。加权逻辑回归结果显示，在倾向评分加权多变量分析中，接受阿片类镇痛药的儿童（调整后的优势比=1.6，95%置信区间=0.9-2.9）与接受非阿片类镇痛药的儿童相比，哮喘恶化的风险没有统计学显著增加。 在目前患有哮喘的儿童中，与镇痛药物使用相关的哮喘恶化是一种罕见事件，接受阿片类药物与非阿片类药物镇痛的儿童风险相当。 这项研究得到了医疗保健研究和质量局（AHRQ）的支持和资助，项目编号：1R03HS026790-01A1。研究内容完全由作者负责，AHRQ 对研究的设计和实施没有任何作用。作者没有什么可披露的。
