Stanley Brooklyn, Chapaneri Jatin, Khezrian Mina, Maslova Ekaterina, Patel Soram, Gurnell Mark, Canonica Giorgio Walter, Reddel Helen K, Heaney Liam G, Bourdin Arnaud, Neil David L, Carter Victoria, Price David B
Observational and Pragmatic Research Institute, Singapore, Singapore.
BioPharmaceutical Medical, AstraZeneca, Cambridge, UK.
Pragmat Obs Res. 2025 Mar 25;16:95-109. doi: 10.2147/POR.S484146. eCollection 2025.
Oral corticosteroids (OCS) are commonly used to treat asthma but increase the risks for multiple morbidities; reducing OCS exposure may benefit patients. We analysed independent risk factors and longitudinal changes in OCS usage among patients with asthma to predict future risks of OCS-related adverse outcomes.
Optimum Patient Care Research Database United Kingdom primary care electronic medical records (EMR) from January 1990 to June 2021 were used to select adults (18-93 years) with asthma who had follow-up data from ≥2 years before to ≥3 years after an index visit for active symptoms; this date was defined by the largest pre-visit to post-visit change in mean annual OCS use. OCS usage during every follow-up year was categorised as none, low (mean <2 prescriptions/year), or high (mean ≥2 prescriptions/year). Pre-index to post-index changes between usage categories were calculated. Risk modelling selected cohorts without 17 morbidities (documented pre-index) reported to be associated with OCS exposure, including type 2 diabetes, osteoporosis, hypertension, and pneumonia. Cox regression analyses selected published risk factors associated with each condition and available in EMR for inclusion in proportional hazards models.
The pre-index to post-index OCS usage category remained unchanged in 38.6% of patients, increased in 39.2%, and decreased in 22.2%, with 20.7% having no further OCS prescriptions. In models, the risks of all adverse outcomes increased with projected categoric OCS use; for example, hazard ratios for a one-category increment (none to low, low to high) were 1.55 (1.42-1.69) for type 2 diabetes, 1.56 (1.36-1.78) for post-menopausal osteoporosis, 1.05 (1.00-1.10) for hypertension, and 1.67 (1.52-1.83) for pneumonia (all p < 0.001).
OCS exposure in this primary care asthma population usually continued longitudinally. Our models predict increased risk of multiple morbidities with higher projected OCS exposure. These findings support early initiation of strategies to minimise OCS use in asthma.
口服糖皮质激素（OCS）常用于治疗哮喘，但会增加多种疾病的风险；减少OCS暴露可能使患者受益。我们分析了哮喘患者OCS使用的独立危险因素和纵向变化，以预测OCS相关不良结局的未来风险。
利用1990年1月至2021年6月英国初级保健电子病历（EMR）中的最佳患者护理研究数据库，选择18至93岁患有哮喘且在因活动性症状进行索引就诊前至少2年至就诊后至少3年有随访数据的成年人；该日期由就诊前至就诊后平均每年OCS使用量的最大变化来定义。每次随访年的OCS使用情况分为无、低（平均<2张处方/年）或高（平均≥2张处方/年）。计算使用类别之间索引前到索引后的变化。风险建模选择了没有报告与OCS暴露相关的17种疾病（索引前记录）的队列，包括2型糖尿病、骨质疏松症、高血压和肺炎。Cox回归分析选择了与每种疾病相关且EMR中可用的已发表风险因素，纳入比例风险模型。
38.6%的患者索引前到索引后的OCS使用类别保持不变，39.2%增加，22.2%减少，20.7%不再有OCS处方。在模型中，所有不良结局的风险随着预计的分类OCS使用而增加；例如，一类增加（无到低，低到高）的风险比，2型糖尿病为1.55（1.42 - 1.69），绝经后骨质疏松症为1.56（1.36 - 1.78），高血压为1.05（1.00 - 1.10），肺炎为1.67（1.52 - 1.83）（所有p < 0.001）。
该初级保健哮喘人群中的OCS暴露通常呈纵向持续。我们的模型预测，预计OCS暴露增加会使多种疾病的风险增加。这些发现支持尽早启动策略以尽量减少哮喘患者的OCS使用。
