Hee Sun Park, Jungkuk Lee, Hasung Kim, Seong-Dae Woo
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Outcomes assessed included treatment adherence, asthma exacerbations, hospitalizations, emergency-department visits, mortality, and safety outcomes within 3-month and 1-year post-index periods.</p><p><strong>Results: </strong>Overall, 13,850 eligible patients were included, with subgroups categorized and compared according to inhaler type and component (metered dose inhalers [MDIs] vs. dry powder inhalers [DPIs], budesonide vs. fluticasone, and formoterol vs. salmeterol). Efficacy and safety profiles did not significantly differ across device types or ICS/LABA combination components during the 3-month and 1-year follow-up periods. However, the DPI group exhibited a significantly higher mean proportion of days covered (0.67 ± 0.23 vs. 0.62 ± 0.23; P < 0.001) and a lower risk of discontinuation (adjusted hazard ratio, 0.867; 95% confidence interval, 0.804-0.927; P < 0.001) than did the MDI group, with no significant differences observed between the other subgroups.</p><p><strong>Conclusions: </strong>The choice of inhaler device (MDI vs. DPI) and specific ICS/LABA combination components does not significantly impact efficacy and safety profiles in patients newly diagnosed with asthma. However, DPI use may be associated with improved adherence. 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引用次数: 0
摘要
背景：选择有效的设备（吸入皮质类固醇[ICS]-长效β2激动剂[LABA]联合吸入器）作为维持治疗对于哮喘患者的治疗至关重要。我们的目的是比较ICS/LABA联合使用不同吸入器类型和成分对新诊断哮喘患者的疗效、安全性和依从性。方法：利用韩国国民健康保险服务的数据，我们进行了一项基于人群的队列研究，纳入了2016年1月至2020年12月期间接受ICS/LABA联合治疗的18-80岁新诊断为哮喘的患者。评估的结果包括治疗依从性、哮喘加重、住院、急诊科就诊、死亡率和指数后3个月和1年内的安全性结果。结果：总体而言，纳入了13850例符合条件的患者，并根据吸入器类型和成分（计量吸入器[mdi]与干粉吸入器[dbi]，布地奈德与氟替卡松，福莫特罗与沙美特罗）对亚组进行了分类和比较。在3个月和1年的随访期间，不同器械类型或ICS/LABA组合组件的疗效和安全性无显著差异。然而，DPI组的平均覆盖天数比例显著高于对照组(0.67±0.23∶0.62±0.23；结论：吸入器（MDI vs. DPI）和特定ICS/LABA组合成分的选择对新诊断哮喘患者的疗效和安全性没有显著影响。然而，DPI的使用可能与依从性的提高有关。这些结果为临床医生在现实环境中选择适当的和个性化的吸入器疗法提供了有价值的见解。
Comparative analysis of real-world data on the efficacy and safety of and adherence to ICS/LABA combinations in asthma management.
Background: Choosing effective devices (inhaled corticosteroid [ICS]-long-acting β2 agonist [LABA] combination inhalers) as maintenance treatment is critical for managing patients with asthma. We aimed to compare ICS/LABA combination efficacy, safety, and adherence across inhaler types and components in patients newly diagnosed with asthma.
Methods: Utilizing South Korea's National Health Insurance Service data, we conducted a population-based cohort study involving patients aged 18-80 years, newly diagnosed with asthma who received ICS/LABA combination therapy between January 2016 and December 2020. Outcomes assessed included treatment adherence, asthma exacerbations, hospitalizations, emergency-department visits, mortality, and safety outcomes within 3-month and 1-year post-index periods.
Results: Overall, 13,850 eligible patients were included, with subgroups categorized and compared according to inhaler type and component (metered dose inhalers [MDIs] vs. dry powder inhalers [DPIs], budesonide vs. fluticasone, and formoterol vs. salmeterol). Efficacy and safety profiles did not significantly differ across device types or ICS/LABA combination components during the 3-month and 1-year follow-up periods. However, the DPI group exhibited a significantly higher mean proportion of days covered (0.67 ± 0.23 vs. 0.62 ± 0.23; P < 0.001) and a lower risk of discontinuation (adjusted hazard ratio, 0.867; 95% confidence interval, 0.804-0.927; P < 0.001) than did the MDI group, with no significant differences observed between the other subgroups.
Conclusions: The choice of inhaler device (MDI vs. DPI) and specific ICS/LABA combination components does not significantly impact efficacy and safety profiles in patients newly diagnosed with asthma. However, DPI use may be associated with improved adherence. These results provide valuable insights for clinicians in selecting appropriate and individually tailored inhaler therapies in real-world settings.
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.
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