Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA.
Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA.
Int J Geriatr Psychiatry. 2018 Feb;33(2):e212-e220. doi: 10.1002/gps.4772. Epub 2017 Aug 22.
The effect of treating comorbid depression to achieve optimal management of chronic obstructive pulmonary disease (COPD) has not yet empirically tested. We examined the association between antidepressant treatment and use of and adherence to COPD maintenance medications among patients with new-onset COPD and comorbid depression.
Using 2006-2012 Medicare data, this retrospective cohort study identified patients with newly diagnosed COPD and new-onset major depression. Two exposures-antidepressant use (versus non-use) and adherence measured by proportion of days covered (PDC) (PDC ≥0.8 versus <0.8)-were assessed quarterly. We used marginal structural models to estimate the effects of prior antidepressant use and adherence on subsequent COPD maintenance inhaler use and adherence outcomes, accounting for time-varying confounders.
A total of 25 458 COPD-depression patients, 82% with antidepressant treatment, were followed for a median of 2.5 years. Nearly half (48%) used at least 1 COPD maintenance inhaler in any given quarter; among users, 3 in 5 (61%) had a PDC of <0.8. Compared to patients with no antidepressant treatment, those with antidepressant use were more likely to use (relative ratio [RR] = 1.15, 95% confidence interval [CI] = 1.12- 1.17) and adhere to (RR = 1.08, 95% = 1.03-1.14) their COPD maintenance inhalers. Patients who adhered to antidepressant treatment were more likely to use and adhere to COPD maintenance inhalers.
Regularly treated depression may increase use of and adherence to necessary maintenance medications for COPD. Antidepressant treatment may be a key determinant to improving medication-taking behaviors among COPD patients comorbid with depression.
治疗合并抑郁以实现慢性阻塞性肺疾病（COPD）最佳管理的效果尚未通过经验测试。我们研究了新诊断的 COPD 患者和合并有抑郁的患者中，抗抑郁治疗与 COPD 维持药物的使用和依从性之间的关联。
使用 2006-2012 年 Medicare 数据，本回顾性队列研究确定了新诊断为 COPD 和新发重度抑郁症的患者。两个暴露因素——抗抑郁药物的使用（与不使用相比）和通过覆盖天数比例（PDC）测量的依从性（PDC≥0.8 与<0.8）——每季度评估一次。我们使用边缘结构模型估计先前使用抗抑郁药和依从性对随后 COPD 维持吸入器使用和依从性结果的影响，同时考虑到随时间变化的混杂因素。
共纳入 25458 例 COPD-抑郁患者，其中 82%接受抗抑郁治疗，中位随访时间为 2.5 年。近一半（48%）在任何给定季度至少使用 1 种 COPD 维持吸入器；在使用者中，有 3 人中有 5 人（61%）PDC<0.8。与未接受抗抑郁治疗的患者相比，使用抗抑郁药物的患者更有可能使用（相对比值[RR]1.15，95%置信区间[CI]1.12-1.17）和遵守（RR1.08，95%置信区间[CI]1.03-1.14）其 COPD 维持吸入器的使用。遵医嘱使用抗抑郁药的患者更有可能使用和遵守 COPD 维持吸入器。
定期治疗抑郁可能会增加 COPD 所需维持药物的使用和依从性。抗抑郁治疗可能是改善合并抑郁的 COPD 患者药物治疗行为的关键决定因素。
