Pasquale Cara B, Choate Radmila, McCreary Gretchen, Mularski Richard A, Clark William, Houlihan MaryEllen, Malanga Elisha, Yawn Barbara P
COPD Foundation, Inc, Washington, DC, United States.
Department of Epidemiology, College of Public Health University of Kentucky, Lexington, Kentucky, United States.
Chronic Obstr Pulm Dis. 2021 Oct 28;8(4):474-487. doi: 10.15326/jcopdf.2021.0252.
Pharmacotherapy is one cornerstone of Chronic Obstructive Pulmonary Disease (COPD) management. Published U.S. data seldom includes patient-reported COPD medication use and adherence. We add this patient perspective to the commonly reported administrative prescribing and fill data.
This survey study used inhaler and nebulizer pictures and lists of oral COPD medications to query members of the COPD Foundation Patient-Powered Research Network, a national self-reported online registry. Medications used, adherence, inhaler education, cost concerns, previous exacerbations, and COPD Assessment Test scores were assessed and summarized using simple descriptive statistics and hazard ratios controlling for age, gender, and disease burden.
Respondents mean age was 68 years, 60% were women, >69% with the COPD Assessment Test (CAT) scores >15, and >50% reported 2 or more exacerbations in the past 12 months. Overall, >98% used one or more inhaled COPD medications, 7.6% rescue inhaler only, 17.8% used long-acting bronchodilator only therapy (11.1% dual), and 72.8% using corticosteroid therapies, including 53% triple therapy. Nebulizers were used by 59.4% and 34.8% use oral COPD medications. Reported adherence rates were high (80.1%), but 41% reported trouble paying for medications, with 20.1% reported missing medications due to cost.
In this population, COPD had a high burden with >50% of respondents using triple therapy, and one in eight maintenance oral corticosteroids. Self-reported adherence was high, but with significant cost concerns reported resulting in missed medications.
药物治疗是慢性阻塞性肺疾病（COPD）管理的基石之一。美国公布的数据很少包括患者报告的COPD药物使用情况和依从性。我们将患者的这一视角加入到通常报告的行政处方和配药数据中。
这项调查研究使用吸入器和雾化器图片以及口服COPD药物清单，对COPD基金会患者驱动研究网络的成员进行询问，该网络是一个全国性的自我报告在线登记处。使用简单描述性统计和控制年龄、性别和疾病负担的风险比，对使用的药物、依从性、吸入器教育、费用担忧、既往加重情况和COPD评估测试分数进行评估和总结。
受访者的平均年龄为68岁，60%为女性，超过69%的COPD评估测试（CAT）分数>15，超过50%的人报告在过去12个月中有2次或更多次加重。总体而言，超过98%的人使用一种或多种吸入性COPD药物，7.6%仅使用急救吸入器，17.8%仅使用长效支气管扩张剂治疗（11.1%为联合治疗），72.8%使用皮质类固醇疗法，其中53%为三联疗法。59.4%的人使用雾化器，34.8%的人使用口服COPD药物。报告的依从率较高（80.1%），但41%的人报告支付药物费用有困难，20.1%的人报告因费用而漏服药物。
在这一人群中，COPD负担较重，超过50%的受访者使用三联疗法，八分之一的人使用维持性口服皮质类固醇。自我报告的依从性较高，但报告称费用担忧严重导致漏服药物。
