Thomas Mike, Radwan Amr, Stonham Carol, Marshall Sam
1Department of Primary Care Research, University of Southampton , UK.
COPD. 2014 Jun;11(3):300-9. doi: 10.3109/15412555.2013.841671. Epub 2013 Oct 23.
Chronic Obstructive Pulmonary Disease (COPD) management represents a significant health resource use burden. Understanding of current resource use, treatment strategies and outcomes can improve future COPD management, for patient benefit and to aid efficient service delivery. This study aimed to describe exacerbation frequency, pharmacotherapy and health resource use in COPD management in routine UK primary care. A retrospective, observational study using routine clinical records of 511 patients with COPD, was undertaken in 10 General Practices in England. Up to 3 years' patient data were collected and analysed. 75% (234/314) patients with mild-moderate COPD (≥50% predicted FEV1) received inhaled corticosteroids (ICS). 11% of patients (54/511) received ICS monotherapy. Mean (standard deviation) annual exacerbation frequency was 1.1 (1.2) in mild-moderate, 1.7 (1.6) in severe (30-49% predicted FEV1) and 2.2 (2.0) in very severe (<30% predicted FEV1) COPD. 14% patients (69/511) had a mean exacerbation frequency of ≥3/year ('frequent-exacerbators'); 9% (27/314) of patients with mild-moderate, 19% (27/145) with severe and 29% (15/52) with very severe COPD. 14% (10/69) of frequent-exacerbators failed to receive inhaled long-acting beta agonists (LABA), 25% (17/69) inhaled long-acting muscarinic antagonists (LAMA), and 12% (`/69) ICS. Frequent-exacerbators had a median of 6.67 primary care contacts/year, 1.0 secondary care visits/year and 21% were hospitalised for COPD/year. Inhaled therapy was frequently inappropriate, with over-use of ICS in patients with mild-moderate COPD. COPD exacerbations were associated with high health resource use and occurred at all levels of disease severity. COPD management strategies should encompass risk-stratification for both exacerbation frequency and physiological impairment.
慢性阻塞性肺疾病（COPD）的管理给卫生资源利用带来了巨大负担。了解当前的资源利用情况、治疗策略和治疗效果，有助于改善未来的COPD管理，从而使患者受益，并促进高效的医疗服务提供。本研究旨在描述英国常规初级医疗中COPD管理的急性加重频率、药物治疗及卫生资源利用情况。利用英格兰10家全科诊所中511例COPD患者的常规临床记录进行了一项回顾性观察研究。收集并分析了患者长达3年的数据。75%（234/314）的轻中度COPD（预计FEV1≥50%）患者接受了吸入性糖皮质激素（ICS）治疗。11%的患者（54/511）接受了ICS单药治疗。轻中度COPD患者的平均（标准差）年急性加重频率为1.1（1.2）次，重度（预计FEV1为30%-49%）患者为1.7（1.6）次，极重度（预计FEV1<30%）患者为2.2（2.0）次。14%的患者（69/511）平均急性加重频率≥3次/年（“频繁急性加重者”）；轻中度COPD患者中9%（27/314）、重度患者中19%（27/145）、极重度患者中29%（15/52）属于此类。14%（10/69）的频繁急性加重者未接受吸入长效β受体激动剂（LABA）治疗，25%（17/69）未接受吸入长效毒蕈碱拮抗剂（LAMA）治疗，12%（8/69）未接受ICS治疗。频繁急性加重者每年平均有6.67次初级医疗接触、1.0次二级医疗就诊，21%的患者每年因COPD住院。吸入治疗常常不恰当，并存在轻中度COPD患者过度使用ICS的情况。COPD急性加重与高卫生资源利用相关，且在疾病的各个严重程度阶段均会发生COPD管理策略应包括针对急性加重频率和生理功能损害的风险分层。
