Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.
Ann Pharmacother. 2010 Feb;44(2):257-66. doi: 10.1345/aph.1M481. Epub 2010 Jan 26.
Chronic obstructive pulmonary disease (COPD) is a prevalent disease that is frequently treated in primary care. However, data regarding the primary care management of COPD are scarce. Such observational data are necessary to detect problem areas and to develop targeted interventions for improvement of COPD management.
To provide a detailed description of (1) drug therapy, (2) drug adherence, (3) inhalation technique, and (4) health status of patients with COPD recruited via community pharmacies.
A cross-sectional, observational study was conducted in 93 pharmacies in Belgium. Participants (N = 555) completed a questionnaire collecting information on personal characteristics, smoking history, influenza vaccination, COPD medication, and adverse effects. Adherence to COPD maintenance medication was analyzed 1 year retrospectively through prescription refill rates. Inhalation technique was scored using a checklist. Health status was evaluated with the St. George's Respiratory Questionnaire, the Clinical COPD Questionnaire, and the Modified Medical Research Council dyspnea scale.
The mean age of the patients was 68.6 years; 73.7% were men and 37.2% were current smokers. The influenza vaccination status was significantly lower in patients aged less than 65 years (65.7%) than in patients aged 65 years or more (86.2%) (p < 0.001). Fixed combinations of inhaled corticosteroids and long-acting beta(2)-agonists were the most frequently used COPD medications (75.4%). About 48% of patients were underadherent (<80% adherence), 47% were adherent (80-120% adherence) and 5% were overadherent (>120% adherence). Predictors for underadherence were age and number of drugs. Twenty-one percent of patients made major inhalation technique errors with rescue medication; these were all errors in handling pressurized metered-dose inhalers (pMDIs).
This observational study on COPD management in primary care highlights 4 main aspects that could be improved: (1) drug adherence, (2) inhalation technique with pMDIs, (3) influenza vaccination in COPD patients younger than 65 years, and (4) smoking cessation.
慢性阻塞性肺疾病（COPD）是一种常见疾病，常在初级保健中进行治疗。然而，关于 COPD 的初级保健管理的数据很少。这种观察性数据对于发现问题领域和为改善 COPD 管理而制定有针对性的干预措施是必要的。
详细描述（1）药物治疗、（2）药物依从性、（3）吸入技术和（4）通过社区药房招募的 COPD 患者的健康状况。
在比利时的 93 家药店进行了一项横断面、观察性研究。参与者（N=555）填写了一份问卷，收集个人特征、吸烟史、流感疫苗接种、COPD 药物和不良反应的信息。通过回顾性分析处方续配率来分析 COPD 维持药物的依从性。使用检查表对吸入技术进行评分。使用圣乔治呼吸问卷、临床 COPD 问卷和改良医学研究委员会呼吸困难量表评估健康状况。
患者的平均年龄为 68.6 岁；73.7%为男性，37.2%为当前吸烟者。年龄小于 65 岁的患者流感疫苗接种情况明显低于年龄 65 岁或以上的患者（65.7%比 86.2%）（p<0.001）。吸入性皮质类固醇和长效β2-激动剂的固定组合是最常用的 COPD 药物（75.4%）。约 48%的患者用药不依从（<80%的依从性），47%的患者用药依从（80-120%的依从性），5%的患者用药过度依从（>120%的依从性）。不依从的预测因素是年龄和药物数量。21%的患者在使用急救药物时犯了主要的吸入技术错误；这些都是在处理压力定量吸入器（pMDI）时犯的错误。
这项关于初级保健中 COPD 管理的观察性研究突出了 4 个可以改进的主要方面：（1）药物依从性，（2）pMDI 的吸入技术，（3）年龄小于 65 岁的 COPD 患者的流感疫苗接种，以及（4）戒烟。
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