Program Development Center, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands.
Int J Chron Obstruct Pulmon Dis. 2011;6:493-501. doi: 10.2147/COPD.S24443. Epub 2011 Sep 26.
Polypharmacy of respiratory medications is commonly observed in patients with chronic obstructive pulmonary disease (COPD). The aims of this study were to investigate determinants of polypharmacy and to study the consistency of actual respiratory drug use with current Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in pulmonary rehabilitation candidates with COPD.
Data were extracted from the records of all patients with a diagnosis of COPD referred for pulmonary rehabilitation to CIRO+ between 2005 and 2009. Use of respiratory medications, self-reported COPD exacerbations, lung function, blood gases, exercise capacity, Medical Research Council (MRC) dyspnea grade, and St George's Respiratory Questionnaire (SGRQ) were recorded as part of assessment of health status.
In total, 1859 COPD patients of mean age (± standard deviation) 64.3 ± 9.7 years and with a forced expiratory volume in one second (FEV(1)) of 44.7% ± 18.2% were included. On average, patients used 3.5 ± 1.5 respiratory medications; this number increased with increasing GOLD stage, MRC score, and SGRQ scores. FEV(1) (% predicted), SGRQ, and number of recent exacerbations were independent determinants of polypharmacy. Use of long-acting bronchodilators and inhaled corticosteroids was substantial and comparable in all GOLD stages. Use of corticosteroids was not restricted to patients with frequent exacerbations.
Polypharmacy of respiratory medications is common in COPD patients with persistent symptoms. In addition to severity of disease, health status is an independent predictor of polypharmacy. Actual drug use in COPD patients referred for pulmonary rehabilitation is partially inconsistent with current GOLD guidelines.
慢性阻塞性肺疾病（COPD）患者常同时使用多种呼吸系统药物。本研究旨在探讨COPD 患者多药治疗的决定因素，并研究肺康复候选者中实际使用的呼吸系统药物与当前慢性阻塞性肺疾病全球倡议（GOLD）指南的一致性。
从 2005 年至 2009 年在 CIRO+接受肺康复治疗的所有 COPD 患者的病历中提取数据。记录使用的呼吸系统药物、自我报告的 COPD 加重次数、肺功能、血气、运动能力、呼吸困难量表（MRC）评分和圣乔治呼吸问卷（SGRQ）评分，作为健康状况评估的一部分。
共纳入 1859 例 COPD 患者，平均年龄（±标准差）为 64.3 ± 9.7 岁，第一秒用力呼气量（FEV1）为 44.7% ± 18.2%。患者平均使用 3.5 ± 1.5 种呼吸系统药物；该数量随 GOLD 分期、MRC 评分和 SGRQ 评分的增加而增加。FEV1（%预计值）、SGRQ 和近期加重次数是多药治疗的独立决定因素。长效支气管扩张剂和吸入性皮质类固醇的使用量较大，且在所有 GOLD 分期中相当。皮质类固醇的使用并不仅限于频繁加重的患者。
持续存在症状的 COPD 患者常同时使用多种呼吸系统药物。除疾病严重程度外，健康状况也是多药治疗的独立预测因素。肺康复候选者中实际使用的药物与当前 GOLD 指南部分不符。
