背景:2020年6月,新西兰(NZ)青少年和成人哮喘指南推荐布地奈德/福莫特罗,作为维持和/或缓解治疗,作为首选的治疗方法。
目的:调查这些建议是否与哮喘药物使用趋势表明的临床实践变化有关。
方法:对2010年1月至2021年12月新西兰国家吸入药物配药数据进行了综述。每月吸入布地奈德/福莫特罗,吸入性皮质类固醇(ICS),其他ICS/长效β2-激动剂(LABA),和吸入短效β2-激动剂(SABA),对于12岁以上的年龄组,以图形方式显示,分段回归用于按时间生成利率图,断点为2020年7月1日。数据可用的过去六个月(2021年7月至12月)的分配数量与同期进行了比较,2019年7月-12月。
结果:布地奈德/福莫特罗在2020年7月1日之后的分配量明显增加(回归系数为41.1吸入器分配量/100,000人口/每月(95CI:36.3至45.6,P<0.0001);2019年7月至12月至2021年7月之间的分配量增加了64.7%),与“其他ICS/LABA”(回归系数-15.9(95CI:-22.2至-9.6,P<0.0001);-1.7%下降)和SABA(回归系数-14.7(95CI:-29.7至0.3,P=0.055);-10.6%下降),分别。
结论:在新西兰,布地奈德/福莫特罗配药逐渐增加,伴随着SABA和“其他ICS/LABA”分配的减少,发生在2020NZ哮喘指南发布后。在承认时间关联解释的局限性的同时,这些研究结果表明,如果在国家指南中推荐并推广为首选治疗方法,则可以实现向基于ICS/福莫特罗缓解剂的治疗过渡.
In June 2020, the New Zealand (NZ) adolescent and adult asthma
guidelines recommended budesonide/formoterol, taken as maintenance and/or reliever therapy, as the preferred therapeutic approach.
To investigate whether these recommendations were associated with changes in clinical practice indicated by asthma medication use trends.
NZ national dispensing data for inhaler medications from January 2010 to December 2021 were reviewed. Monthly \"dispensings\" of inhaled budesonide/formoterol, inhaled corticosteroid (ICS), other ICS/long-acting β2-agonists (LABA), and inhaled short-acting β2-agonists (SABA), for the 12+ age group, were displayed graphically with piecewise regression used to produce plots of rates by time with a July 1, 2020, break point. The number of dispensings in the last 6 months that data were available (July-December 2021) was compared with the corresponding period, July-December 2019.
Budesonide/formoterol dispensing increased markedly after July 1, 2020 (regression coefficient 41.1 inhalers dispensed/100,000 population per month [95% confidence interval (CI): 36.3-45.6, P < .0001]; 64.7% increase in the number of dispensings between July-December 2019 and July-December 2021), in contrast to \"other ICS/LABA\" (regression coefficient: -15.9 [95% CI: -22.2 to -9.6, P < .0001]; -1.7% decrease) and SABA (regression coefficient: -14.7 [95% CI: -29.7 to 0.3, P = .055]; -10.6% decrease), respectively.
In NZ, a progressive increase in budesonide/formoterol dispensing, accompanied by a reduction in SABA and \"other ICS/LABA\" dispensing, occurred after publication of the 2020 NZ asthma
guidelines. While acknowledging the limitations in the interpretation of temporal associations, these findings suggest that the transition to ICS/formoterol reliever-based therapy can be achieved if recommended and promoted as the preferred therapeutic approach in national
guidelines.