van Ganse E, Hubloue I, Vincken W, Leufkens H G, Gregoire J, Ernst P
Respiratory Division, Academic Hospital, University of Brussels, Belgium.
Eur J Clin Pharmacol. 1997;51(6):449-54. doi: 10.1007/s002280050229.
The relationship between therapy and adverse outcome in asthma is debated especially for naturally occurring situations. This is due in part to insufficient information regarding actual use of medications.
This study was conducted to clarify the relationship between actual intake of anti-asthma drugs and asthma hospitalisation, considered as an outcome.
A case-control study was performed. Patients hospitalised for an asthma exacerbation were matched to community controls identified in surrounding general practices. Patients were questioned to identify prior use of anti-asthma medications, level of use of inhaled corticosteroids and attitude towards therapy.
Twenty-three cases and 31 matched controls were interviewed. Cases tended to have more severe asthma than controls, as judged by more frequent use of oral corticosteroids. Cases tended to make more frequent use of oral xanthines and inhaled anticholinergics, but the proportion of patients using inhaled beta 2-adrenoceptor agonists and inhaled corticosteroids was similar in both groups. Use of lower doses of inhaled corticosteroids was associated with an increased risk of hospitalisation, while higher dosage was associated with decreased risk. Cases and controls differed as to their answers to a questionnaire concerning attitudes: cases expressed less interest in optimal usage of inhaled corticosteroids than controls; they also expressed more confidence in inhaled beta 2-agonists. When both risks were combined, overconfidence in beta 2-agonists and suboptimal use of inhaled steroids, the relationship with hospitalisation was significant (OR 5.5, 95% CI 1.1; 26.1).
The results suggest that patients' attitudes to inhaled corticosteroids and actual consumption of these medications are directly related to adverse outcome in asthma.
哮喘治疗与不良结局之间的关系存在争议，尤其是在自然发生的情况下。部分原因是关于药物实际使用的信息不足。
本研究旨在阐明抗哮喘药物的实际摄入量与作为结局的哮喘住院之间的关系。
进行了一项病例对照研究。因哮喘急性加重住院的患者与在周边普通诊所确定的社区对照进行匹配。询问患者以确定先前使用抗哮喘药物的情况、吸入性糖皮质激素的使用水平以及对治疗的态度。
对23例病例和31例匹配对照进行了访谈。根据口服糖皮质激素使用频率判断，病例的哮喘往往比对照更严重。病例更频繁使用口服黄嘌呤类药物和吸入性抗胆碱能药物，但两组中使用吸入性β2肾上腺素能激动剂和吸入性糖皮质激素的患者比例相似。使用较低剂量的吸入性糖皮质激素与住院风险增加相关，而较高剂量则与风险降低相关。病例和对照在关于态度的问卷回答上存在差异：病例对吸入性糖皮质激素最佳使用的兴趣低于对照；他们对吸入性β2激动剂也表现出更多信心。当两种风险结合时，即对β2激动剂过度自信和吸入性糖皮质激素使用不足，与住院的关系具有显著性（比值比5.5，95%可信区间1.1；26.1）。
结果表明，患者对吸入性糖皮质激素的态度以及这些药物的实际使用情况与哮喘的不良结局直接相关。
