使用短效β -受体激动剂治疗间歇性或轻度持续性哮喘患者的加重负担

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology Pub Date : 2025-05-01 DOI:10.1016/j.anai.2025.02.009

Njira L. Lugogo MD , Ileen A. Gilbert MD , Hitesh N. Gandhi MBBS, MHA, MAS , Joseph P. Tkacz MS , Miguel J. Lanz MD

{"title":"使用短效β -受体激动剂治疗间歇性或轻度持续性哮喘患者的加重负担","authors":"Njira L. Lugogo MD , Ileen A. Gilbert MD , Hitesh N. Gandhi MBBS, MHA, MAS , Joseph P. Tkacz MS , Miguel J. Lanz MD","doi":"10.1016/j.anai.2025.02.009","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Most people in the United States with asthma use therapies for intermittent/mild-persistent disease; however, exacerbations and death occur in patients with infrequent symptoms or labeled as mild asthma.</div></div><div><h3>Objective</h3><div>To evaluate relationships between short-acting β<sub>2</sub>-agonist (SABA) use, exacerbations, and maintenance adherence in intermittent/mild-persistent asthma.</div></div><div><h3>Methods</h3><div>Retrospective cohort study using US Merative MarketScan administrative claims (January 2010 to December 2017) for patients aged 12 years or older treated as intermittent/mild-persistent asthma. Patients were indexed on a random SABA claim, with 12 months continuous enrollment pre- and post-index. Post-index SABA groups were defined as low (index fill only), medium (2-3 fills), and high (≥4 fills). Severe exacerbations were compared within the treatment, SABA fill, and adherence (medication possession ratio) groups through unadjusted comparison of proportions, χ<sup>2</sup>, and odds ratios (OR [95% CI]); <em>P</em> less than or equal to .05.</div></div><div><h3>Results</h3><div>A total of 533,679 patients were included: 68.1% female; mean age (SD) 34.6 (18.3) years; 70.0% intermittent (SABA only) and 30.0% mild-persistent (8.6% low-dose inhaled corticosteroid [ICS]; 21.4% leukotriene modifier [LM]). The proportion of patients with high SABA fills differed among the treatments: SABA only (14.8%), low-dose ICS (37.0%), and LM (25.5%) (<em>P</em> < .001). The proportion experiencing 1 or more exacerbations was higher in SABA only (61.2%) vs low-dose ICS (40.4%) or LM (50.4%): OR (95% CI) 2.32 (2.28-2.37) and 1.55 (1.53-1.57), respectively (both <em>P</em> < .001). The medication possession ratio was less than 50% in 59.3% of patients with mild-persistent asthma; however, adherence was only related to exacerbations in the high SABA group.</div></div><div><h3>Conclusion</h3><div>Patients treated as intermittent/mild-persistent asthma rely on SABA and experience exacerbations. Shifting from SABA only to an anti-inflammatory rescue therapy could decrease morbidity.</div></div>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"134 5","pages":"Pages 539-547.e1"},"PeriodicalIF":5.8000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Exacerbation burden in patients treated as intermittent or mild-persistent asthma using short-acting β2-agonist rescue\",\"authors\":\"Njira L. Lugogo MD , Ileen A. Gilbert MD , Hitesh N. Gandhi MBBS, MHA, MAS , Joseph P. Tkacz MS , Miguel J. Lanz MD\",\"doi\":\"10.1016/j.anai.2025.02.009\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Most people in the United States with asthma use therapies for intermittent/mild-persistent disease; however, exacerbations and death occur in patients with infrequent symptoms or labeled as mild asthma.</div></div><div><h3>Objective</h3><div>To evaluate relationships between short-acting β<sub>2</sub>-agonist (SABA) use, exacerbations, and maintenance adherence in intermittent/mild-persistent asthma.</div></div><div><h3>Methods</h3><div>Retrospective cohort study using US Merative MarketScan administrative claims (January 2010 to December 2017) for patients aged 12 years or older treated as intermittent/mild-persistent asthma. Patients were indexed on a random SABA claim, with 12 months continuous enrollment pre- and post-index. Post-index SABA groups were defined as low (index fill only), medium (2-3 fills), and high (≥4 fills). Severe exacerbations were compared within the treatment, SABA fill, and adherence (medication possession ratio) groups through unadjusted comparison of proportions, χ<sup>2</sup>, and odds ratios (OR [95% CI]); <em>P</em> less than or equal to .05.</div></div><div><h3>Results</h3><div>A total of 533,679 patients were included: 68.1% female; mean age (SD) 34.6 (18.3) years; 70.0% intermittent (SABA only) and 30.0% mild-persistent (8.6% low-dose inhaled corticosteroid [ICS]; 21.4% leukotriene modifier [LM]). The proportion of patients with high SABA fills differed among the treatments: SABA only (14.8%), low-dose ICS (37.0%), and LM (25.5%) (<em>P</em> < .001). The proportion experiencing 1 or more exacerbations was higher in SABA only (61.2%) vs low-dose ICS (40.4%) or LM (50.4%): OR (95% CI) 2.32 (2.28-2.37) and 1.55 (1.53-1.57), respectively (both <em>P</em> < .001). The medication possession ratio was less than 50% in 59.3% of patients with mild-persistent asthma; however, adherence was only related to exacerbations in the high SABA group.</div></div><div><h3>Conclusion</h3><div>Patients treated as intermittent/mild-persistent asthma rely on SABA and experience exacerbations. Shifting from SABA only to an anti-inflammatory rescue therapy could decrease morbidity.</div></div>\",\"PeriodicalId\":50773,\"journal\":{\"name\":\"Annals of Allergy Asthma & Immunology\",\"volume\":\"134 5\",\"pages\":\"Pages 539-547.e1\"},\"PeriodicalIF\":5.8000,\"publicationDate\":\"2025-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Allergy Asthma & Immunology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1081120625000882\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ALLERGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Allergy Asthma & Immunology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1081120625000882","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ALLERGY","Score":null,"Total":0}

