Pneumology Department, Hospital Universitari Vall d´Hebron/Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
Centro de Salud Dra. Teresa Pique, Mallorca, Spain.
Int J Chron Obstruct Pulmon Dis. 2022 Jan 25;17:245-258. doi: 10.2147/COPD.S342220. eCollection 2022.
Inhaled corticosteroids (ICS) are frequently used to treat chronic obstructive pulmonary disease (COPD) outside the current recommendations. Our aim was to describe ICS use in COPD patients and to identify factors associated with ICS use among COPD patients treated within primary care in Spain.
This was a cross-sectional, non-interventional and multicenter study of patients with COPD treated in primary care. Patient characteristics and exacerbations were described in terms of ICS use among the overall cohort, and among those with spirometry confirmed COPD (post-bronchodilator forced expiratory volume in 1 second [FEV]/forced vital capacity [FVC] ratio <70%). Multivariable logistic regression was used to identify factors associated with ICS use.
A total of 901 patients were included, of which 47.9% (n = 432) were treated with ICS. A total of 240 patients (26.6%) experienced moderate/severe exacerbations in the prior year, while 309 (34.3%) during the previous two years. History of asthma totaled 11.6% (n = 105). The most frequent phenotype was non-exacerbator (51.6%), and the proportion of patient with moderate or severe exacerbations was significantly higher among ICS treated patients compared to non-treated: 37.5% versus 16.6% during the previous year (p < 0.001), and 46.8% versus 22.8% during the previous 2-years (p < 0.001), respectively. Patient characteristics were similar among spirometry confirmed patients and the overall population. Factors significantly associated with ICS use were a history of asthma (OR = 4.39, 95% CI: 2.67-7.26), the presence of moderate or severe exacerbations in the last year (OR = 2.52, 95% CI: 1.81-3.49), followed by higher mMRC and higher CAT score.
Nearly half of patients in primary care in Spain are treated with ICS, despite most of them being non-exacerbators. History of asthma, exacerbations, and worse dyspnea and CAT scores are associated with ICS use.
吸入性皮质类固醇（ICS）常用于治疗慢性阻塞性肺疾病（COPD），超出了当前的建议范围。我们的目的是描述在西班牙初级保健中治疗 COPD 患者中 ICS 的使用情况，并确定与 ICS 使用相关的因素。
这是一项在初级保健中治疗 COPD 的患者的横断面、非干预性和多中心研究。根据总体队列中ICS 的使用情况以及支气管扩张剂后一秒用力呼气量（FEV）/用力肺活量（FVC）比值<70%的患者中，描述了患者特征和加重情况。采用多变量逻辑回归来确定与 ICS 使用相关的因素。
共纳入 901 例患者，其中 47.9%（n=432）接受 ICS 治疗。在过去一年中，共有 240 例（26.6%）患者发生中重度/重度加重，在过去两年中，共有 309 例（34.3%）患者发生中重度/重度加重。哮喘病史为 11.6%（n=105）。最常见的表型是非加重者（51.6%），与未接受 ICS 治疗的患者相比，ICS 治疗患者的中重度加重比例明显更高：在过去一年中为 37.5%比 16.6%（p<0.001），在过去两年中为 46.8%比 22.8%（p<0.001）。在接受支气管扩张剂后 FEV/FVC 比值<70%的患者和总体人群中，患者特征相似。与 ICS 使用显著相关的因素包括哮喘史（OR=4.39，95%CI：2.67-7.26）、过去一年中存在中重度加重（OR=2.52，95%CI：1.81-3.49），其次是更高的 mMRC 和 CAT 评分。
尽管大多数患者是非加重者，但在西班牙初级保健中，近一半的 COPD 患者接受 ICS 治疗。哮喘史、加重、呼吸困难加重和 CAT 评分更高与 ICS 使用相关。
