| Summary: | 碩士 === 國立陽明大學 === 傳統醫藥研究所 === 104 === Introduction
The prevalence of childhood asthma under 18 years old is 12% worldwide, and the prevalence rate of childhood asthma in Taiwan increased year by year from 13.0% in 2002 to 16.9% in 2008. According to the past research, a proportion of medication induced asthma exacerbation, such as aspirin or NSAIDs. On the other hand, some parents seek traditional Chinese medicine (TCM) to help their children to relieve asthma symptoms. The safety and efficacy of TCM in treating childhood asthma has not been established, therefore, the aim of the study is to (1) investigate the relationship between NSAIDs and asthma exacerbation in children (2) investigate the relationship between integration of Western medicine and TCM and asthma-related hospitalization in children with asthma.
Methods
The study population included one million randomized people enrolled in the year 2005 from the National Health Insurance Research Database (NHIRD) in Taiwan. The research contains two parts. Both the study designs were conducted retrospective cohort study, and population aged less than 18 years old and having at least three times confirmed diagnosis by physicians were enrolled. In the research Part 1, all the medical records from 1997 to 2012 were researched, and the study populations were divided into groups of concurrently using NSAIDs with anti-asthmatic drugs (index group), and only using anti-asthmatic drugs (reference group). The start of the observation date was the first diagnosis date of asthma and the endpoint was either the date that patients were hospitalized with asthma initially or the date of last medical visit before December 31, 2012. The Relative Risk was used to estimate the risk of asthma-related hospitalization in the two groups, and logistic regression model was used to ananlyze the most frequently prescribed NSAIDs in 1-2 days prior to asthma-related hospitalization. In the research Part 2, we conducted a retrospective cohort study with the population who was diagnosed with asthma at the age less than 18 years old, indeed, at least three times confirmed diagnosis by physicians were enrolled. The medical records from 2000 to 2012 were researched, and we divided the study population into group of using TCM more than 30 days (traditional Chinese medicine, TCM users), and group of using TCM less than 30 days or without using TCM (Non TCM users). After adjustment for gender, age, comorbidities and types of asthma medication, the risk of asthma-related hospitalization in the two groups were estimated by using Cox proportional hazards model.
Results
In research Part1, among total 29,484 patients, 19,622 (66.6%) patients used anti-asthmatic agents alone (reference group), while 9,862 (33.4%) patients used anti-asthmatic agents concurrently with NSAIDs (index group). Index group had more asthma-related hospitalization (RR: 1.35, 95% CI: 1.30–1.41). After adjusting for NSAIDs, we found that aspirin, ibuprofen, and diclofenac posed certain risks with regard to asthma-related hospitalization, and exposure to ibuprofen in 7 to 365 days had positive correlation to asthma-related hospitalization (aOR: 1.53-1.54, 95% CI:1.01-2.33). In research Part2, among the total 33,685 patients, 14,783 (43.6%) were TCM users, and 19,082 (56.4%) patients were non-TCM users. The TCM users were mostly girls in gender, and the age distribution were older than non-TCM users, and higher percentage was found living in central Taiwan, Kaohsiung city, and southern Taiwan. In the aspect of cormobidity, patients combined with allergic rhinitis, acute bronchitis, sinusitis, gastroesophageal reflux disease, or urticaria are prone to use TCM combination therapy. After adjustment for gender, age, cormobidities and types of asthma medication, TCM therapy had a lower risk of asthma-related hospitalization in comparison with non-TCM therapy (aHR:0.90,95% CI: 0.83-0.95). Moreover, children older than 6 years of age using TCM therapy more than 180 days had a 29% reduction in the asthma-related hospitlaization consequently (aHR:0.71,95% CI:0.51-0.98).
Conclusion
NSAIDs have positive correlation with asthma-related hospitalization in children, especially ibuprofen, diclofenac, and aspirin. Furthermore, long-term exposure to ibuprofen of 7 to 365 days increased the risk for asthma-related hospitalization. On the other hand, integration of Western medicine and TCM in treating children with asthma was safe and did not increase the risk of asthma-related hospitalizaion. Moreover, using TCM combination therapy in children older than 6 years of age decreased the risk of subsequent asthma-related hospitalization.
|
|---|
