Vasquez Monica M, McClure Leslie A, Sherrill Duane L, Patel Sanjay R, Krishnan Jerry, Guerra Stefano, Parthasarathy Sairam
Arizona Respiratory Center, University of Arizona, Tucson.
Dornsife School of Public Health, Drexel University, Philadelphia, Pa.
Am J Med. 2017 Jul;130(7):809-818. doi: 10.1016/j.amjmed.2016.11.045. Epub 2017 Jan 13.
Hospitalization of patients with chronic obstructive pulmonary disease creates a huge healthcare burden. Positive airway pressure therapy is sometimes used in patients with chronic obstructive pulmonary disease, but the possible impact on hospitalization risk remains controversial. We studied the hospitalization risk of patients with chronic obstructive pulmonary disease before and after initiation of various positive airway pressure therapies in a "real-world" bioinformatics study.
We performed a retrospective analysis of administrative claims data of hospitalizations in patients with chronic obstructive pulmonary disease who received or did not receive positive airway pressure therapy: continuous positive airway pressure, bilevel positive airway pressure, and noninvasive positive pressure ventilation using a home ventilator.
The majority of 1,881,652 patients with chronic obstructive pulmonary disease (92.5%) were not receiving any form of positive airway pressure therapy. Prescription of bilevel positive airway pressure (1.5%), continuous positive airway pressure (5.6%), and noninvasive positive pressure ventilation (<1%) in patients with chronic obstructive pulmonary disease demonstrated geographic-, sex-, and age-related variability. After adjusting for confounders and propensity score, noninvasive positive pressure ventilation (odds ratio [OR], 0.19; 95% confidence interval [CI], 0.13-0.27), bilevel positive airway pressure (OR, 0.42; 95% CI, 0.39-0.45), and continuous positive airway pressure (OR, 0.70; 95% CI, 0.67-0.72) were individually associated with lower hospitalization risk in the 6 months post-treatment when compared with the 6 months pretreatment but not when compared with the baseline period between 12 and 6 months before treatment initiation. Stratified analysis suggests that comorbid sleep-disordered breathing, chronic respiratory failure, heart failure, and age less than 65 years were associated with greater benefits from positive airway pressure therapy.
Initiation of positive airway pressure therapy was associated with reduction in hospitalization among patients with chronic obstructive pulmonary disease, but the causality needs to be determined by randomized controlled trials.
慢性阻塞性肺疾病患者的住院治疗带来了巨大的医疗负担。气道正压通气疗法有时用于慢性阻塞性肺疾病患者，但对住院风险的可能影响仍存在争议。我们在一项“真实世界”生物信息学研究中，研究了慢性阻塞性肺疾病患者开始各种气道正压通气疗法前后的住院风险。
我们对接受或未接受气道正压通气疗法（持续气道正压通气、双水平气道正压通气和使用家用呼吸机的无创正压通气）的慢性阻塞性肺疾病患者的住院管理索赔数据进行了回顾性分析。
1,881,652例慢性阻塞性肺疾病患者中的大多数（92.5%）未接受任何形式的气道正压通气疗法。慢性阻塞性肺疾病患者中双水平气道正压通气（1.5%）、持续气道正压通气（5.6%）和无创正压通气（<1%）的处方显示出与地域、性别和年龄相关的差异。在调整混杂因素和倾向得分后，与治疗前6个月相比，治疗后6个月时，无创正压通气（优势比[OR]，0.19；95%置信区间[CI]，0.13 - 0.27）、双水平气道正压通气（OR，0.42；95% CI，0.39 - 0.45）和持续气道正压通气（OR，0.70；95% CI，0.67 - 0.72）分别与较低的住院风险相关，但与治疗开始前12至6个月的基线期相比则不然。分层分析表明，合并睡眠呼吸障碍、慢性呼吸衰竭、心力衰竭以及年龄小于65岁与气道正压通气疗法带来的更大益处相关。
气道正压通气疗法的启动与慢性阻塞性肺疾病患者住院率的降低相关，但因果关系需要通过随机对照试验来确定。
