哮喘和 COPD 患者使用低气候影响与高气候影响吸入器的效果：一项全国性队列分析。
Effect of low climate impact vs. high climate impact inhalers for patients with asthma and COPD-a nationwide cohort analysis.
机构信息
Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
出版信息
Respir Res. 2024 Sep 12;25(1):339. doi: 10.1186/s12931-024-02942-8.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) and asthma can be treated with inhaled corticosteroids (ICS) delivered by low climate impact inhalers (dry powder inhalers) or high climate impact inhalers (pressurized metered-dose inhalers containing potent greenhouse gasses). ICS delivered with greenhouse gasses is prescribed ubiquitously and frequent despite limited evidence of superior effect. Our aim was to examine the beneficial and harmful events of ICS delivered by low and high climate impact inhalers in patients with asthma and COPD.
METHODS
Nationwide retrospective cohort study of Danish outpatients with asthma and COPD treated with ICS delivered by low and high climate impact inhalers. Patients were propensity score matched by the following variables; age, gender, tobacco exposure, exacerbations, dyspnoea, body mass index, pulmonary function, ICS dose and entry year. The primary outcome was a composite of hospitalisation with exacerbations and all-cause mortality analysed by Cox proportional hazards regression.
RESULTS
Of the 10,947 patients with asthma and COPD who collected ICS by low or high climate impact inhalers, 2,535 + 2,535 patients were propensity score matched to form the population for the primary analysis. We found no association between high climate impact inhalers and risk of exacerbations requiring hospitalization and all-cause mortality (HR 1.02, CI 0.92-1.12, p = 0.77), nor on pneumonia, exacerbations requiring hospitalization, all-cause mortality, or all-cause admissions. Delivery with high climate impact inhalers was associated with a slightly increased risk of exacerbations not requiring hospitalization (HR 1.10, CI 1.01-1.21, p = 0.03). Even with low lung function there was no sign of a superior effect of high climate impact inhalers.
CONCLUSION
Low climate impact inhalers were not inferior to high climate impact inhalers for any risk analysed in patients with asthma and COPD.
背景
慢性阻塞性肺疾病（COPD）和哮喘可以通过低气候影响吸入器（干粉吸入器）或高气候影响吸入器（含有强效温室气体的压力计量剂量吸入器）输送的吸入性皮质类固醇（ICS）进行治疗。尽管ICS 治疗的效果有限，但仍普遍频繁地使用含有温室气体的ICS。我们的目的是研究哮喘和 COPD 患者使用低气候影响和高气候影响吸入器输送的 ICS 的有益和有害事件。
方法
这是一项在丹麦门诊患者中进行的全国性回顾性队列研究，这些患者使用低气候影响和高气候影响吸入器输送 ICS。患者通过以下变量进行倾向评分匹配：年龄、性别、吸烟暴露、恶化、呼吸困难、体重指数、肺功能、ICS 剂量和进入年份。主要结局是通过 Cox 比例风险回归分析住院和全因死亡率的复合结果。
结果
在使用低或高气候影响吸入器收集 ICS 的 10947 例哮喘和 COPD 患者中，2535 例+2535 例患者进行了倾向评分匹配，形成了主要分析的人群。我们没有发现高气候影响吸入器与因恶化需要住院和全因死亡率的风险增加之间存在关联（HR 1.02，CI 0.92-1.12，p=0.77），也没有与肺炎、因恶化需要住院、全因死亡率或全因入院率之间存在关联。高气候影响吸入器的输送与无需住院治疗的恶化风险略有增加相关（HR 1.10，CI 1.01-1.21，p=0.03）。即使肺功能较低，高气候影响吸入器也没有表现出优越的效果。
结论
在哮喘和 COPD 患者中，低气候影响吸入器在任何分析风险方面都不劣于高气候影响吸入器。
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