Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada.
Department of Ophthalmology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.
Int J Chron Obstruct Pulmon Dis. 2021 Mar 25;16:751-759. doi: 10.2147/COPD.S290805. eCollection 2021.
In contemporary guidelines for the management of Chronic Obstructive Pulmonary Disease (COPD), the history of acute exacerbations plays an important role in the choice of long-term inhaled therapies. This study aimed at evaluating population-level trends of filled inhaled prescriptions over the time course of COPD and their relation to the history of exacerbations.
We used administrative health databases in British Columbia, Canada (1997-2015), to create a retrospective incident cohort of individuals with diagnosed COPD. We quantified long-acting inhaled medication prescriptions within each year of follow-up and documented their trend over the time course of COPD. Using generalized linear models, we investigated the association between the frequent exacerbator status (≥2 moderate or ≥1 severe exacerbation(s) in the previous 12 months) and filling a prescription after a physician visit.
132,004 COPD patients were included (mean age 68.6, 49.2% female). The most common medication class during the first year of diagnosis was inhaled corticosteroids (ICS, used by 49.9%), followed by long-acting beta-2 adrenoreceptor agonists (LABA, 31.8%). Long-acting muscarinic receptor antagonists (LAMA) were the least commonly prescribed (10.4%). ICS remained the most common prescription throughout follow-up, being used by approximately 50% of patients during each year. 39.0% of patients received combination inhaled therapies in their first year of diagnosis, with ICS+LABA being the most common (30.7%). The association with exacerbation history was the most pronounced for triple therapy with an odds ratio (OR) of 2.68 for general practitioners and 2.02 for specialists (p<0.001 for both). Such associations were generally stronger among GPs compared with specialists, with the exception of monotherapy with LABA or ICS.
We documented low utilization of monotherapies (specifically LAMA) and high utilization of combination therapies (particularly ICS containing). Specialists were less likely to consider exacerbation history in the choice of inhaled therapies compared with GPs.
在慢性阻塞性肺疾病（COPD）的现代管理指南中，急性加重的病史在长期吸入治疗的选择中起着重要作用。本研究旨在评估 COPD 病程中吸入性处方的人群水平趋势及其与加重史的关系。
我们使用加拿大不列颠哥伦比亚省的医疗保健数据库（1997-2015 年），创建了一个诊断为 COPD 的患者的回顾性队列。我们在随访的每一年中量化了长效吸入药物的处方，并记录了它们在 COPD 病程中的趋势。我们使用广义线性模型，研究了频繁加重者状态（过去 12 个月中≥2 次中度或≥1 次重度加重）与医生就诊后开处方之间的关系。
共纳入 132004 例 COPD 患者（平均年龄 68.6 岁，49.2%为女性）。诊断后第一年最常用的药物类别是吸入皮质类固醇（ICS，49.9%使用），其次是长效β2 肾上腺素能受体激动剂（LABA，31.8%）。长效毒蕈碱受体拮抗剂（LAMA）的处方最少（10.4%）。ICS 在整个随访期间一直是最常用的药物，大约 50%的患者在每年都使用。39.0%的患者在诊断后的第一年接受了联合吸入治疗，其中 ICS+LABA 最常见（30.7%）。与加重史的关联在三联治疗中最为显著，全科医生的比值比（OR）为 2.68，专科医生的 OR 为 2.02（均<0.001）。与专科医生相比，全科医生的这种关联更强，除了单独使用 LABA 或 ICS 之外。
我们记录了单药治疗（特别是 LAMA）的利用率低，联合治疗（特别是含 ICS）的利用率高。与全科医生相比，专科医生在选择吸入治疗时不太考虑加重史。
