吸入疗法的依从性及其对慢性阻塞性肺疾病（COPD）的影响。
Adherence to inhaled therapy and its impact on chronic obstructive pulmonary disease (COPD).
机构信息
Department of Pulmonology, Kepler University Hospital, Krankenhausstrasse 9, A4021, Linz, Austria.
Faculty of Medicine, Johannes-Kepler-University, Linz, Austria.
出版信息
BMC Pulm Med. 2018 Oct 19;18(1):163. doi: 10.1186/s12890-018-0724-3.
BACKGROUND
COPD is a treatable disease with increasing prevalence worldwide. Treatment aims to stop disease progression, to improve quality of life, and to reduce exacerbations. We aimed to evaluate the association of the stage of COPD on adherence to inhaled therapy and the relationship between adherence and COPD exacerbations.
METHODS
A retrospective analysis of patients hospitalized for acute exacerbation of COPD in a tertiary care hospital in Upper Austria and discharged with a guideline conform inhaled therapy was performed. Follow-up data on medical utilization was recorded for the subsequent 24 months. Adherence to inhaled therapy was defined according to the percentage of prescribed inhalers dispensed to the patient and classified as complete (> 80%), partial (50-80%) or low (< 50%).
RESULTS
Out of 357 patients, 65.8% were male with a mean age of 66.5 years and a mean FEV of 55.0%pred. Overall, 35.3% were current smokers, and only 3.9% were never-smokers. In 77.0% inhaled triple therapy (LAMA + LABA + ICS) was prescribed. 33.6% showed complete adherence to their therapy (33.2% in men, 34.4% in women), with a mean age of 67.0 years. Mean medication possession ratio by GOLD spirometry class I - IV were 0.486, 0.534, 0.609 and 0.755, respectively (p = 0.002). Hence, subjects with complete adherence to therapy had a significantly lower FEV compared to those with low adherence (49.2%pred. vs 59.2%pred., respectively; p < 0.001). The risk of exacerbations leading to hospitalization was 10-fold higher in GOLD spirometry class IV compared to GOLD spirometry class I, which was even more evident in multivariate analysis (OR 13.62).
CONCLUSION
Complete adherence to inhaled therapy was only seen in 33.6% and was higher among those with more severe COPD.
TRIAL REGISTRATION
Not applicable.
背景
COPD 是一种可治疗的疾病，在全球范围内的患病率不断增加。治疗旨在阻止疾病进展、提高生活质量并减少恶化。我们旨在评估 COPD 阶段与吸入治疗依从性的关系，以及依从性与 COPD 恶化之间的关系。
方法
对奥地利上奥地利州一家三级保健医院因 COPD 急性加重而住院并开具符合指南的吸入治疗的患者进行回顾性分析。随后 24 个月记录了患者的医疗利用数据。根据患者所开吸入器的处方比例定义了吸入治疗的依从性，并将其分类为完全（>80%）、部分（50-80%）或低（<50%）。
结果
在 357 名患者中，65.8%为男性，平均年龄为 66.5 岁，平均 FEV 为 55.0%预计值。总体而言，35.3%为当前吸烟者，只有 3.9%为从不吸烟者。77.0%的患者开具了三联吸入治疗（LAMA+LABA+ICS）。33.6%的患者完全依从治疗（男性为 33.2%，女性为 34.4%），平均年龄为 67.0 岁。按 GOLD 肺功能分级 I-IV 级，药物持有率分别为 0.486、0.534、0.609 和 0.755（p=0.002）。因此，完全依从治疗的患者与低依从性的患者相比，FEV 明显更低（分别为 49.2%预计值和 59.2%预计值，p<0.001）。与 GOLD 肺功能分级 I 级相比，GOLD 肺功能分级 IV 级患者因恶化而住院的风险高 10 倍，多变量分析结果更为明显（OR 13.62）。
结论
完全依从吸入治疗的患者仅占 33.6%，且在 COPD 更严重的患者中更为常见。
试验注册
不适用。
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