Di Martino Mirko, Agabiti Nera, Bauleo Lisa, Kirchmayer Ursula, Cascini Silvia, Pistelli Riccardo, Colamesta Vittoria, Patorno Elisabetta, Pinnarelli Luigi, Fusco Danilo, Perucci Carlo Alberto, Davoli Marina
1Department of Epidemiology, Lazio Regional Health Service , Roma , Italy.
COPD. 2014 Aug;11(4):414-23. doi: 10.3109/15412555.2013.839646. Epub 2013 Oct 3.
COPD is the fourth leading cause of death in the world. In the case of exacerbations or persistent symptoms, regular treatment with long-acting bronchodilators is recommended to control the symptoms, reduce exacerbations and improve health status. Objectives. To describe patterns of drug utilization among patients diagnosed with COPD, to measure continuity with long-acting bronchodilators, to identify determinants of not receiving long-acting therapy continuously.
We identified a cohort of patients discharged from hospital with diagnosis of COPD between 2006 and 2008. Patients were observed for a two-year follow-up period, starting from the day of discharge. Follow-up was segmented in six-month periods, in order to dynamically evaluate prescription patterns of Long-Acting Beta-Agonists (LABA), tiotropium, and inhaled corticosteroids. Patients with prescriptions for LABA and/or tiotropium in each of the six-month periods were defined as "continuously treated with long-acting bronchodilators." The degree of drug treatment coverage was measured through the Medication Possession Ratio (MPR). Logistic regression was performed to identify determinants of not receiving long-acting bronchodilators continuously.
A total of 11,452 patients diagnosed with COPD were enrolled. Only 34.8% received long-acting bronchodilators continuously. The MPR was greater than 75% in 19.6% of cases. Among the determinants of not receiving long-acting bronchodilators continuously, older age and co-morbidities played an important role.
In clinical practice, the COPD pharmacotherapy is not consistent with clinical guidelines. Medical education is needed to disseminate evidence-based prescribing patterns for COPD, and to raise awareness among physicians and patients on the health benefits of an appropriate pharmacological treatment.
慢性阻塞性肺疾病（COPD）是全球第四大致死原因。在病情加重或症状持续的情况下，建议使用长效支气管扩张剂进行规律治疗，以控制症状、减少病情加重并改善健康状况。目的：描述慢性阻塞性肺疾病患者的药物使用模式，衡量长效支气管扩张剂的用药持续性，确定未持续接受长效治疗的决定因素。
我们确定了一组在2006年至2008年期间因慢性阻塞性肺疾病诊断而出院的患者。从出院之日起，对患者进行为期两年的随访。随访分为六个月的时间段，以便动态评估长效β受体激动剂（LABA）、噻托溴铵和吸入性糖皮质激素的处方模式。在每个六个月时间段内开具LABA和/或噻托溴铵处方的患者被定义为“持续接受长效支气管扩张剂治疗”。通过药物持有率（MPR）来衡量药物治疗覆盖程度。进行逻辑回归分析以确定未持续接受长效支气管扩张剂治疗的决定因素。
共纳入11452例诊断为慢性阻塞性肺疾病的患者。只有34.8%的患者持续接受长效支气管扩张剂治疗。19.6%的病例中药物持有率大于75%。在未持续接受长效支气管扩张剂治疗的决定因素中，年龄较大和合并症起重要作用。
在临床实践中，慢性阻塞性肺疾病的药物治疗与临床指南不一致。需要开展医学教育，以传播基于证据的慢性阻塞性肺疾病处方模式，并提高医生和患者对适当药物治疗健康益处的认识。
