COPD 患者对吸入器的依从性及合并症。来自希腊的一项横断面初级保健研究。
Adherence to inhalers and comorbidities in COPD patients. A cross-sectional primary care study from Greece.
机构信息
Health Planning Unit. Department of Social Medicine, Faculty of Medicine, University of Crete, Voutes Campus, Heraklion, GR-71003, Crete, Greece.
Department of Public Health, Heraklion University Hospital, Heraklion, Crete, Greece.
出版信息
BMC Pulm Med. 2020 Sep 25;20(1):253. doi: 10.1186/s12890-020-01296-3.
BACKGROUND
Comorbidities and adherence to inhaled therapy appears to have a major impact on treatment goals, health status and disease control in chronic obstructive pulmonary disease (COPD). Aim of the study was to assess levels of adherence to inhalers, comorbidities and associations with COPD outcomes in patients residing in rural and semi-urban areas of Greece.
METHODS
Two hundred fifty-seven COPD patients were enrolled from primary health care in 2015-2016. Physicians used structured interviews and questionnaires to assess quality of life and disease status. Patients were classified into groups according to GOLD 2019 guidelines (based on CAT and mMRC). Adherence to inhalers was measured with the Test of Adherence to Inhalers (TAI). Multivariate linear and logistics regression models were used to assess associations between comorbidities and adherence to inhalers with COPD outcomes, including CAT and mMRC scores, exacerbations and GOLD A-D status.
RESULTS
74.1% of COPD patients reported poor adherence, while most of them were characterized as deliberate non-compliers (69.5%). 77.1% had ≥2 comorbidities, with overweight/obese (82.2%), hypertension (72.9%) and diabetes mellitus (58%) being the most prevalent. In multivariate analysis, COPD outcomes having significant associations with poor adherence included worse health status [OR (95% CI) 4.86 (1.61-14.69) and 2.93 (1.51-5.71) based on CAT and mMRC, respectively], having ≥2 exacerbations in the past year [4.68 (1.51-4.44)], and disease status e.g., be in groups C or D [3.13 (1.49-8.53) and 3.35 (1.24-9.09) based on CAT and mMRC, respectively). Subjects with gastroesophageal reflux showed better inhaler adherence [OR (95% CI) 0.17 (0.6-0.45)], but none of the comorbid conditions was associated with COPD outcomes after adjustments.
CONCLUSIONS
Poor adherence to inhalers and comorbidities are both prevalent in COPD patients of primary care residing in rural/semi-urban areas of Greece, with adherence influencing COPD outcomes. Raising awareness of patients and physicians on the importance of comorbidities control and inhaler adherence may lead to interventions and improve outcomes.
背景
合并症和吸入疗法的依从性似乎对慢性阻塞性肺疾病（COPD）的治疗目标、健康状况和疾病控制有重大影响。本研究的目的是评估居住在希腊农村和半城市地区的 COPD 患者的吸入器依从性、合并症水平及其与 COPD 结局的相关性。
方法
2015-2016 年，我们从初级保健中招募了 257 名 COPD 患者。医生使用结构化访谈和问卷评估生活质量和疾病状况。根据 GOLD 2019 指南（基于 CAT 和 mMRC），患者被分为不同组别。使用吸入器依从性测试（TAI）来衡量吸入器的依从性。采用多元线性和逻辑回归模型来评估合并症与吸入器依从性与 COPD 结局（包括 CAT 和 mMRC 评分、加重和 GOLD A-D 状态）之间的相关性。
结果
74.1%的 COPD 患者报告依从性差，其中大多数患者被归类为故意不依从者（69.5%）。77.1%的患者有≥2 种合并症，超重/肥胖（82.2%）、高血压（72.9%）和糖尿病（58%）最为常见。在多变量分析中，与依从性差显著相关的 COPD 结局包括较差的健康状况[CAT 和 mMRC 分别为 4.86（1.61-14.69）和 2.93（1.51-5.71）]、过去 1 年有≥2 次加重[4.68（1.51-4.44）]和疾病状况，例如，处于 C 或 D 组[CAT 和 mMRC 分别为 3.13（1.49-8.53）和 3.35（1.24-9.09）]。胃食管反流的患者吸入器依从性更好[OR（95%CI）0.17（0.6-0.45）]，但调整后无任何合并症与 COPD 结局相关。
结论
居住在希腊农村/半城市地区的初级保健 COPD 患者普遍存在吸入器依从性差和合并症，而依从性会影响 COPD 结局。提高患者和医生对控制合并症和吸入器依从性重要性的认识，可能会采取干预措施并改善结局。
Zotero 插件