Guruparan Yalini, S Navaratinaraja Thiyahiny, Selvaratnam Gowry, Sri Ranganathan Shalini
Pharmacology, Faculty of Medicine, University of Jaffna, Jaffna, Northern Province, Sri Lanka
Pharmacology, Faculty of Medicine, University of Jaffna, Jaffna, Northern Province, Sri Lanka.
BMJ Open Respir Res. 2025 Feb 27;12(1):e002675. doi: 10.1136/bmjresp-2024-002675.
Inhaled corticosteroids (ICS) alone, or combined with long-acting beta-agonist (LABA), are recommended for chronic asthma. Limited access to inhaled medications hinders effective control of asthma in low-income and middle-income countries.
This study aimed to compare the effectiveness of inhaled therapies in a cohort of adult patients with asthma who were receiving treatment in a tertiary hospital in Northern Sri Lanka.
A prospective cohort study was conducted among adult patients with asthma on either ICS alone or ICS/LABA combination for at least 3 months. Participants were followed up for 6 months, with two follow-up interviews conducted 3 months apart. The primary outcome measure was asthma control, assessed by a locally validated asthma control patient-reported outcome measure. Secondary outcome measures included the use of short-acting beta-agonists (SABA) and the percentage of patients required nebulisations and hospitalisations. McNemar's test was used to determine the statistical significance. A p value≤0.05 was considered significant.
Of the 1094 participants, 827 (76%) were on ICS monotherapy and 267 (24%) were on ICS/LABA. Though there were no changes in the treatment, progressive improvement in asthma control was observed from baseline to second follow-up in both ICS (54%-72%) and ICS/LABA (76%-81%) groups. Significant improvement in asthma control (p<0.001) and SABA overuse (p<0.001) at both follow-ups and nebulisation (0.008) at the first follow-up were observed in the ICS group.
Both ICS monotherapy and ICS/LABA were effective in controlling asthma. Though control was greater with ICS/LABA, the effect of additional monitoring during the follow-up was higher and significant in ICS monotherapy. Considering the low access to ICS/LABA, a treatment package comprising ICS plus non-pharmacological approaches could be a more realistic and cost-effective treatment strategy in the local context. ICS/LABA could be reserved for patients who fail to respond. However, this observation needs to be confirmed by interventional studies.
单独使用吸入性糖皮质激素（ICS）或联合长效β受体激动剂（LABA）被推荐用于治疗慢性哮喘。在低收入和中等收入国家，吸入药物的可及性有限阻碍了哮喘的有效控制。
本研究旨在比较在斯里兰卡北部一家三级医院接受治疗的成年哮喘患者队列中吸入疗法的有效性。
对成年哮喘患者进行一项前瞻性队列研究，这些患者单独使用ICS或使用ICS/LABA联合治疗至少3个月。对参与者进行6个月的随访，每隔3个月进行两次随访访谈。主要结局指标是哮喘控制情况，通过本地验证的哮喘控制患者报告结局指标进行评估。次要结局指标包括短效β受体激动剂（SABA）的使用情况以及需要雾化治疗和住院治疗的患者百分比。采用McNemar检验确定统计学意义。p值≤0.05被认为具有统计学意义。
在1094名参与者中，827名（76%）接受ICS单药治疗，267名（24%）接受ICS/LABA治疗。尽管治疗方案没有改变，但在ICS组（54%-72%）和ICS/LABA组（76%-81%）中，从基线到第二次随访均观察到哮喘控制情况有逐步改善。在ICS组中，两次随访时哮喘控制情况（p<0.001）和SABA过度使用情况（p<0.001）均有显著改善，第一次随访时雾化治疗情况（0.008）也有显著改善。
ICS单药治疗和ICS/LABA联合治疗在控制哮喘方面均有效。尽管ICS/LABA的控制效果更好，但在随访期间额外监测的效果在ICS单药治疗中更高且具有显著意义。考虑到ICS/LABA的可及性较低，在当地背景下，包含ICS加非药物方法的治疗方案可能是一种更现实且具有成本效益的治疗策略。ICS/LABA可保留给无反应的患者。然而，这一观察结果需要通过干预性研究来证实。
