Kim Jinhee, Kim Kyungjoo, Kim Yuri, Yoo Kwang-Ha, Lee Chin Kook, Yoon Hyoung Kyu, Kim Young Sam, Park Young Bum, Lee Jin Hwa, Oh Yeon-Mok, Lee Sang-Do, Lee Sei Won
Office of Health Services Research, National Evidence-based Healthcare Collaborating Agency, Republic of Korea.
Department of Research Support, National Strategic Coordinating Center for Clinical Research, Republic of Korea.
Respir Med. 2014 Jan;108(1):153-61. doi: 10.1016/j.rmed.2013.08.003. Epub 2013 Aug 30.
Although the efficacy of inhaled long-acting bronchodilators has been well documented in randomised controlled studies, whether similar effects are obtained in real-life clinical practice is not clear. In this study, we analysed the effect of inhaled long-acting bronchodilators in newly-diagnosed COPD patients.
The Korean Health Insurance Review and Assessment Service databases were used. Participants ≥40-years-old who had not been diagnosed with COPD between 2007 and 2008 but were diagnosed and prescribed COPD medication in 2009 were designated as newly-diagnosed COPD patients. Patients were divided into three groups based on the use of bronchodilators, an inhaled long-acting bronchodilator (LA-B), an inhaled short-acting bronchodilator (SA-B) and an oral medication (OM) group.
A total of 77,480 newly-diagnosed COPD patients with a mean age of 68.5 years, among which 43,530 (56.2%) were men, were included in the study. ER visits and hospitalisation were associated with SA-B group, male gender, older age, Medicaid coverage, tertiary healthcare centre visits and higher comorbidities. Multivariate analysis showed that the SA-B group was associated with more ER visits, recurrent ER visits, hospitalisation and recurrent hospitalisation (adjusted ORs [95% confidence intervals] = 4.32 [3.93-4.75], 6.19 [5.24-7.30], 5.04 [2.95-3.39], and 8.49 [7.67-9.39], respectively) compared with the LA-B group. Medical utilisation cost was also higher in the SA-B group.
Inhaled long-acting bronchodilator use was associated with lower rates of hospitalisation, fewer ER visits and lower medical costs in newly-diagnosed COPD patients in real-life clinical practice.
尽管吸入长效支气管扩张剂的疗效在随机对照研究中已有充分记录，但在现实临床实践中是否能获得类似效果尚不清楚。在本研究中，我们分析了吸入长效支气管扩张剂对新诊断的慢性阻塞性肺疾病（COPD）患者的影响。
使用韩国健康保险审查与评估服务数据库。将2007年至2008年未被诊断为COPD但在2009年被诊断并开具COPD药物的40岁及以上参与者指定为新诊断的COPD患者。根据支气管扩张剂的使用情况，将患者分为三组：吸入长效支气管扩张剂（LA-B）组、吸入短效支气管扩张剂（SA-B）组和口服药物（OM）组。
共有77480例新诊断的COPD患者纳入研究，平均年龄68.5岁，其中43530例（56.2%）为男性。急诊就诊和住院与SA-B组、男性、年龄较大、医疗补助覆盖、三级医疗中心就诊以及更高的合并症有关。多变量分析显示，与LA-B组相比，SA-B组与更多的急诊就诊、反复急诊就诊、住院和反复住院相关（调整后的比值比[95%置信区间]分别为4.32[3.93-4.75]、6.19[5.24-7.30]、5.04[2.95-3.39]和8.49[7.67-9.39]）。SA-B组的医疗使用成本也更高。
在现实临床实践中，新诊断的COPD患者使用吸入长效支气管扩张剂与较低的住院率、较少的急诊就诊和较低的医疗成本相关。
