Negewo Netsanet A, Gibson Peter G, Wark Peter Ab, Simpson Jodie L, McDonald Vanessa M
Priority Research Centre for Healthy Lungs.
Hunter Medical Research Institute, Faculty of Health and Medicine, The University of Newcastle, Callaghan.
Int J Chron Obstruct Pulmon Dis. 2017 Oct 6;12:2929-2942. doi: 10.2147/COPD.S136256. eCollection 2017.
COPD patients are often prescribed multiple medications for their respiratory disease and comorbidities. This can lead to complex medication regimens resulting in poor adherence, medication errors, and drug-drug interactions. The relationship between clinical outcomes and medication burden beyond medication count in COPD is largely unknown.
The aim of this study was to explore the relationships of medication burden in COPD with clinical outcomes, comorbidities, and multidimensional indices.
In a cross-sectional study, COPD patients (n=222) were assessed for demographic information, comorbidities, medication use, and clinical outcomes. Complexity of medication regimens was quantified using the validated medication regimen complexity index (MRCI).
Participants (58.6% males) had a mean (SD) age of 69.1 (8.3) years with a postbronchodilator forced expiratory volume in 1 second % predicted of 56.5 (20.4) and a median of five comorbidities. The median (1, 3) total MRCI score was 24 (18.5, 31). COPD-specific medication regimens were more complex than those of non-COPD medications (median MRCI: 14.5 versus 9, respectively; <0.0001). Complex dosage formulations contributed the most to higher MRCI scores of COPD-specific medications while dosing frequency primarily drove the complexity associated with non-COPD medications. Participants in Global Initiative for Chronic Obstructive Lung Disease quadrant D had the highest median MRCI score for COPD medications (15.5) compared to those in quadrants A (13.5; =0.0001) and B (12.5; <0.0001). Increased complexity of COPD-specific treatments showed significant but weak correlations with lower lung function and 6-minute walk distance, higher St George's Respiratory Questionnaire and COPD assessment test scores, and higher number of prior year COPD exacerbations and hospitalizations. Comorbid cardiovascular, gastrointestinal, or metabolic diseases individually contributed to higher total MRCI scores and/or medication counts for all medications. Charlson Comorbidity Index and COPD-specific comorbidity test showed the highest degree of correlation with total MRCI score (=0.289 and =0.326; <0.0001, respectively).
In COPD patients, complex medication regimens are associated with disease severity and specific class of comorbidities.
慢性阻塞性肺疾病（COPD）患者常因呼吸系统疾病及其合并症而被开具多种药物。这可能导致用药方案复杂，进而造成依从性差、用药错误及药物相互作用。COPD中临床结局与用药负担（超出用药数量）之间的关系很大程度上尚不清楚。
本研究旨在探讨COPD患者的用药负担与临床结局、合并症及多维指标之间的关系。
在一项横断面研究中，对222例COPD患者进行了人口统计学信息、合并症、用药情况及临床结局评估。使用经过验证的用药方案复杂性指数（MRCI）对用药方案的复杂性进行量化。
参与者（58.6%为男性）的平均（标准差）年龄为69.1（8.3）岁，支气管扩张剂使用后1秒用力呼气容积占预计值的百分比为56.5（20.4），合并症中位数为5种。MRCI总评分的中位数（第1、3四分位数）为24（18.5，31）。COPD特异性用药方案比非COPD用药方案更复杂（MRCI中位数分别为14.5和9；<0.0001）。复杂剂型对COPD特异性药物较高的MRCI评分贡献最大，而给药频率主要影响与非COPD药物相关的复杂性。与全球慢性阻塞性肺疾病倡议A象限（13.5；P = 0.0001）和B象限（12.5；<0.0001）的参与者相比，D象限的参与者COPD药物的MRCI中位数最高（15.5）。COPD特异性治疗复杂性增加与较低的肺功能和6分钟步行距离、较高的圣乔治呼吸问卷和COPD评估测试评分以及上一年较高的COPD急性加重次数和住院次数呈显著但较弱的相关性。合并心血管、胃肠道或代谢疾病分别导致所有药物的总MRCI评分和/或用药数量增加。查尔森合并症指数和COPD特异性合并症测试与总MRCI评分的相关性最高（分别为r = 0.289和r = 0.326；均<0.0001）。
在COPD患者中，复杂的用药方案与疾病严重程度及特定类型的合并症相关。
