短效β受体激动剂、抗生素、口服皮质类固醇和慢性阻塞性肺病的相关负担

CHEST pulmonary Pub Date : 2024-02-19 DOI:10.1016/j.chpulm.2024.100042

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摘要

研究问题慢性阻塞性肺疾病（COPD）的实际负担与患者的用药史，特别是短效β-激动剂（SABA）、抗生素和口服皮质类固醇（OCS）的接触史有何关系？研究设计与方法对加拿大艾伯塔省的慢性阻塞性肺病患者进行了一项基于人群的回顾性队列研究，研究对象是根据行政医疗数据确定的慢性阻塞性肺病患者（2011 年 4 月 1 日至 2019 年 3 月 31 日）。研究了90天内发生严重AECOPD（导致住院或急诊就诊的慢性阻塞性肺病事件）和慢性阻塞性肺病特异性HCRU的风险与上一年SABA、抗生素和OCS病史的相关性。在控制了年龄、性别、发病历年、发病时的合并症和既往严重AECOPD后，在特定年份中频繁接触SABA、抗生素或OCS的患者90天内发生严重AECOPD的风险显著升高，且呈正相关关系。SABA暴露量最高的患者（特定年份中≥6罐）的严重AECOPD发病率是只暴露1罐SABA的患者的两倍（发病率比[IRR]，2.06；95% CI，2.01-2.11）。抗生素配药次数≥6 次与 1-2 次的患者 90 天内严重 AECOPD 的发生率高出 51%（IRR，1.51；95% CI，1.48-1.55），OCS 爆破天数≥6 天与 1-5 天的患者 90 天内严重 AECOPD 的发生率高出 3%（IRR，1.03；95% CI，1.00-1.06）。平均年化住院率和急诊室就诊率最高的是配发了≥ 6 罐（vs 少于 6 罐）SABA 或抗生素的患者，以及在给定年度内有任何 OCS 突发天数的患者。

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Short-Acting Beta-Agonists, Antibiotics, Oral Corticosteroids, and the Associated Burden of COPD

Background

Severe acute exacerbations of COPD (AECOPDs) are key events that drive health care resource use (HCRU) and negatively impact patients’ quality of life.

Research Question

What is the real-world burden of COPD relative to patients’ medication history, specifically, exposure to short-acting beta-agonists (SABAs), antibiotics, and oral corticosteroids (OCSs)?

Study Design and Methods

A population-based retrospective cohort study was conducted of patients in Alberta, Canada, identified as having COPD based on administrative health care data (April 1, 2011-March 31, 2019). The risk of severe AECOPDs over 90 days (COPD events resulting in hospitalization or ED visits) and COPD-specific HCRU were studied relative to prior-year SABA, antibiotic, and OCS history.

Results

One hundred eighty-eight thousand nine hundred sixty-nine patients identified with COPD were identified (mean ± SD age, 68.8 ± 13.0 years). After controlling for age, sex, calendar year at index, comorbidities at index, and prior severe AECOPDs, patients with frequent SABA, antibiotic, or OCS exposure in a given year showed significantly higher 90-day risks of severe AECOPDs in a positively associated relationship. Patients with the highest SABA exposure (≥ 6 canisters in a given year) showed twice the rate of severe AECOPDs as patients with 1 SABA canister (incidence rate ratio [IRR], 2.06; 95% CI, 2.01-2.11). The 90-day rates of severe AECOPDs were 51% higher for patients with ≥ 6 vs 1 to 2 antibiotic dispensations (IRR, 1.51; 95% CI, 1.48-1.55) and 3% higher for patients with ≥ 6 vs 1 to 5 OCS burst days (IRR, 1.03; 95% CI, 1.00-1.06). Mean annualized rates of hospitalization and ED visits were highest for patients dispensed ≥ 6 (vs fewer) SABA canisters or antibiotics and patients with any OCS burst days in a given year.

Interpretation

Histories of frequent or prolonged exposure to SABAs, antibiotics, or OCSs were associated with higher rates of severe AECOPDs and HCRU.

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CHEST pulmonary

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