美国的喘控制:短效β2抗体和全身性皮质类固醇使用之间的关系
Geoffrey Chupp1, Kevin R Murphy2, Hitesh N Gandhi3
1Department of Pulmonary, Critical Care, and Sleep Medicine, Yale University, New Haven, Connecticut.
概括
不受控制的喘,标志着全身皮质类固醇 (SCS) 和短效β2-激动剂 (SABA) 的使用,即使在轻度至中度病例中也很普遍. 对症状负担和恶化风险的全面评估对于准确的喘控制评估至关重要.
科学领域:
- 肺部病理学 肺部病理学
- 呼吸系统医学 呼吸系统医学
- 临床药房 临床药房
背景情况:
- 喘控制评估传统上依赖于评估当前症状 (损伤) 和恶化史 (风险).
- 要了解非控制性喘的全部范围,需要检查损伤和风险的标志物.
- 系统性皮质类固醇 (SCS) 和短效β2-激动剂 (SABA) 的处方填充作为关键指标.
研究的目的:
- 评估SCS和SABA作为风险和损伤标志物的处方填充之间的关系.
- 使用这些标志物来确定失控喘的程度.
- 在喘控制评估中识别潜在的错误分类.
主要方法:
- 美国患者数据的回顾性分析 (IQVIA纵向访问和判断数据).
- 年度SCS和SABA处方填充的评估.
- 根据全球喘倡议 (GINA) 的阶段性治疗水平,根据疾病严重程度的分类.
- 控制不下的喘的定义是每年SCS填充≥2次或SABA填充≥3次.
主要成果:
- 分析了超过450万名患者,15.1%的患者有≥2次SCS填充,29.1%的患者有≥3次SABA填充.
- 37.4%的患者符合失控喘的标准.
- 如果仅考虑使用SCS或SABA,特别是在轻度至中度喘时,则发生了重大错误分类.
- 80.9%的非控制性喘病例发生在为轻度至中度疾病治疗的患者中.
结论:
- 高症状负担和SCS使用在轻度至中度喘中很常见,而不仅仅是严重的病例.
- 依靠单个标志物 (SCS或SABA) 会导致低估失控喘.
- 精确评估喘控制需要评估所有疾病严重程度的损伤 (SABA使用) 和风险 (SCS使用).
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