Lanes S F, Lanza L L, Wentworth C E
Epidemiology Resources Inc., Newton Lower Falls, Massachusetts, USA.
Am J Respir Crit Care Med. 1998 Sep;158(3):857-61. doi: 10.1164/ajrccm.158.3.9803047.
We used automated health insurance claims records of a New England insurer to assess the relation between salmeterol and severe nonfatal asthma. We identified 61,712 members who received a beta-agonist from January 1, 1993 to August 31, 1995, including 2, 708 recipients of salmeterol. Compared with recipients of other beta-agonists, future salmeterol recipients had higher rates of asthma hospitalization and dispensings of asthma medications during the year before they received salmeterol. We selected as a comparison group 3,825 recipients of sustained-release theophylline. We defined a baseline period as the year before the start of the follow-up period, and we characterized patients according to age, sex, calendar period, presence of baseline hospitalizations for asthma, presence of chronic obstructive pulmonary disease (COPD), and baseline dispensings of asthma medications. After adjusting for baseline factors, incidence rates of severe asthma in the salmeterol group were not elevated for emergency care (rate ratio estimate [RR] = 0.69, 95% confidence intervals [CI] = 0.42, 1.11), hospitalization (RR = 1.09, 95% CI = 0.60, 1.98), or intensive care unit (ICU) stays (RR = 0.81, 95% CI = 0.25, 2.62). We conclude that salmeterol was prescribed preferentially to high-risk patients and, after adjusting for baseline risk, salmeterol recipients did not have a greater risk than theophylline recipients of severe nonfatal asthma.
我们利用一家新英格兰保险公司的自动健康保险理赔记录，来评估沙美特罗与严重非致命性哮喘之间的关系。我们确定了在1993年1月1日至1995年8月31日期间接受β受体激动剂治疗的61712名成员，其中包括2708名沙美特罗接受者。与其他β受体激动剂接受者相比，未来的沙美特罗接受者在接受沙美特罗治疗前一年的哮喘住院率和哮喘药物配给率更高。我们选择了3825名缓释茶碱接受者作为对照组。我们将基线期定义为随访期开始前的一年，并根据年龄、性别、日历期、哮喘基线住院情况、慢性阻塞性肺疾病（COPD）的存在情况以及哮喘药物的基线配给情况对患者进行特征描述。在对基线因素进行调整后，沙美特罗组严重哮喘的急诊发病率（率比估计值[RR]=0.69，95%置信区间[CI]=0.42，1.11）、住院发病率（RR=1.09，95%CI=0.60，1.98）或重症监护病房（ICU）住院率（RR=0.81，95%CI=0.25，2.62）均未升高。我们得出结论，沙美特罗优先开给高危患者，在对基线风险进行调整后，沙美特罗接受者发生严重非致命性哮喘的风险并不高于茶碱接受者。
