Lopez-Campos Jose Luis, Navarrete Bernardino Alcázar, Soriano Joan B, Soler-Cataluña Juan J, González-Moro José Miguel Rodríguez, Ferrer Manuel E Fuentes, Rubio Myriam Calle
Medical-Surgical Unit of Respiratory Diseases, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain,
CIBER of Respiratory Diseases, Instituto de Salud Carlos III, Madrid, Spain,
Int J Chron Obstruct Pulmon Dis. 2018 Jul 27;13:2279-2288. doi: 10.2147/COPD.S160842. eCollection 2018.
Current COPD management recommendations indicate that pharmacological treatment can be stepped up or down, but there are no recommendations on how to make this adjustment. We aimed to describe pharmacological prescriptions during a routine clinical visit for COPD and study the determinants of changing therapy.
EPOCONSUL is a Spanish nationwide observational cross-sectional clinical audit with prospective case recruitment including 4,508 COPD patients from outpatient respiratory clinics for a period of 12 months (May 2014-May 2015). Prescription patterns were examined in 4,448 cases and changes analyzed in stepwise backward, binomial, multivariate, logistic regression models.
Patterns of prescription of inhaled therapy groups were no treatment prescribed, 124 (2.8%) cases; one or two long-acting bronchodilators (LABDs) alone, 1,502 (34.6%) cases; LABD with inhaled corticosteroids (ICSs), 389 (8.6%) cases; and triple therapy cases, 2,428 (53.9%) cases. Incorrect prescriptions of inhaled therapies were observed in 261 (5.9%) cases. After the clinical visit was audited, 3,494 (77.5%) cases did not modify their therapeutic prescription, 307 (6.8%) cases had a step up, 238 (5.3%) cases had a change for a similar scheme, 182 (4.1%) cases had a step down, and 227 (5.1%) cases had other nonspecified change. Stepping-up strategies were associated with clinical presentation (chronic bronchitis, asthma-like symptoms, and exacerbations), a positive bronchodilator test, and specific inhaled medication groups. Stepping down was associated with lung function impairment, ICS containing regimens, and nonexacerbator phenotype.
The EPOCONSUL study shows a comprehensive evaluation of pharmacological treatments in COPD care, highlighting strengths and weaknesses, to help us understand how physicians use available drugs.
当前慢性阻塞性肺疾病（COPD）管理建议指出，药物治疗可上调或下调，但未就如何进行这种调整给出建议。我们旨在描述COPD常规临床就诊期间的药物处方情况，并研究治疗方案改变的决定因素。
EPOCONSUL是一项西班牙全国性的观察性横断面临床审计，前瞻性招募病例，纳入来自门诊呼吸科诊所的4508例COPD患者，为期12个月（2014年5月至2015年5月）。对4448例患者的处方模式进行了检查，并在逐步向后、二项式、多变量逻辑回归模型中分析了变化情况。
吸入治疗组的处方模式为：未开任何治疗，124例（2.8%）；仅使用一种或两种长效支气管扩张剂（LABD），1502例（34.6%）；LABD联合吸入性糖皮质激素（ICS），389例（8.6%）；三联疗法，2428例（53.9%）。观察到261例（5.9%）患者吸入治疗处方有误。临床就诊审计后，3494例（77.5%）患者未改变治疗处方，307例（6.8%）患者治疗方案上调，238例（5.3%）患者更换为类似方案，182例（4.1%）患者治疗方案下调，227例（5.1%）患者有其他未明确说明的变化。治疗方案上调策略与临床表现（慢性支气管炎、哮喘样症状和急性加重）、支气管扩张试验阳性以及特定吸入药物组相关。治疗方案下调与肺功能损害、含ICS的治疗方案以及非急性加重型表型相关。
EPOCONSUL研究对COPD治疗中的药物治疗进行了全面评估，突出了优点和不足，有助于我们了解医生如何使用现有药物。
