Use of ICS/LABA Combinations or LAMA Is Associated with a Lower Risk of Acute Exacerbation in Patients with Coexistent COPD and Asthma

被引：57

作者：

Su, Vincent Yi-Fong ^{[1
,2
,3
]}

Yang, Kuang-Yao ^{[2
,4
]}

Yang, Yao-Hsu ^{[5
,6
,7
,8
]}

Tsai, Ying-Huang ^{[9
,10
]}

Perng, Diahn-Warng ^{[2
,4
]}

Su, Wei-Juin ^{[2
,4
]}

Chou, Kun-Ta ^{[2
,3
,4
]}

Su, Kang-Cheng ^{[2
,4
]}

Yen, Yung-Feng ^{[1
,2
]}

Chen, Pau-Chung ^{[8
,11
,12
]}

机构：

[1] Taipei City Hosp, Dept Internal Med, Taipei, Taiwan

[2] Natl Yang Ming Univ, Sch Med, Fac Med, Taipei, Taiwan

[3] Natl Yang Ming Univ, Inst Clin Med, Taipei, Taiwan

[4] Taipei Vet Gen Hosp, Dept Chest Med, Taipei, Taiwan

[5] Chang Gung Mem Hosp, Hlth Informat & Epidemiol Lab, Chiayi, Taiwan

[6] Chang Gung Mem Hosp, Dept Tradit Chinese Med, Chiayi, Taiwan

[7] Chang Gung Univ, Coll Med, Sch Med, Taoyuan, Taiwan

[8] Natl Taiwan Univ, Inst Occupat Med & Ind Hyg, Coll Publ Hlth, Taipei, Taiwan

[9] Chang Gung Mem Hosp, Div Pulm & Crit Care Med, Dept Resp Care, Chiayi, Taiwan

[10] Chang Gung Univ, Dept Resp Therapy, Taoyuan, Taiwan

[11] Natl Taiwan Univ Hosp, Dept Environm & Occupat Med, Taipei, Taiwan

[12] Natl Taiwan Univ, Coll Med, Taipei, Taiwan

来源：

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE | 2018年 / 6卷 / 06期

关键词：

Asthma; COPD; Exacerbations; ACO; Asthma-COPD overlap; OBSTRUCTIVE PULMONARY-DISEASE; IMMORTAL TIME BIAS; INHALED CORTICOSTEROIDS; CONCOMITANT ASTHMA; TIOTROPIUM; SALMETEROL; POPULATION; PNEUMONIA; EXAMPLE;

D O I：

10.1016/j.jaip.2018.01.035

中图分类号：

R392 [医学免疫学];

学科分类号：

100102 ;

摘要：

BACKGROUND: Based on current guidelines, more research is urgently needed to guide appropriate treatment for patients with asthma-chronic obstructive pulmonary disease (COPD) overlap. OBJECTIVE: The objective of this study was to investigate medication effects on acute exacerbation in patients with coexistent COPD and asthma. METHODS: Using Taiwan's National Health Insurance Research Database, we conducted a nationwide population-based study to evaluate medication effects in patients with COPD and asthma. Patients diagnosed with both asthma and COPD between 1997 and 2012 were enrolled as the COPD + asthma cohort. The primary endpoint was acute exacerbation. The definitions of COPD and asthma were validated. The validation study confirmed the accuracy of definitions of COPD (86.2% sensitivity) and asthma (92.0% sensitivity). RESULTS: The study included 251,398 patients with COPD + asthma and 514,522 patients with COPD alone, with a mean follow-up period of 9.85 years. After adjustment, hazard ratios (HRs) for long-acting muscarinic antagonist (LAMA) and inhaled corticosteroid/long-acting beta(2)-agonist (ICS/LABA) combinations were lower (time-dependent model, 1 year: LAMA, HR 0.51, 95% confidence interval [CI] 0.49-0.54; ICS/LABA combinations, HR 0.61, 95% CI 0.60-0.62; all P < .0001) than were those for LABAs or ICSs in patients with COPD and asthma. CONCLUSIONS: The use of LAMA or ICS/LABA combinations was associated with a lower risk of acute exacerbation in patients [GRAPHICS] with COPD and asthma in this study. (C) 2018 American Academy of Allergy, Asthma & Immunology

引用

页码：1927 / +

页数：12

共 28 条

[1]

[Anonymous], GLOB STRAT ASTHM MAN

[2] Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease [J].

