Effects of Asthma Medication Type on Asthma Exacerbation in a Real-World Setting
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Currently, there are multiple options for the pharmacological treatment of asthma. This study aimed to compare the ef fects of different asthma medications on exacerbation in a real-world setting. Materials and Methods: We retrospectively reviewed electronic medical records of asthma patients who visited the hospital fromNovember 1, 2016 to October 31, 2019. The number of asthma exacerbations requiring administration of systemic steroids wasthe primary outcome. A time-varying Cox regression analysis was used to reflect the real-world setting: variable usage times, dis continuation, and switching of medication. Results: Among 937 patients with asthma, 228 (24.3%) experienced asthma exacerbation during the study period. Asthma exacer bation was observed in patients using short-acting β2-agonists (SABA) alone (50.4% vs. 28.6%, p<0.001) as well as in patients not us ing inhaled corticosteroids (ICS) (58.8% vs. 40.3%, p<0.001), long-acting β2-agonists (LABA) (54.8% vs. 36.1%, p<0.001), and leukot riene receptor antagonists (71.5% vs. 50.8%, p<0.001). A time-varying Cox regression analysis of asthma exacerbations according tothe duration of asthma medication showed that SABA alone increased the risk of asthma exacerbation [hazard ratio (HR), 1.834;95% confidence interval (CI), 1.299–2.588; p=0.001], whereas ICS-LABA decreased the risk (HR, 0.733; 95% CI, 0.538–0.997;p=0.048). However, in the subgroup analysis according to medication type, specific ingredients showed no significant differences. Conclusion: In the real world, asthma medications affect asthma exacerbation variably according to the medication type.
Abstract
Purpose: Currently, there are multiple options for the pharmacological treatment of asthma. This study aimed to compare the ef fects of different asthma medications on exacerbation in a real-world setting. Materials and Methods: We retrospectively reviewed electronic medical records of asthma patients who visited the hospital fromNovember 1, 2016 to October 31, 2019. The number of asthma exacerbations requiring administration of systemic steroids wasthe primary outcome. A time-varying Cox regression analysis was used to reflect the real-world setting: variable usage times, dis continuation, and switching of medication. Results: Among 937 patients with asthma, 228 (24.3%) experienced asthma exacerbation during the study period. Asthma exacer bation was observed in patients using short-acting β2-agonists (SABA) alone (50.4% vs. 28.6%, p<0.001) as well as in patients not us ing inhaled corticosteroids (ICS) (58.8% vs. 40.3%, p<0.001), long-acting β2-agonists (LABA) (54.8% vs. 36.1%, p<0.001), and leukot riene receptor antagonists (71.5% vs. 50.8%, p<0.001). A time-varying Cox regression analysis of asthma exacerbations according tothe duration of asthma medication showed that SABA alone increased the risk of asthma exacerbation [hazard ratio (HR), 1.834;95% confidence interval (CI), 1.299–2.588; p=0.001], whereas ICS-LABA decreased the risk (HR, 0.733; 95% CI, 0.538–0.997;p=0.048). However, in the subgroup analysis according to medication type, specific ingredients showed no significant differences. Conclusion: In the real world, asthma medications affect asthma exacerbation variably according to the medication type.
