在瑞典临床实践中,哮喘人群的布地奈德吸入装置的切换模式
2015/10/30
摘要
背景:在哮喘治疗中,随着新装置的应用,干粉吸入(DPI)装置的切换可能增加。我们研究了瑞典现有的布地奈德(BUD)DPI类似物的切换模式。
方法:本项观察性现实生活研究链接了从西约特兰地区到瑞典国家登记处的初级卫生保健的医疗记录数据,包含了使用多剂量DPI BUD的哮喘患者。开始日期:BUD DPI的第一次使用。切换日期:另一种BUD DPI装置的使用。研究结果(切换vs不切换)为哮喘急性发作和短效β2-受体激动剂的使用。研究时间为2005年7月1日至2013年10月31日。
结果:总体而言,15,169例哮喘患者采用BUD DPI治疗。在研究过程中,1178例(7.35%)切换到另一种BUD DPI。将切换者与非切换者进行成对1:1匹配,最终两组各463例患者(平均年龄为36岁,女性患者占55%)。相对于非切换组,切换组的哮喘急性发作率高出25%(0.40与0.32,p=0.047)。切换组比非切换组年轻4.5岁,并有较低的药品持有率。切换时有和没有进行初级卫生保健访问患者的会诊和急性发作没有差异(无访问患者分别为4.96和0.90,有访问患者分别为4.29和0.77)。然而,切换时没有进行初级卫生保健访问患者的门诊就诊次数明显增加(2.01 vs 0.81;p<0.001).
结论:考虑到较低的切换率,在瑞典的临床实践中,哮喘患者和医生似乎不愿意切换到另一种BUD DPI装置。切换,特别是没有进行初级卫生保健访问时,与哮喘控制的降低相关,会导致更高的急性发作率和更多的门诊就诊。
(杨冬 审校)
Int J Clin Pract. 2015 Aug 3. doi: 10.1111/ijcp.12685. [Epub ahead of print]
Budesonide inhaler device switch patterns in an asthma population in Swedish clinical practice (ASSURE).
Ekberg-Jansson A1,2, Svenningsson I3, Rågdell P4, Stratelis G5, Telg G5, Thuresson M6, Nilsson F7.
Abstract
BACKGROUND:Dry powder inhaler (DPI) device switch in asthma treatment could potentially increase with the entrance of new devices. We examined the switch patterns of budesonide (BUD) DPI analogues available in Sweden.
METHODS:This observational real-life study linked primary healthcare medical records data from the Västra Götaland region to national Swedish registries, and included asthma patients (ICD-10-CM J45) prescribed BUD in a multidose DPI. Index date: first dispense of BUD DPI. Switch date: prescription of another BUD DPI device. Study outcomes (switch vs. non-switch) were exacerbations and prescription of short-acting β2 -agonists. Study period was 1 July 2005 to 31 October 2013.
RESULTS:Overall, 15,169 asthma patients were on treatment with BUD DPI; 1178 (7.35%) switched to another BUD DPI during the study. Pair-wise 1:1 matching of switchers vs. non-switchers resulted in two groups of 463 patients each (mean age 36 years, 55% female patients). A 25% higher exacerbation rate was seen postswitch (0.40 vs. 0.32; p = 0.047). Switchers were 4.5 year younger and had lower medication possession rate than non-switchers. Switch without primary healthcare visit did not differ between groups regarding consultations and exacerbations (no visit 4.96 and 0.90; visit 4.29 and 0.77, respectively). However, patients without primary healthcare visit at switch had significantly more outpatient hospital visits (2.01 vs. 0.81; p < 0.001).
CONCLUSIONS:Considering the low switch rate, asthma patients and physicians in Swedish general practice seem reluctant to switch to another BUD DPI device. Switch, especially without primary healthcare visit, was associated with decreased asthma control resulting in higher exacerbation rate and more outpatient hospital visits.
Int J Clin Pract. 2015 Aug 3. doi: 10.1111/ijcp.12685. [Epub ahead of print]
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噻托溴铵治疗中重度症状性青少年哮喘:一项通过荟萃分析进行的系统性回顾
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成人哮喘临床指南对吸入性皮质激素处方趋势的影响:一项准实验研究