Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
BMC Pulm Med. 2022 Mar 14;22(1):85. doi: 10.1186/s12890-022-01883-6.
Severe asthma exacerbation reduces patients' quality of life, results in visits to the emergency department (ED) and hospitalization, and incurs additional medical costs. Antipsychotics block receptors with bronchodilation function; however, the association between antipsychotic use and severe asthma exacerbation is unknown. This study aimed to investigate the effects of antipsychotics on asthma-related ED visits and hospitalizations.
A case-crossover design was used in this study. Using the 2003-2017 Taiwan National Health Insurance Reimbursement Database, we established a cohort of 18,657 adults with asthma exacerbation leading to ED visits or hospitalization. Univariate and multivariate conditional logistic regressions were conducted to explore the association between antipsychotic use and severe asthma exacerbation. Subgroup analyses of different classes, doses, receptor functions of antipsychotics, different psychiatric disease, and sensitivity analyses of excluding patients with schizophrenia were also performed.
Antipsychotic use was associated with a higher risk of severe asthma exacerbation (adjusted odds ratio [OR]: 1.27; 95% confidence interval [CI] 1.05-1.54; P = 0.013) compared with no use of antipsychotics. The use of typical antipsychotics increased the risk of severe asthma exacerbation (adjusted OR: 1.40, 95% CI 1.10-1.79, P = 0.007), whereas the use of atypical antipsychotics did not. These results did not change after the exclusion of patients with schizophrenia. There was a dose-dependent effect of antipsychotics (trend test, P = 0.025). Antipsychotics that block the M2 muscarinic or D2 dopaminergic receptors were associated with an increased risk of severe asthma exacerbation (adjusted OR: 1.39, 95% CI 1.10-1.76, P = 0.007 and adjusted OR: 1.33, 95% CI 1.08-1.63, P = 0.008, respectively). However, use of antipsychotics did not increase risk of severe asthma exacerbation in patients with psychiatric disorder.
The use of typical antipsychotics is associated with a dose-dependent increased risk of severe asthma exacerbation, especially for patients without psychiatric disorders. Further research on the impact of typical antipsychotics on asthma exacerbation is warranted.
严重哮喘发作降低了患者的生活质量，导致急诊就诊和住院，并增加了额外的医疗费用。抗精神病药阻断具有支气管扩张功能的受体；然而，抗精神病药的使用与严重哮喘发作之间的关联尚不清楚。本研究旨在探讨抗精神病药对哮喘相关急诊就诊和住院的影响。
本研究采用病例交叉设计。我们使用 2003-2017 年台湾全民健康保险补偿数据库，建立了一个由 18657 名哮喘发作导致急诊就诊或住院的成年人组成的队列。采用单变量和多变量条件逻辑回归分析抗精神病药使用与严重哮喘发作之间的关系。还进行了不同类别、剂量、抗精神病药受体功能、不同精神疾病的亚组分析和排除精神分裂症患者的敏感性分析。
与未使用抗精神病药相比，使用抗精神病药与严重哮喘发作的风险增加相关（调整后的优势比[OR]：1.27；95%置信区间[CI]：1.05-1.54；P=0.013）。使用典型抗精神病药会增加严重哮喘发作的风险（调整后的 OR：1.40，95%CI 1.10-1.79，P=0.007），而使用非典型抗精神病药则不会。排除精神分裂症患者后，这些结果没有改变。抗精神病药存在剂量依赖性效应（趋势检验，P=0.025）。阻断 M2 毒蕈碱或 D2 多巴胺能受体的抗精神病药与严重哮喘发作风险增加相关（调整后的 OR：1.39，95%CI 1.10-1.76，P=0.007 和调整后的 OR：1.33，95%CI 1.08-1.63，P=0.008）。然而，在有精神障碍的患者中，使用抗精神病药不会增加严重哮喘发作的风险。
使用典型抗精神病药与严重哮喘发作风险呈剂量依赖性增加相关，尤其是对于无精神障碍的患者。需要进一步研究典型抗精神病药对哮喘发作的影响。
