Varol Yelda, Karakurt Zuhal, Çırak Ali Kadri, Şahin Hülya Doğan, Kıraklı Cenk, Kömürcüoğlu Berna
Department of Pulmonology, University of Health Sciences, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, İzmir, Turkey.
Department of Pulmonology, University of Health Sciences, Süreyyapasa Chest Diseases and Surgery Training and Research Hospital, İstanbul, Turkey.
Turk Thorac J. 2020 Nov;21(6):397-403. doi: 10.5152/TurkThoracJ.2020.19074. Epub 2020 Nov 1.
Most exacerbations are mild to moderate, and antibiotic treatment for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is recommended for patients with severe exacerbations or severe underlying chronic obstructive pulmonary disease (COPD). Therefore, we aimed to investigate the patient factors that are associated with the prescription of antibiotics for inappropriate indication in AECOPD.
This study was an observational cross-sectional study conducted in an outpatient clinic. The patients diagnosed with AECOPD and prescribed an antibiotic by a pulmonary physician were enrolled in the study. These prescriptions were documented by the pharmacist who asked the patient about the three cardinal symptoms. Appropriate and inappropriate prescription groups were defined by the types of exacerbations, as defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) COPD report.
There were 138 patients, predominantly male (83%), with a mean age of 64 (±9) years. A total of 64% of the prescriptions were appropriate; however, there were 50 (36%) patients with inappropriate antibiotic prescription according to the mentioned criteria. When we compared the patient factors between the appropriate and inappropriate antibiotic prescriptions, there was no statistically significant difference in terms of age, Forced expiratory volume in first second % (FEV1%) predicted, FEV1 ml, forced vital capacity (FVC) ml, FEV1/FVC, and amount (packs/year) of smoking (p>0.05 for all parameters). FVC% was statistically significantly lower in the appropriate antibiotic prescription group compared with that in the inappropriate antibiotic prescription group (p=0.049).
This study shows that most pulmonary physicians have a tendency to prescribe antibiotics for AECOPD according to the defined GOLD criteria. However, some of the physicians also prefer to prescribe antibiotics self-directedly, irrespective of the GOLD criteria. A physician-based questionnaire can be completed for future studies to define the underlying reasons for antibiotic prescription demands for cases of mild AECOPD.
大多数加重情况为轻度至中度，对于重度加重或患有严重基础慢性阻塞性肺疾病（COPD）的慢性阻塞性肺疾病急性加重（AECOPD）患者，建议使用抗生素治疗。因此，我们旨在调查与AECOPD中不适当适应症抗生素处方相关的患者因素。
本研究是在门诊进行的一项观察性横断面研究。纳入了被诊断为AECOPD并由肺科医生开具抗生素处方的患者。这些处方由药剂师记录，药剂师询问了患者三个主要症状。根据慢性阻塞性肺疾病全球倡议（GOLD）COPD报告所定义的加重类型，确定适当和不适当的处方组。
共有138例患者，以男性为主（83%），平均年龄64（±9）岁。共有64%的处方是适当的；然而，根据上述标准，有50例（36%）患者的抗生素处方不适当。当我们比较适当和不适当抗生素处方之间的患者因素时，在年龄、第一秒用力呼气容积百分比（FEV1%）预测值、FEV1毫升、用力肺活量（FVC）毫升、FEV1/FVC以及吸烟量（包/年）方面，没有统计学上的显著差异（所有参数p>0.05）。与不适当抗生素处方组相比，适当抗生素处方组的FVC%在统计学上显著更低（p=0.049）。
本研究表明，大多数肺科医生倾向于根据既定的GOLD标准为AECOPD开具抗生素。然而，一些医生也倾向于自行开具抗生素，而不顾及GOLD标准。未来的研究可以完成一份基于医生的问卷，以确定轻度AECOPD病例抗生素处方需求的潜在原因。
