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首页> 美国卫生研究院文献>NPJ Primary Care Respiratory Medicine >Beta-agonist overuse and delay in obtaining medical review in high risk asthma: a secondary analysis of data from a randomised controlled trial
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Beta-agonist overuse and delay in obtaining medical review in high risk asthma: a secondary analysis of data from a randomised controlled trial

机译：β-激动剂过度使用和高风险哮喘患者获得医学审查的延迟：来自随机对照试验的数据的二次分析

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Asthma mortality surveys report delays in seeking medical review and overuse of beta-agonist therapy as factors contributing to a fatal outcome. However, the strength of these associations is limited because many asthma deaths are unwitnessed. We undertook a secondary analysis of data from a 24-week randomised controlled trial of 303 patients with high-risk asthma, randomised to combination budesonide/formoterol inhaler according to a single maintenance and reliever therapy regimen or fixed dose budesonide/formoterol with salbutamol as reliever (Standard) regimen. Medication use was measured by electronic monitors. The thresholds for high, marked and extreme beta-agonist use days were defined in the single maintenance and reliever therapy arm as: >8, >12 and >16 actuations of budesonide/formoterol in excess of four maintenance doses, respectively; and in the Standard arm as: >16, >24 and >32 actuations of salbutamol, respectively. Whether a medical review was obtained within 48 h of an overuse episode was determined by review of data collected during the study by participant report. The mean (standard deviation) proportion of days in which high, marked and extreme beta-agonist overuse occurred without medical review within 48 h was 0·94(0·20), 0·94(0·15) and 0·94(0·17), and 0·92(0·19), 0·90(0·26) and 0·94(0·15) for single maintenance and reliever therapy and Standard regimens, respectively. In at least 90% of days, in which beta-agonist overuse occurred, patients did not obtain medical review within 48 h of beta-agonist overuse, regardless of the magnitude of overuse or the inhaled corticosteroid/long-acting beta-agonist regimen.
机译：哮喘死亡率调查报告称，寻求医学检查的延迟和过度使用β-激动剂是导致致命结果的因素。但是，由于许多哮喘死亡是目击者，因此这些关联的强度受到限制。我们对303名高危哮喘患者进行了为期24周的随机对照试验，对数据进行了二次分析，根据单一的维持和缓解治疗方案或固定剂量的布地奈德/福莫特罗联合沙丁胺醇作为缓解剂，随机分配至布地奈德/福莫特罗联合吸入剂（标准）疗程。药物的使用由电子监控器测量。在单个维持和缓解治疗组中，高，显着和极端的β-激动剂使用天数的阈值定义为：布地奈德/福莫特罗的致动分别> 8，> 12和> 16，超过四个维持剂量；在标准臂中分别为：> 16，> 24和> 32沙丁胺醇致动。是否在过度使用发作后48小时内获得医学检查，是通过研究参与者报告对研究期间收集的数据进行检查来确定的。在48 h内未进行医学检查就发生高，明显和极度过度使用β-激动剂的平均天数（标准差）比例是0·94（0·20），0·94（0·15）和0·94（ 0·17）和0·92（0·19），0·90（0·26）和0·94（0·15）分别用于单一维持和缓解疗法以及标准方案。在至少90％的日子里，发生过β-激动剂过度使用的情况，无论过度使用的程度或吸入的皮质类固醇/长效β-激动剂治疗方案的高低，患者在48h内都无法获得医学检查。

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