Covvey J R, Mullen A B, Ryan M, Steinke D T, Johnston B F, Wood F T, Boyter A C
Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.
Int J Clin Pract. 2014 Oct;68(10):1200-8. doi: 10.1111/ijcp.12451. Epub 2014 May 5.
To describe and compare adherence and persistence with maintenance therapies in patients with asthma or chronic obstructive pulmonary disease (COPD) in the United Kingdom (UK).
A retrospective prescribing database cohort was obtained from 44 general practitioner surgeries in National Health Service Forth Valley Scotland. Patients with physician-diagnosed asthma or COPD who received maintenance therapy between January 2008 and December 2009 were included. Five classes of therapy were assessed: inhaled corticosteroids, long-acting beta-agonists, combination therapy inhalers, theophyllines and long-acting muscarinic antagonists. Adherence was calculated using the medication possession ratio (MPR) and persistence was determined using Kaplan-Meier survival analysis for the time to discontinuation (TTD) over 1 year. Two step-wise logistic regressions were performed to assess the contribution of diagnosis to adherence/persistence.
A total of 13,322 patients were included in the analysis: 10,521 patients with asthma and 2801 patients with COPD. 25.2% of medication episodes for asthma and 45.6% of medication episodes for COPD were classified as having an adequate medication supply (MPR of 80-120%). The overall median TTD was 92 days (IQR, interquartile range: 50-186 days) for patients with asthma and 116 days (IQR: 58-259 days, comparison p < 0.001) for patients with COPD. Patients with COPD were found to be more likely to achieve an MPR of at least 80% (OR: 1.27, 95% CI: 1.15-1.40), but had a similar likelihood of persistence at 1 year to patients with asthma.
Adherence and persistence with respiratory therapies in the UK is relatively low. There is suggestion that patients with COPD may display more adherent behaviours than patients with asthma.
描述并比较英国哮喘或慢性阻塞性肺疾病（COPD）患者维持治疗的依从性和持续性。
从苏格兰国民健康服务福斯谷地区的44家全科医生诊所获取回顾性处方数据库队列。纳入2008年1月至2009年12月期间接受维持治疗的医生诊断为哮喘或COPD的患者。评估了五类治疗：吸入性糖皮质激素、长效β受体激动剂、联合治疗吸入器、茶碱和长效毒蕈碱拮抗剂。使用药物持有率（MPR）计算依从性，并使用Kaplan-Meier生存分析确定1年停药时间（TTD）的持续性。进行了两步逻辑回归以评估诊断对依从性/持续性的贡献。
分析共纳入13322例患者：10521例哮喘患者和2801例COPD患者。哮喘药物治疗事件的25.2%和COPD药物治疗事件的45.6%被归类为药物供应充足（MPR为80%-120%）。哮喘患者的总体中位TTD为92天（四分位间距IQR：50-186天），COPD患者为116天（IQR：58-259天，比较p<0.001）。发现COPD患者更有可能达到至少80%的MPR（OR：1.27，95%CI：1.15-1.40），但1年持续性与哮喘患者相似。
英国呼吸治疗的依从性和持续性相对较低。有迹象表明，COPD患者可能比哮喘患者表现出更多的依从行为。
