Lim Jeong Uk, Kim Kyungjoo, Kim Sang Hyun, Lee Myung Goo, Lee Sang Yeub, Yoo Kwang Ha, Lee Sang Haak, Jung Ki-Suck, Rhee Chin Kook, Hwang Yong Il
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, St Paul's Hospital.
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul.
Int J Chron Obstruct Pulmon Dis. 2017 Sep 11;12:2711-2721. doi: 10.2147/COPD.S143244. eCollection 2017.
Patients with mild to moderate chronic obstructive pulmonary disease (COPD) are underdiagnosed and undertreated due to the asymptomatic nature of the disease. Previous studies on patients with mild COPD have focused on symptomatic patients. Therefore, in this study, we evaluated the treatment status of patients with early COPD in Korea.
We compared hospital visits, medical costs per person, and COPD medication use by patients with COPD screened from the general population and COPD cohort patients. Patients with COPD aged ≥40 years with the value of forced expiratory volume in 1 s (FEV) ≥60% were selected from the 2007 to 2012 Korea National Health and Nutrition Examination Survey (KNHANES) data. Data including the number of outpatient clinic visits, admission to hospitals, COPD-related medications, and medical costs were obtained from the Health Insurance Review and Assessment Service and were compared with the data of patients with COPD with FEV ≥60% from the Korean COPD Subtype Study (KOCOSS) cohort.
Based on EuroQol 5-dimension questionnaire index scores of 0.9±0.14, we found that patients with COPD from the KNHANES group showed few symptoms compared to those from the KOCOSS cohort. In 2007, among the patients with COPD with an FEV value of ≥60%, only 3.6% from the KNHANES group and 30% from the KOCOSS cohort visited medical facilities. Total medical cost per person per year increased from 264.37±663.41 US Dollars (USD) in 2007 to 797.00±2,724.21 USD in 2012 for the KNHANES group. In 2012, only 20.7% of the patients from KNHANES database received long-acting muscarinic agonists (LAMA), whereas 78.7% of the patients from KOCOSS database received LAMA.
Medical resource utilization and medical costs per person for patients with early COPD in Korea increased. However, asymptomatic patients with COPD represented by the KNHANES group do not receive adequate long-term treatment compared to relatively symptomatic patients, and require more clinical attention from physicians.
由于轻度至中度慢性阻塞性肺疾病（COPD）具有无症状的特性，此类患者存在诊断不足和治疗不足的情况。既往针对轻度COPD患者的研究主要集中在有症状的患者身上。因此，在本研究中，我们评估了韩国早期COPD患者的治疗状况。
我们比较了从普通人群中筛查出的COPD患者以及COPD队列研究患者的就诊情况、人均医疗费用和COPD药物使用情况。年龄≥40岁且1秒用力呼气容积（FEV）值≥60%的COPD患者选自2007年至2012年韩国国家健康与营养检查调查（KNHANES）数据。包括门诊就诊次数、住院情况、COPD相关药物和医疗费用等数据来自健康保险审查与评估服务机构，并与韩国COPD亚型研究（KOCOSS）队列中FEV≥60%的COPD患者数据进行比较。
基于欧洲五维健康量表问卷指数评分为0.9±0.14，我们发现KNHANES组的COPD患者与KOCOSS队列中的患者相比症状较少。2007年，在FEV值≥60%的COPD患者中，KNHANES组仅有3.6%的患者以及KOCOSS队列中有30%的患者前往医疗机构就诊。KNHANES组人均每年的总医疗费用从2007年的264.37±663.41美元增加到2012年的797.00±2724.21美元。2012年，KNHANES数据库中仅有20.7%的患者接受长效毒蕈碱受体激动剂（LAMA）治疗，而KOCOSS数据库中有78.7%的患者接受LAMA治疗。
韩国早期COPD患者的医疗资源利用率和人均医疗费用有所增加。然而，以KNHANES组为代表的无症状COPD患者与相对有症状的患者相比未得到充分的长期治疗，需要医生给予更多的临床关注。