Calverley, Peter M. A. ;

Anderson, Julie A. ;

Celli, Bartolome ;

Ferguson, Gary T. ;

Jenkins, Christine ;

Jones, Paul W. ;

Yates, Julie C. ;

Vestbo, Jorgen ;

Calverley, P. M. A. ;

Anderson, J. A. ;

Celli, B. ;

Ferguson, G. T. ;

Jenkins, C. ;

Jones, P. W. ;

Knobil, K. ;

Yates, J. C. ;

Vestbo, J. ;

Cherniack, R. ;

Similowski, T. ;

Cleland, J. ;

Whitehead, A. ;

Wise, R. ;

McGarvey, L. ;

John, M. .

NEW ENGLAND JOURNAL OF MEDICINE, 2007, 356 (08) :775-789

[3] Pneumonia risk in COPD patients receiving inhaled corticosteroids alone or in combination: TORCH study results [J].

Crim, C. ;

Calverley, P. M. A. ;

Anderson, J. A. ;

Celli, B. ;

Ferguson, G. T. ;

Jenkins, C. ;

Jones, P. W. ;

Willits, L. R. ;

Yates, J. C. ;

Vestbo, J. .

EUROPEAN RESPIRATORY JOURNAL, 2009, 34 (03) :641-647

[4] Once-daily indacaterol versus tiotropium for patients with severe chronic obstructive pulmonary disease (INVIGORATE): a randomised, blinded, parallel-group study [J].

Decramer, Marc L. ;

Chapman, Kenneth R. ;

Dahl, Ronald ;

Frith, Peter ;

Devouassoux, Gilles ;

Fritscher, Carlos ;

Cameron, Ray ;

Shoaib, Muhammad ;

Lawrence, David ;

Young, David ;

McBryan, Danny .

LANCET RESPIRATORY MEDICINE, 2013, 1 (07) :524-533

[5]

Diagnosis of Diseases of Chronic Airflow Limitation: Asthma COPD and Asthma-COPD Overlap Syndrome (ACOS), 2015, DIAGNOSIS DIS CHRONI

[6] Inhaled Corticosteroids in Patients With Stable Chronic Obstructive Pulmonary Disease A Systematic Review and Meta-analysis [J].

Drummond, M. Bradley ;

Dasenbrook, Elliott C. ;

Pitz, Marshall W. ;

Murphy, David J. ;

Fan, Eddy .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2008, 300 (20) :2407-2416

[7] Effects of Cardiovascular rugs on Mortality in Severe Chronic Obstructive Pulmonary Disease A Time-Dependent Analysis [J].

Ekstrom, Magnus P. ;

Hermansson, Anna Bornefalk ;

Strom, Kerstin E. .

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2013, 187 (07) :715-720

[8] Combination Long-Acting β-Agonists and Inhaled Corticosteroids Compared With Long-Acting β-Agonists Alone in Older Adults With Chronic Obstructive Pulmonary Disease [J].

Gershon, Andrea S. ;

Campitelli, Michael A. ;

Croxford, Ruth ;

Stanbrook, Matthew B. ;

To, Teresa ;

Upshur, Ross ;

Stephenson, Anne L. ;

Stukel, Therese A. .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2014, 312 (11) :1114-1121

[9]

Global Initiative for Chronic Obstructive Lung Disease, 2017, GLOBAL STRATEGY DIAG

[10] Immortal time bias in observational studies of time-to-event outcomes [J].

Jones, Mark ;

Fowler, Robert .

JOURNAL OF CRITICAL CARE, 2016, 36 :195-199

← 1 2 3 →