Value Evidence and Outcomes, Epidemiology, R&D Global Medical, GlaxoSmithKline, Research Triangle Park, NC, USA.
Respiratory Clinical Sciences, GlaxoSmithKline, Collegeville, PA, USA.
Int J Chron Obstruct Pulmon Dis. 2022 Mar 3;17:415-426. doi: 10.2147/COPD.S336158. eCollection 2022.
Clinical guidelines for COPD management suggest pharmacologic treatment algorithms based on symptoms and exacerbation history. As previous research has suggested that prescribing patterns are not always aligned with these recommendations, this study investigated the burden of disease in patients with COPD receiving, and persisting on, new inhaled maintenance therapy.
This was a retrospective observational study using two linked electronic databases containing health records of patients in England. Patients aged ≥35 years with a confirmed diagnosis of COPD, and who initiated a new inhaled respiratory pharmacologic maintenance regimen between January 1, 2014 and December 31, 2016 (index date) were eligible for inclusion. New treatments could be long-acting muscarinic antagonist (LAMA) or long-acting β-agonist (LABA) monotherapy, inhaled corticosteroid (ICS)/LABA or LAMA/LABA dual therapy, or a multiple-inhaler triple therapy (MITT; LAMA/LABA/ICS). Patients were required to have 12 months of available medical history prior to, and after, the index date.
In total, 25,350 eligible patients were identified, of these 8282 (mean age: 70.9 years; 51.5% male) persisted with their newly prescribed inhaled therapy for ≥12 months and were included in the analysis. In the 12 months prior to index, 54% of patients had moderate or severe dyspnea (Medical Research Council score ≥3). The most common therapy initiated at index was MITT (42%), followed by ICS/LABA dual therapy (31.2%). The proportion of patients with moderate or severe dyspnea in the post-index period ranged from 29.0% of patients receiving ICS to 64.2% of patients receiving MITT. In the post-index period, 48.1% of patients experienced ≥1 exacerbation and 54.9% had ≥5 general practitioner visits.
Many of the patients with COPD in our study continued to experience symptoms and exacerbations, despite persisting on the same treatment for ≥12 months. This suggests that some patients may benefit from treatment modification in accordance with guideline recommendations.
慢性阻塞性肺疾病（COPD）管理临床指南建议根据症状和加重史制定药物治疗方案。由于之前的研究表明，处方模式并不总是与这些建议一致，因此本研究调查了接受并坚持新的吸入性维持治疗的 COPD 患者的疾病负担。
这是一项回顾性观察性研究，使用了两个包含英国患者健康记录的链接电子数据库。年龄≥35 岁、确诊为 COPD、2014 年 1 月 1 日至 2016 年 12 月 31 日（索引日期）期间开始新的吸入性呼吸药物维持治疗方案的患者符合纳入条件。新的治疗方法可以是长效毒蕈碱拮抗剂（LAMA）或长效β-激动剂（LABA）单药治疗、吸入性皮质类固醇（ICS）/LABA 或 LAMA/LABA 双重治疗，或多吸入器三联疗法（MITT；LAMA/LABA/ICS）。患者在索引日期之前和之后必须有 12 个月的可用病史。
共确定了 25350 名符合条件的患者，其中 8282 名（平均年龄：70.9 岁；51.5%为男性）坚持新处方吸入治疗≥12 个月，纳入分析。在索引前 12 个月，54%的患者有中度或重度呼吸困难（改良医学研究委员会呼吸困难量表评分≥3）。索引时开始的最常见治疗方法是 MITT（42%），其次是 ICS/LABA 双重治疗（31.2%）。在索引后的时期，中度或重度呼吸困难患者的比例范围从接受 ICS 的患者的 29.0%到接受 MITT 的患者的 64.2%。在索引后的时期，48.1%的患者经历了≥1 次加重，54.9%的患者有≥5 次全科医生就诊。
在我们的研究中，许多 COPD 患者尽管坚持相同的治疗方案≥12 个月，但仍继续出现症状和加重。这表明，一些患者可能需要根据指南建议进行治疗调整。
