Nishi Shawn P E, Maslonka Matthew, Zhang Wei, Kuo Yong-Fang, Sharma Gulshan
1-Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston.
2-Department of Internal Medicine, University of Texas Medical Branch, Galveston.
Chronic Obstr Pulm Dis. 2018 Jan 24;5(1):16-26. doi: 10.15326/jcopdf.5.1.2017.0153.
Maintenance medications provide symptomatic relief, improve lung function and reduce the risk of exacerbations in patients with chronic obstructive pulmonary disease (COPD). Despite their proven benefits, limited information exists on maintenance medication use and adherence among users. We examined the patterns and factors associated with the receipt of and adherence to maintenance medication in individuals with COPD. A retrospective cross-sectional study of 5% of Medicare beneficiaries enrolled in Parts A, B and D with COPD who received maintenance medication from 2008 to 2013 was conducted. Maintenance medication includes: inhaled corticosteroids (ICSs), long-acting beta2- agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) alone or in combination. We examined the proportion of beneficiaries with COPD who had at least one prescription filled for maintenance medication. Among users of maintenance medications, we also examined adherence, defined as proportion of days covered (PDC) ≥80% over the year from the first maintenance medication prescription fill date. Overall, maintenance medication (LAMAs, LABAs, ICSs and/or LABA/ICS) use increased from 67.8% in 2008 to 72.1% in 2013. The increase is related to increases in use of LABA/ICS, which rose from 41.1% in 2008 to 49.6% in 2013. Factors associated with receipt of maintenance medication include female gender, recent COPD hospitalization (odds ratio [OR] 1.63; 95% confidence interval [CI] 1.54-1.73), oxygen therapy (OR 1.74 95% CI, 1.68-1.81), dual eligibility status (OR 1.45; 95% CI 1.39-1.51), higher education level and evaluation by a pulmonary provider (OR 1.88; 95% CI 1.81-1.96). The overall adherence among maintenance medication users remained flat. The most important factor associated with adherence was dual eligibility status (OR, 1.67; 95% CI: 1.59-1.75). Receipt of maintenance medications increased during the study period and was higher in those with dual eligibility. Overall, adherence to maintenance medications was suboptimal and remained unchanged.
维持治疗药物可缓解慢性阻塞性肺疾病（COPD）患者的症状，改善肺功能并降低病情加重的风险。尽管其益处已得到证实，但关于维持治疗药物的使用情况以及使用者的依从性方面的信息却很有限。我们研究了COPD患者接受维持治疗药物及依从性的模式和相关因素。对2008年至2013年期间参加医疗保险A、B和D部分且患有COPD并接受维持治疗药物的5%的医疗保险受益人进行了一项回顾性横断面研究。维持治疗药物包括：吸入性糖皮质激素（ICSs）、长效β2受体激动剂（LABAs）和长效毒蕈碱拮抗剂（LAMAs），单独使用或联合使用。我们研究了至少有一张维持治疗药物处方配药记录的COPD受益人的比例。在维持治疗药物使用者中，我们还研究了依从性，依从性定义为从首次维持治疗药物处方配药日期起一年中覆盖天数比例（PDC）≥80%。总体而言，维持治疗药物（LAMAs、LABAs、ICSs和/或LABA/ICS）的使用从2008年的67.8%增至2013年的72.1%。这种增加与LABA/ICS使用的增加有关，LABA/ICS的使用从2008年的41.1%增至2013年的49.6%。与接受维持治疗药物相关的因素包括女性、近期COPD住院治疗（比值比[OR]1.63；95%置信区间[CI]1.54 - 1.73）、氧疗（OR 1.74，95% CI，1.68 - 1.81）、双重资格状态（OR 1.45；95% CI 1.39 - 1.51）、较高的教育水平以及由肺部专科医生进行评估（OR 1.88；95% CI 1.81 - 1.96）。维持治疗药物使用者的总体依从性保持平稳。与依从性相关的最重要因素是双重资格状态（OR，1.67；95% CI：1.59 - 1.75）。在研究期间，维持治疗药物的接受率有所增加，双重资格者的接受率更高。总体而言，维持治疗药物的依从性欠佳且保持不变。
