Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
CIBER de Enfermedades Respiratorias (CIBERES), ISCIII, Madrid, Spain.
Int J Chron Obstruct Pulmon Dis. 2022 Jul 12;17:1577-1587. doi: 10.2147/COPD.S369118. eCollection 2022.
Identifying the variables that guide decision-making in relation to the use of inhaled corticosteroids (ICS) can contribute to the appropriate use of these drugs. The objective of this study was to identify the clinical variables that physicians consider most relevant for prescribing or withdrawing ICS in COPD.
A cross-sectional survey was conducted in Spain from November 2020 to May 2021. Therapeutic decisions on the use of ICS in 11 hypothetical COPD patient profiles were collected using an online survey answered by specialists with experience in the management of patients with COPD. Mixed-effects logistic regression was used to analyze the impact of patients' characteristics in the therapeutic decision for prescribing ICS or proceeding to its withdrawal.
A total of 74 pulmonologists agreed to collaborate in the survey and answered the questionnaire. The results showed great variability, with only 2 profiles achieving consensus for starting or withdrawing the treatment. The frequency and severity of exacerbations influenced the decision to prescribe ICS in a dose-response fashion (1 exacerbation odds ratio (OR) = 1.86, 95% confidence interval (CI) 1.02 to 3.43, two exacerbations OR = 11.6, 95% CI: 4.47 to 30.2 and three OR = 123, 95% CI: 25 to 601). Similarly, increasing blood eosinophils and history of asthma were associated with ICS use. On the other hand, pneumonia reduced the probability of initiating treatment with ICS (OR = 0.54 [0.29 to 0.98]). Lung function and dyspnea degree did not influence the clinician's therapeutic decision. The results for withdrawal of ICS were similar but in the opposite direction.
In accordance with guidelines, exacerbations, blood eosinophils and history of asthma or pneumonia are the factors considered by pulmonologist for the indication or withdrawal of ICS. However, the agreement in prescription or withdrawal of ICS when confronted with hypothetical cases is very low, suggesting a great variability in clinical practice.
确定与使用吸入性皮质类固醇（ICS）相关的决策变量有助于这些药物的合理使用。本研究的目的是确定医生认为与 COPD 患者使用 ICS 相关的最相关的临床变量。
2020 年 11 月至 2021 年 5 月在西班牙进行了一项横断面调查。使用在线调查收集了 11 个假设 COPD 患者病例中关于 ICS 使用的治疗决策，由具有 COPD 患者管理经验的专家回答。使用混合效应逻辑回归分析患者特征对开始或停止 ICS 治疗的治疗决策的影响。
共有 74 名肺病专家同意参与调查并回答了问卷。结果显示存在很大的变异性，只有 2 种情况在开始或停止治疗方面达成共识。加重的频率和严重程度以剂量反应的方式影响了开始 ICS 治疗的决定（1 次加重的优势比 (OR) = 1.86，95%置信区间 (CI) 1.02 至 3.43，2 次加重 OR = 11.6，95%CI：4.47 至 30.2，3 次 OR = 123，95%CI：25 至 601）。同样，血嗜酸性粒细胞增多和哮喘史与 ICS 使用相关。另一方面，肺炎降低了开始 ICS 治疗的可能性（OR = 0.54 [0.29 至 0.98]）。肺功能和呼吸困难程度不影响临床医生的治疗决策。停止 ICS 的结果相似，但方向相反。
根据指南，加重、血嗜酸性粒细胞和哮喘或肺炎史是肺病专家决定使用 ICS 的指征或停止使用 ICS 的因素。然而，在面对假设病例时，开始或停止 ICS 的一致性非常低，这表明临床实践中存在很大的变异性。
