Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2022 Jul;63(7):603-610. doi: 10.3349/ymj.2022.63.7.603.
Currently, there are multiple options for the pharmacological treatment of asthma. This study aimed to compare the effects of different asthma medications on exacerbation in a real-world setting.
We retrospectively reviewed electronic medical records of asthma patients who visited the hospital from November 1, 2016 to October 31, 2019. The number of asthma exacerbations requiring administration of systemic steroids was the primary outcome. A time-varying Cox regression analysis was used to reflect the real-world setting: variable usage times, discontinuation, and switching of medication.
Among 937 patients with asthma, 228 (24.3%) experienced asthma exacerbation during the study period. Asthma exacerbation was observed in patients using short-acting β-agonists (SABA) alone (50.4% vs. 28.6%, <0.001) as well as in patients not using inhaled corticosteroids (ICS) (58.8% vs. 40.3%, <0.001), long-acting β-agonists (LABA) (54.8% vs. 36.1%, <0.001), and leukotriene receptor antagonists (71.5% vs. 50.8%, <0.001). A time-varying Cox regression analysis of asthma exacerbations according to the duration of asthma medication showed that SABA alone increased the risk of asthma exacerbation [hazard ratio (HR), 1.834; 95% confidence interval (CI), 1.299-2.588; =0.001], whereas ICS-LABA decreased the risk (HR, 0.733; 95% CI, 0.538-0.997; =0.048). However, in the subgroup analysis according to medication type, specific ingredients showed no significant differences.
In the real world, asthma medications affect asthma exacerbation variably according to the medication type.
目前，有多种药理学方法可用于治疗哮喘。本研究旨在比较不同哮喘药物在真实环境下对哮喘恶化的影响。
我们回顾性分析了 2016 年 11 月 1 日至 2019 年 10 月 31 日期间在我院就诊的哮喘患者的电子病历。主要结局为需要全身用皮质类固醇治疗的哮喘恶化次数。采用时变 Cox 回归分析来反映真实环境：药物的使用次数、停药和换药情况。
在 937 例哮喘患者中，228 例（24.3%）在研究期间发生哮喘恶化。单独使用短效β激动剂（SABA）的患者（50.4%比 28.6%，<0.001）和未使用吸入皮质激素（ICS）的患者（58.8%比 40.3%，<0.001）、长效β激动剂（LABA）（54.8%比 36.1%，<0.001）和白三烯受体拮抗剂（LTRA）（71.5%比 50.8%，<0.001）哮喘恶化的发生率较高。根据哮喘药物使用时间的哮喘恶化时间变化 Cox 回归分析显示，单独使用 SABA 会增加哮喘恶化的风险[风险比（HR），1.834；95%置信区间（CI），1.299-2.588；=0.001]，而 ICS-LABA 则降低了风险（HR，0.733；95%CI，0.538-0.997；=0.048）。然而，根据药物类型的亚组分析，特定成分没有显示出显著差异。
在真实世界中，根据药物类型，哮喘药物对哮喘恶化的影响各不相同。
