Effect of low climate impact vs. high climate impact inhalers for patients with asthma and COPD-a nationwide cohort analysis

IF 4.7 2区医学 Q1 RESPIRATORY SYSTEM

Respiratory Research Pub Date : 2024-09-12 DOI:10.1186/s12931-024-02942-8

Barbara Bonnesen, Josefin Eklöf, Tor Biering-Sørensen, Daniel Modin, Marc Miravitlles, Alexander G. Mathioudakis, Pradeesh Sivapalan, Jens-Ulrik Staehr Jensen

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Abstract

Chronic obstructive pulmonary disease (COPD) and asthma can be treated with inhaled corticosteroids (ICS) delivered by low climate impact inhalers (dry powder inhalers) or high climate impact inhalers (pressurized metered-dose inhalers containing potent greenhouse gasses). ICS delivered with greenhouse gasses is prescribed ubiquitously and frequent despite limited evidence of superior effect. Our aim was to examine the beneficial and harmful events of ICS delivered by low and high climate impact inhalers in patients with asthma and COPD. Nationwide retrospective cohort study of Danish outpatients with asthma and COPD treated with ICS delivered by low and high climate impact inhalers. Patients were propensity score matched by the following variables; age, gender, tobacco exposure, exacerbations, dyspnoea, body mass index, pulmonary function, ICS dose and entry year. The primary outcome was a composite of hospitalisation with exacerbations and all-cause mortality analysed by Cox proportional hazards regression. Of the 10,947 patients with asthma and COPD who collected ICS by low or high climate impact inhalers, 2,535 + 2,535 patients were propensity score matched to form the population for the primary analysis. We found no association between high climate impact inhalers and risk of exacerbations requiring hospitalization and all-cause mortality (HR 1.02, CI 0.92–1.12, p = 0.77), nor on pneumonia, exacerbations requiring hospitalization, all-cause mortality, or all-cause admissions. Delivery with high climate impact inhalers was associated with a slightly increased risk of exacerbations not requiring hospitalization (HR 1.10, CI 1.01–1.21, p = 0.03). Even with low lung function there was no sign of a superior effect of high climate impact inhalers. Low climate impact inhalers were not inferior to high climate impact inhalers for any risk analysed in patients with asthma and COPD.

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对哮喘和慢性阻塞性肺病患者使用低气候影响与高气候影响吸入器的效果--全国队列分析

慢性阻塞性肺病（COPD）和哮喘可通过低气候影响吸入器（干粉吸入器）或高气候影响吸入器（含有强效温室气体的加压计量吸入器）吸入皮质类固醇（ICS）进行治疗。使用温室气体吸入的 ICS 无处不在，而且使用频率很高，尽管只有有限的证据表明其效果更佳。我们的目的是研究在哮喘和慢性阻塞性肺病患者中使用低气候影响和高气候影响吸入器给予 ICS 的有益和有害事件。对丹麦哮喘和慢性阻塞性肺病门诊患者进行全国性回顾性队列研究，研究对象为使用低度和高度气候影响吸入器吸入 ICS 的患者。根据以下变量对患者进行倾向评分匹配：年龄、性别、烟草接触、病情加重、呼吸困难、体重指数、肺功能、ICS剂量和入院年份。主要研究结果是因病情加重住院和全因死亡率的复合结果，通过 Cox 比例危险度回归进行分析。在使用低或高气候影响吸入器吸入 ICS 的 10947 名哮喘和慢性阻塞性肺病患者中，有 2535+2535 名患者进行了倾向评分匹配，从而形成了主要分析的人群。我们发现，高气候影响吸入器与需要住院治疗的病情加重风险和全因死亡率（HR 1.02，CI 0.92-1.12，P = 0.77）之间没有关联，与肺炎、需要住院治疗的病情加重、全因死亡率或全因入院率之间也没有关联。使用气候影响大的吸入器与不需要住院治疗的病情加重风险略有增加有关（HR 1.10，CI 1.01-1.21，p = 0.03）。即使在肺功能较低的情况下，也没有迹象表明高气候影响吸入器具有更优越的效果。在分析哮喘和慢性阻塞性肺病患者的任何风险时，低气候影响吸入器的效果都不优于高气候影响吸入器。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Respiratory Research 医学-呼吸系统

自引率

1.70%

发文量

314

期刊介绍： Respiratory Research publishes high-quality clinical and basic research, review and commentary articles on all aspects of respiratory medicine and related diseases. As the leading fully open access journal in the field, Respiratory Research provides an essential resource for pulmonologists, allergists, immunologists and other physicians, researchers, healthcare workers and medical students with worldwide dissemination of articles resulting in high visibility and generating international discussion. Topics of specific interest include asthma, chronic obstructive pulmonary disease, cystic fibrosis, genetics, infectious diseases, interstitial lung diseases, lung development, lung tumors, occupational and environmental factors, pulmonary circulation, pulmonary pharmacology and therapeutics, respiratory immunology, respiratory physiology, and sleep-related respiratory problems.