Sicras A, Ferrer V, Collar J M, Navarro R, Sáez M
CAP Vicenç Papaciet, La Roca del Vallès (Barcelona), España.
CAP Vicenç Papaciet, La Roca del Vallès (Barcelona), España.
Semergen. 2017 Jul-Aug;43(5):375-386. doi: 10.1016/j.semerg.2016.05.008. Epub 2016 Jul 16.
To assess the initial treatment persistence with inhaled corticosteroids and long-acting beta-2 adrenergic bronchodilators (ICS/LABA) depending on the inhaler device used (pMDI or DPI), for the treatment of asthma and COPD.
An multicenter observational study. Subjects in initial treatment with ICS/LABA during 2007-2011 were included, and a follow-up period of 3 years. 2 groups of study (asthma, COPD) and 2 subgroups were prepared according to the device type inhaler (pMDI or DPI). The main measurements were: sociodemographic, comorbidity, adherence (rate possession medication -RPM-), persistence, drugs, exacerbation rates, resources use, and their costs (direct and indirect costs). Multivariate methods were used for the variables correction, with significance level of P<.05.
The study included 2,082 asthma patients (pMDI: N = 566, 27.2%; DPI = 1,516, 72.8%). Patients with MDI devices showed a higher degree of persistence (32.5 vs. 27.8%; P=.037), treatment adherence (RPM: 83.1 vs. 80.5%; P<.001), fewer exacerbations (17.7 vs. 24.9%; P=.001) and lower health care costs (2,583 vs. 2,938 EUR; P = 0.042). 1,418 patients with COPD also were analyzed (pMDI: N = 524, 41.9%; DPI: N = 824, 58.1%) were analyzed. Patients with MDI devices also showed a higher degree of persistence (31.5 vs. 24.8%; P=.005), treatment adherence (RPM: 83.3 vs. 80.1%; P= .001), less exacerbations (40.1 vs. 48.2%; P=.002) and lower health care costs (3,922 vs. 4,588 EUR; P=.021).
pMDI devices (as ICS/LABA initial treatment) are associated with higher treatment persistence either in asthma or COPD, with lower exacerbation rates, and use of health resources and cost.
根据所使用的吸入装置（压力定量吸入器或干粉吸入器）评估吸入性糖皮质激素和长效β2肾上腺素能支气管扩张剂（ICS/LABA）用于哮喘和慢性阻塞性肺疾病（COPD）治疗时的初始治疗持续性。
一项多中心观察性研究。纳入2007年至2011年期间开始使用ICS/LABA治疗的受试者，并进行3年的随访。根据吸入器装置类型（压力定量吸入器或干粉吸入器）将研究分为2组（哮喘、COPD）和2个亚组。主要测量指标包括：社会人口统计学、合并症、依从性（药物持有率 -RPM-）、持续性、药物、急性加重率、资源使用及其成本（直接和间接成本）。采用多变量方法对变量进行校正，显著性水平为P<0.05。
该研究纳入了2082例哮喘患者（压力定量吸入器：N = 566，27.2%；干粉吸入器 = 1516，72.8%）。使用压力定量吸入器的患者显示出更高的持续性（32.5%对27.8%；P = 0.037）、治疗依从性（RPM：83.1%对80.5%；P<0.001）、更少的急性加重（17.7%对24.9%；P = 0.001）以及更低的医疗保健成本（2583欧元对2938欧元；P = 0.042）。还分析了1418例COPD患者（压力定量吸入器：N = 524，41.9%；干粉吸入器：N = 824，58.1%）。使用压力定量吸入器的患者同样显示出更高的持续性（31.5%对24.8%；P = 0.005）、治疗依从性（RPM：83.3%对80.1%；P = 0.001）、更少的急性加重（40.1%对48.2%；P = 0.002）以及更低的医疗保健成本（3922欧元对4588欧元；P = 0.021）。
压力定量吸入器（作为ICS/LABA初始治疗）与哮喘或COPD更高的治疗持续性相关，急性加重率更低，且医疗资源使用和成本更低。
