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停用吸入性糖皮质激素可降低COPD患者肺炎风险

时间:2016-03-21 23:43来源:未知 作者:admin 点击:
停用吸入性糖皮质激素可降低COPD患者肺炎风险

     吸入性糖皮质激素(ICS)已经广泛用于慢性阻塞性肺疾病(COPD)治疗,但其疗效依然存疑。近期,多项研究发现,与长效支气管扩张剂相比,COPD 患者停用 ICS 所引起的不良事件甚微。目前尚不清楚停用 ICS 是否能降低使用该药期间所增加的肺炎风险。

    加拿大蒙特利尔犹太总医院流行病学研究中心的 Suissa 博士等开展了一项研究,该研究发现,COPD 患者停用 ICS 可显著减少该药引起的肺炎风险。研究结果发表在近期出版的 Chest 杂志上。该研究数据的来自魁北克省医疗数据库,研究人员构建了一个 1990 年 - 2005 年间开始接受 ICS 治疗的 COPD 患者队列,并随访至 2007 年或直至出现重症肺炎事件。重症肺炎定义为因肺炎第一次住院或死亡。采用巢式病例对照分析来评估对年龄、性别、呼吸疾病严重程度和合并症进行校正后的,停用 ICS 和继续使用 ICS 相关的重症肺炎比值比。研究结果表明,该研究中共纳入了 103386 例接受 ICS 治疗的 COPD 患者,其中 14020 例患者在 4.9 年的随访中发生肺炎(发生率为 2.8 / 100 / 年)。停用 ICS 可将肺炎的发生率降低 37%。肺炎风险的下降速率快而明显,从第 1 个月下降 20% 升至停药后第 4 个月的 50%。停用氟替卡松的患者的肺炎风险下降尤其明显,其次为布地奈德。

研究发现,停用 ICS 可降低 COPD 患者 ICS 相关的肺炎发生风险,其中停用氟替卡松后肺炎风险下降最为显著。--以上来自丁香园。

《Discontinuation of Inhaled Corticosteroids in COPD and the Risk Reduction of Pneumonia》

Abstract

BACKGROUND:

The widespread use of inhaled corticosteroids (ICSs) for COPD treatment has been questioned. Recent studies of weaning some patients with COPD off ICSs found little or no adverse consequences compared with long-acting bronchodilators. It is unclear, however, whether discontinuation of ICSs reduces the elevated risk of pneumonia associated with these drugs.

METHODS:

Using the Quebec health insurance databases, we formed a new-user cohort of patients with COPD treated with ICSs during 1990 to 2005 and followed through 2007 or until a serious pneumonia event, defined as a first hospitalization for or death from pneumonia. A nested case-control analysis of the cohort was used to estimate the rate ratio of serious pneumonia associated with discontinuation of ICS use compared with continued use, adjusted for age, sex, respiratory disease severity, and comorbidity.

RESULTS:

The cohort included 103,386 users of ICSs, of whom 14,020 had a serious pneumonia event during 4.9 years of follow-up (incidence rate, 2.8/100/y). Discontinuation of ICSs was associated with a 37% decrease in the rate of serious pneumonia (rate ratio [RR], 0.63; 95% CI, 0.60-0.66). The risk reduction was rapidly evident, going from 20% in the first month to 50% by the fourth month after discontinuation. The risk reduction was particularly marked with fluticasone (RR, 0.58; 95% CI, 0.54-0.61) but less so with budesonide (RR, 0.87; 95% CI, 0.78-0.97).

CONCLUSIONS:

Discontinuation of ICS use in COPD is associated with a reduction in the elevated risk of serious pneumonia, particularly so with fluticasone.

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