참고문헌 (25)
- Byung-Keun Kim, "Evaluation and Management of Difficult-to-Treat and Severe Asthma: An Expert Opinion From the Korean Academy of Asthma, Allergy and Clinical Immunology, the Working Group on Severe Asthma", Allergy, Asthma & Immunology Research, 12(6), pp.910~933 (2020), 대한천식알레르기학회[DOI]
- Lee Youngsoo, "Biomarkers for Severe Asthma: Lessons From Longitudinal Cohort Studies", Allergy, Asthma & Immunology Research, 13(3), pp.375~389 (2021), 대한천식알레르기학회[DOI]
- Taylor DR, "Regular inhaled beta agonist in asthma : effects on exacerbations and lung function", Thorax, 48, pp.134~138 (1993)
- Aldridge RE, "Effects of terbutaline and budesonide on sputum cells and bronchial hyperresponsiveness in asthma", Am J Respir Crit Care Med, 161, pp.1459~1464 (2000)
- Nwaru BI, "Overuse of short-acting β2-agonists in asthma is associated with increased risk of exacerbation and mortality : a nationwide cohort study of the global SABINA programme", Eur Respir J, 55, pp.1901872~ (2020)
- Beasley R, "Controlled trial of budesonide–formoterol as needed for mild asthma", N Engl J Med, 380, pp.2020~2030 (2019)
- Rabe KF, "Effect of budesonide in combination with formoterol for reliever therapy in asthma exacerbations : a randomised controlled, double-blind study", Lancet, 368, pp.744~753 (2006)
- Suissa S, "Low-dose inhaled corticosteroids and the prevention of death from asthma", N Engl J Med, 343, pp.332~336 (2000)
- Buteau S, "A population-based birth cohort study of the association between childhood-onset asthma and exposure to industrial air pollutant emissions", Environ Int, 121(Pt 1), pp.23~30 (2018)
- Lafeuille MH, "Association between consistent omalizumab treatment and asthma control", J Allergy Clin Immunol Pract, 1, pp.51~57 (2013)
- Lee TA, "Outcomes associated with tiotropium use in patients with chronic obstructive pulmonary disease", Arch Intern Med, 169, pp.1403~1410 (2009)
- Ban Ga-Young, "Risk Factors Predicting Severe Asthma Exacerbations in Adult Asthmatics: A Real-World Clinical Evidence", Allergy, Asthma & Immunology Research, 13(3), pp.420~434 (2021), 대한천식알레르기학회[DOI]
- Cataldo D, "A Belgian survey on the diagnosis of asthma-COPD overlap syndrome", Int J Chron Obstruct Pulmon Dis, 12, pp.601~613 (2017)
- Bloom CI, "Asthma-related health outcomes associated with shortacting β2-agonist inhaler use : an observational UK study as part of the SABINA global program", Adv Ther, 37, pp.4190~4208 (2020)
- Hardy J, "Budesonide-formoterol reliever therapy versus maintenance budesonide plus terbutaline reliever therapy in adults with mild to moderate asthma(PRACTICAL) : a 52-week, open-label, multicentre, superiority, randomised controlled trial", Lancet, 394, pp.919~928 (2019)
- Park HJ, "Impact of the asthma quality assessment program on burden of asthma", J Allergy Clin Immunol Pract, 9, pp.419~425.e6 (2021)[DOI]
- Janson C, "SABINA : an overview of short-acting β2-agonist use in asthma in European countries", Adv Ther, 37, pp.1124~1135 (2020)
- Reddel HK, "Global Initiative for Asthma Strategy 2021 : executive summary and rationale for key changes", Am J Respir Crit Care Med, 205, pp.17~35 (2021)
- Rogliani P, "SMART and as-needed therapies in mild-to-severe asthma : a network metaanalysis", Eur Respir J, 56, pp.2000625~ (2020)
- Desager K, "Adherence to asthma treatment in childhood and adolescence-a narrative literature review", Acta Clin Belg, 73, pp.348~355 (2018)
- Zhao Y, "Effectiveness of drug treatment strategies to prevent asthma exacerbations and increase symptom-free days in asthmatic children : a network meta-analysis", J Asthma, 52, pp.846~857 (2015)
- Hong SH, "A comparison of leukotriene receptor antagonists to low-dose inhaled corticosteroids in the elderly with mild asthma", J Allergy Clin Immunol Pract, 7, pp.2642~2652.e3 (2019)
- Esposito R, "Montelukast improves symptoms and lung function in asthmatic women compared with men", Front Pharmacol, 10, pp.1094~ (2019)
- Yan Wang, "Addition of Theophylline or Increasing the Dose of Inhaled Corticosteroid in Symptomatic Asthma: A Meta-Analysis of Randomized Controlled Trials", Yonsei Medical Journal, 52(2), pp.268~275 (2011), 연세대학교의과대학
- Tang Y, "The efficacy and safety of different long-acting β2-agonists combined with inhaled glucocorticoid regimens in patients with asthma : a network meta-analysis", J Asthma, 56, pp.1159~1171 (2019)