增加高剂量吸入皮质类固醇和未来喘恶化风险的关联:来自美国的数据
Trung N Tran1, Marjan Kerkhof2, Tham T Le1
1Global Medical Respiratory, Global Medical Biopharmaceutical, AstraZeneca, Gaithersburg, Md.
The journal of allergy and clinical immunology. In practice
|October 30, 2025
概括
在严重喘恶化后增加高剂量吸入性皮质类固醇 (ICS) 并没有降低未来喘恶化的风险. 从中等到高的ICS剂量增加与更频繁的喘发作有关.
科学领域:
- 肺部病理学 肺部病理学
- 现实世界的证据.
- 药物治疗 药物治疗
背景情况:
- 关于高剂量吸入性皮质类固醇 (ICS) 在喘恶化后的益处,现实世界的数据有限.
- 在恶化后了解最佳的ICS剂量策略对于管理持久性喘至关重要.
研究的目的:
- 评估在严重喘恶化后增加到高剂量的ICS是否会在现实环境中降低后续恶化的风险.
- 分析ICS剂量调整及其对喘恶化率及其下一次严重事件的时间的影响.
主要方法:
- 使用Optum Clinformatics数据库 (2015年10月 - 2023年12月) 进行的回顾性队列研究.
- 包括成人和青少年喘患者严重恶化和特定的ICS处方模式在事件发生前和之后.
- 使用逆治疗权重概率 (IPTW) 来比较不同ICS剂量变化模式之间的年度喘恶化率 (AAER) 和第一个随后严重恶化的时间.
主要成果:
- 在低剂量队列中,升级到高剂量ICS并没有显著减少AAER或增加到下一次恶化的时间.
- 在中剂量队列中,升级到高剂量ICS与AAER显著增加以及随后恶化更高的可能性有关.
- 这些发现即使在12个月的有限随访期内也保持一致.
结论:
- 在严重喘恶化后增加到高剂量的ICS与持久性喘患者未来恶化的风险降低无关.
- 除了简单地增加ICS剂量之外,替代性喘管理策略可能对这个患者群体更有效.
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