引用次数: 0

摘要

背景：美国大多数哮喘患者使用间歇性/轻度持续性疾病治疗；然而，症状不常见或标记为轻度哮喘的患者会出现恶化和死亡。目的：随着短效β2激动剂（SABA）的使用与维持治疗无关，急性发作和死亡风险增加，我们研究了间歇性/轻度持续性哮喘患者使用SABA、急性发作和维持依从性之间的关系。方法：采用美国MerativeTM MarketScan®行政声明（2010年1月至2017年12月）对≥12例间歇性/轻度持续性哮喘患者进行回顾性队列研究。患者在随机的SABA索赔中进行索引，在索引前后连续登记12个月。指数后SABA组分为低（仅指数填充）、中（2-3次填充）、高（≥4次填充）。通过未调整的比例、卡方、优势比（OR[95% CI]）比较治疗组、SABA填充组和依从性（药物占有比[MPR]）组的严重加重情况；P≤0。。结果：共纳入533,679例患者：女性68.1%；平均[SD]年龄34.6[18.3]岁；70.0%间歇性（仅saba）和30.0%轻度持续性(8.6%低剂量吸入皮质类固醇[ICS]；21.4%白三烯改性剂[LM])。高SABA填充的患者比例在不同的治疗方法中存在差异：仅SABA(14.8%)，低剂量ICS (37.0%), LM (25.5%), p。结论：间歇性/轻度持续性哮喘患者依赖SABA治疗并经历加重。从单纯的saba治疗转向抗炎救援治疗可以降低发病率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Exacerbation burden in patients treated as intermittent or mild-persistent asthma using short-acting β2-agonist rescue

Background

Most people in the United States with asthma use therapies for intermittent/mild-persistent disease; however, exacerbations and death occur in patients with infrequent symptoms or labeled as mild asthma.

Objective

To evaluate relationships between short-acting β₂-agonist (SABA) use, exacerbations, and maintenance adherence in intermittent/mild-persistent asthma.

Methods

Retrospective cohort study using US Merative MarketScan administrative claims (January 2010 to December 2017) for patients aged 12 years or older treated as intermittent/mild-persistent asthma. Patients were indexed on a random SABA claim, with 12 months continuous enrollment pre- and post-index. Post-index SABA groups were defined as low (index fill only), medium (2-3 fills), and high (≥4 fills). Severe exacerbations were compared within the treatment, SABA fill, and adherence (medication possession ratio) groups through unadjusted comparison of proportions, χ², and odds ratios (OR [95% CI]); P less than or equal to .05.

Results

A total of 533,679 patients were included: 68.1% female; mean age (SD) 34.6 (18.3) years; 70.0% intermittent (SABA only) and 30.0% mild-persistent (8.6% low-dose inhaled corticosteroid [ICS]; 21.4% leukotriene modifier [LM]). The proportion of patients with high SABA fills differed among the treatments: SABA only (14.8%), low-dose ICS (37.0%), and LM (25.5%) (P < .001). The proportion experiencing 1 or more exacerbations was higher in SABA only (61.2%) vs low-dose ICS (40.4%) or LM (50.4%): OR (95% CI) 2.32 (2.28-2.37) and 1.55 (1.53-1.57), respectively (both P < .001). The medication possession ratio was less than 50% in 59.3% of patients with mild-persistent asthma; however, adherence was only related to exacerbations in the high SABA group.

Conclusion

Patients treated as intermittent/mild-persistent asthma rely on SABA and experience exacerbations. Shifting from SABA only to an anti-inflammatory rescue therapy could decrease morbidity.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Annals of Allergy Asthma & Immunology 医学-过敏

CiteScore

6.50

自引率

6.80%

发文量

437

审稿时长

33 days

期刊介绍： Annals of Allergy, Asthma & Immunology is a scholarly medical journal published monthly by the American College of Allergy, Asthma & Immunology. The purpose of Annals is to serve as an objective evidence-based forum for the allergy/immunology specialist to keep up to date on current clinical science (both research and practice-based) in the fields of allergy, asthma, and immunology. The emphasis of the journal will be to provide clinical and research information that is readily applicable to both the clinician and the researcher. Each issue of the Annals shall also provide opportunities to participate in accredited continuing medical education activities to enhance overall clinical proficiency.