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北欧人群队列中吸入性糖皮质激素使用与自我报告的声音问题

Inhaled Corticosteroid Use and Self-Reported Voice Problems in a Nordic Population-Based Cohort.

临床研究咽喉科IF 3.7Q2

文献信息

PMID42846458
原文在 PubMed 查看原文 ↗
发表日期2026
作者Sofia Ögefeldt
查看其他 11 位作者

Greta Öhlund Wistbacka；Ellika Schalling；Henrik Johansson；Andrei Malinovschi；Christer Janson；Helena Backman；Mathias Holm；Ane Johannessen；Caroline Ahlroth Pind；Elin Dahlén；Össur Ingi Emilsson

作者单位Department of Public Health and Caring Sciences; Speech-Language Pathology, Uppsala University, Uppsala, Sweden.
查看其他 11 条单位信息

Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.；Department of Geriatrics, Rehabilitation, Pain Centre and Palliative Care, Uppsala University Hospital, Uppsala, Sweden.；Department of Women's and Children's Health: Physiotherapy and Behavioral medicine, Uppsala University, Uppsala, Sweden.；Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden.；Department of Public Health and Clinical Medicine, the OLIN and Sunderby Research Unit, Umeå University, Umeå, Sweden.；Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.；Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.；Centre for Clinical Research Västmanland, Uppsala University, Västerås, Sweden.；Department of Pharmacy; Drug Epidemiology, Uppsala University, Uppsala, Sweden.；The NEPI Foundation-Network for Pharmacoepidemiology, Stockholm, Sweden.；Faculty of Medicine, University of Iceland, Reykjavik, Iceland.

期刊Journal of asthma and allergy
SCI 分区Q2
IF3.7
研究类型临床研究 · 临床
所属专科咽喉科

中文摘要

背景： 吸入性糖皮质激素（ICS）使用者中常报告声音问题，但目前尚不清楚这些问题反映的是药理作用、哮喘还是共存的慢性咳嗽。
目的： 本研究旨在北欧人群队列中考察ICS使用与声音问题之间的关联，并校正哮喘症状和慢性咳嗽。次要目的包括剂量-反应模式以及不同吸入装置类型之间的差异。
方法： 来自瑞典和挪威参与“北欧呼吸健康IV研究”（RHINE，n=5,986）的成人横断面数据与国家处方登记系统相链接。2021年期间的ICS暴露使用年度配药限定日剂量（FDDD）进行量化，该剂量根据每次吸入的糖皮质激素含量和配药剂量数从已配药处方计算得出。采用logistic回归分析自我报告的声音问题与ICS使用、哮喘症状和慢性咳嗽之间的关联，并校正多个混杂因素。在次要分析中考察了剂量-反应、暴露重叠和吸入装置类型。
结果： 声音问题随ICS暴露增加而增多，从非使用者的15.5%上升至最高剂量类别的59.7%。剂量-反应模式显示在较低剂量时急剧增加，而在较高暴露水平时趋于平缓。在包括ICS使用、哮喘症状和慢性咳嗽的校正分析中，ICS使用仍与声音问题相关（1-150 FDDD的aOR为1.54 [1.13-2.10]；151-300 FDDD为2.88 [1.98-4.21]；>300 FDDD为3.00 [2.03-4.43]）；哮喘症状也相关（1个症状的aOR为2.31 [1.90-2.82]；≥2个症状为3.14 [2.45-4.03]）；慢性咳嗽也相关（aOR为2.03 [1.67-2.46]）。在ICS使用、哮喘症状和慢性咳嗽重叠的参与者中观察到最高患病率。吸入装置类型对声音问题没有影响，但需保留低统计效力的限制。
结论： ICS使用、哮喘症状和慢性咳嗽与声音问题独立相关，ICS呈现明确的剂量-反应关系，强调在临床评估中需要考虑药物和呼吸系统症状两方面。

英文摘要

BACKGROUND: Voice problems are frequently reported among users of inhaled corticosteroids (ICS), but it remains unclear whether these problems reflect pharmacological effects, asthma, or comorbid chronic cough.
AIM: This study aimed to examine the association between ICS use and voice problems in a Nordic population-based cohort, accounting for asthma symptoms and chronic cough. Secondary aims included dose-response patterns and differences by inhaler device type.
METHODS: Cross-sectional data from adults in Sweden and Norway participating in the Respiratory Health in Northern Europe IV study (RHINE, n=5,986) were linked to national prescription registers. ICS exposure during 2021 was quantified using annual filled defined daily doses (FDDD), calculated from dispensed prescriptions based on the corticosteroid content per inhalation and number of dispensed doses. Associations between self-reported voice problems and ICS use, asthma symptoms, and chronic cough were analyzed using logistic regression, adjusted for multiple confounders. Dose-response, exposure overlap, and inhaler device type were examined in secondary analyses.
RESULTS: Voice problems increased with higher ICS exposure, from 15.5% among non-users to 59.7% in the highest dose category. The dose-response pattern showed a steep increase at lower doses with attenuation at higher exposure levels. In adjusted analyses including ICS use, asthma symptoms and chronic cough, ICS use remained associated with voice problems (aOR 1.54 [1.13-2.10] for 1-150 FDDD; 2.88 [1.98-4.21] for 151-300 FDDD; and 3.00 [2.03-4.43] for >300 FDDD); as did asthma symptoms (aOR 2.31 [1.90-2.82] for one symptom; 3.14 [2.45-4.03] for ≥2 symptoms); and chronic cough (aOR 2.03 [1.67-2.46]). The highest prevalence was observed among participants with overlapping ICS use, asthma symptoms, and chronic cough. Inhaler device type did not affect voice problems, with reservation for low statistical power.
CONCLUSION: ICS use, asthma symptoms, and chronic cough were independently associated with voice problems, with a clear dose-response for ICS, underscoring the need to consider both medication and respiratory symptoms in clinical assessment.