Ding Bo, DiBonaventura Marco, Karlsson Niklas, Bergström Gina, Holmgren Ulf
AstraZeneca Gothenburg, Mölndal, Sweden.
Kantar Health, New York, NY, USA.
Int J Chron Obstruct Pulmon Dis. 2017 Feb 7;12:529-539. doi: 10.2147/COPD.S114085. eCollection 2017.
Past research has suggested significant relationships between symptoms and health outcomes among patients with COPD. However, these studies have generally focused on a broad COPD sample and may have included those not receiving proper treatment. As a result, the aim of this study was to document the burden of COPD symptoms among those who are currently treated with the standard-of-care (SOC) medications in both the US and Western Europe.
Data from the 2013 US (N=75,000) and 2011 (N=57,512)/2013 (N=62,000) European (France, Germany, Italy, Spain, and UK; 5EU) National Health and Wellness Survey (NHWS) were used. The NHWS is a health survey administered to a demographically representative sample of the adult population in each country. A total of 1,666 and 2,006 patients with self-reported physician diagnosis of COPD in the 5EU and US, respectively, were being treated with the appropriate SOC (based on self-reported medication use) and were included in the analyses. Symptoms (eg, dyspnea, coughing, wheezing) were reported descriptively and summed to create a symptom score (with higher score indicating more frequent symptoms). The relationships between the symptom score and patient outcomes (eg, health status using the Short Form-36 version 2 [SF-36v2], work productivity and activity impairment [WPAI], and self-reported health care resource use) were explored using regression modeling.
Nearly all patients (99.7% and 99.8% in the 5EU and US, respectively) reported experiencing symptoms and >80% reported experiencing at least one symptom "often". Increasing symptom scores were associated with poorer health status (unstandardized beta [] =-0.87 and -0.78 for mental component summary and physical component summary, respectively, in the US and =-0.67 and -0.79 in the 5EU, respectively; all <0.05). Increasing symptom scores were also associated with greater work impairment ( =0.09 and 0.06 for the US and 5EU, respectively), activity impairment ( =0.05 and 0.06, respectively), and health care resource utilization (eg, hospitalizations: =0.05 and 0.06, respectively) (all <0.05). Approximately 70% of patients reported some level of non-adherence. Greater non-adherence was significantly associated with more frequent symptoms, poorer health status, and greater work impairment and health care resource use (all <0.05).
Patients with COPD who are using the appropriate SOC still experience symptoms, which have a significant effect on both humanistic and economic outcomes.
过去的研究表明，慢性阻塞性肺疾病（COPD）患者的症状与健康结果之间存在显著关联。然而，这些研究通常聚焦于广泛的COPD样本，可能包括了未接受适当治疗的患者。因此，本研究的目的是记录美国和西欧目前接受标准治疗（SOC）药物治疗的COPD患者的症状负担。
使用了2013年美国（N = 75,000）以及2011年（N = 57,512）/2013年（N = 62,000）欧洲（法国、德国、意大利、西班牙和英国；5个欧盟国家）国民健康与 Wellness 调查（NHWS）的数据。NHWS是一项针对每个国家具有人口统计学代表性的成年人群样本进行的健康调查。在5个欧盟国家和美国，分别有1,666例和2,006例自我报告经医生诊断为COPD的患者正在接受适当的SOC治疗（基于自我报告的用药情况），并纳入分析。症状（如呼吸困难、咳嗽、喘息）通过描述性方式报告，并汇总以创建症状评分（分数越高表明症状越频繁）。使用回归模型探讨症状评分与患者结果（如使用简短健康调查问卷第2版[SF - 36v2]评估的健康状况、工作生产力和活动受损[WPAI]以及自我报告的医疗资源使用）之间的关系。
几乎所有患者（5个欧盟国家和美国分别为99.7%和99.8%）报告有症状，且超过80%报告“经常”出现至少一种症状。症状评分增加与健康状况较差相关（在美国，心理成分总结和身体成分总结的未标准化β值分别为 - 0.87和 - 0.78，在5个欧盟国家分别为 - 0.67和 - 0.79；均P < 0.05）。症状评分增加还与更大的工作受损（美国和5个欧盟国家分别为0.09和0.06）、活动受损（分别为0.05和0.06）以及医疗资源利用增加（如住院：分别为0.05和0.06）相关（均P < 0.05）。约70%的患者报告有一定程度的不依从。更高的不依从与更频繁的症状、更差的健康状况以及更大的工作受损和医疗资源使用显著相关（均P < 0.05）。
正在使用适当SOC治疗的COPD患者仍有症状，这些症状对人文和经济结果均有显著影响。
