Calle Rubio Myriam, Alcázar-Navarrete Bernardino, López-Campos José Luis, Miravitlles Marc, Soler-Cataluña Juan José, Fuentes Ferrer Manuel E, Rodríguez Hermosa Juan Luis
Department of Pulmonology, Hospital Clínico San Carlos, Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC). CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
Department of Pulmonology, Hospital Virgen de las Nieves, Granada, Spain.
PLoS One. 2025 Jul 18;20(7):e0327775. doi: 10.1371/journal.pone.0327775. eCollection 2025.
To assess the clinical characteristics of high-risk COPD patients considered not stable for having had moderate or severe exacerbations of COPD in the three months prior to the audited review visit based on information extracted from the medical record documenting health interactions prior to the visit, and to analyse the therapeutic measures adopted at the follow-up visit.
This analysis used data from the EPOCONSUL audit, which evaluated outpatient care provided to COPD patients in respiratory clinics in Spain. This analysis included patients with a high-risk level of COPD and assessed patient non-stability at the audited visit defined based on moderate or severe exacerbations in the last three months that were reported at the follow-up visit. Results: 2008 high-risk patients were analysed. 30.1% of patients were considered unstable at visit. Factors associated with non-stability are dyspnoea (MRC-m) ≥2 (OR 1.5, 95% CI 1.18-1.92; p = 0.001), chronic bronchitis criteria (OR 1.61, 95% CI 1.15-2.25; p = 0.005), use of inhaled triple therapy (OR 1. 31, 95% CI 1.06-1.61; p = 0.010), use of oral therapies for COPD (OR 1.68, 95% CI 1.23-2.28, p = 0.001), use of long-term oxygen therapy (OR 1.36, 95% CI 1.07-1.73, p = 0.010), no follow-up in a specialist COPD clinic (OR 1.44, 95% CI 1.11-1.87, p = 0.006). In 10.1% of the patients considered not stable, because at the medical visit they were referred to have had moderate or severe exacerbations in the last three months, no action was taken at the visit and in 56% there was no change in COPD pharmacological treatment. Triple therapy was the most commonly prescribed therapy (68% in non-stable patients). Twenty-five percent of patients on triple inhaled therapy are also prescribed oral therapy.
One third of patients with high-risk COPD report exacerbations requiring treatment with antibiotics and/or systemic corticosteroids in the previous three months at the medical visit; and in more than half of these patients no changes in pharmacological treatment are made at the visit.
根据审核访视前医疗记录中提取的健康互动信息，评估在审核访视前三个月因慢性阻塞性肺疾病（COPD）中度或重度加重而被认为病情不稳定的高危COPD患者的临床特征，并分析随访时采取的治疗措施。
本分析使用了EPOCONSUL审核的数据，该审核评估了西班牙呼吸诊所为COPD患者提供的门诊护理。该分析纳入了高危COPD患者，并根据随访时报告的过去三个月中的中度或重度加重情况评估审核访视时患者的病情不稳定情况。结果：分析了2008例高危患者。30.1%的患者在访视时被认为病情不稳定。与病情不稳定相关的因素有呼吸困难（医学研究委员会分级-m）≥2（比值比[OR]1.5，95%置信区间[CI]1.18-1.92；p = 0.001）、慢性支气管炎标准（OR 1.61，95% CI 1.15-2.25；p = 0.005）、使用吸入三联疗法（OR 1.31，95% CI 1.06-1.61；p = 0.010）、使用COPD口服疗法（OR 1.68，95% CI 1.23-2.28，p = 0.001）、使用长期氧疗（OR 1.36，95% CI 1.07-1.73，p = 0.010）、未在COPD专科诊所进行随访（OR 1.44，95% CI 1.11-1.87，p = 0.006）。在10.1%被认为病情不稳定的患者中，因为在医疗访视时被告知过去三个月有中度或重度加重，但访视时未采取任何措施，56%的患者COPD药物治疗没有变化。三联疗法是最常用的治疗方法（病情不稳定患者中占68%）。25%接受吸入三联疗法的患者也同时接受口服疗法。
三分之一的高危COPD患者在医疗访视时报告在过去三个月有需要用抗生素和/或全身糖皮质激素治疗的加重情况；其中一半以上的患者在访视时药物治疗没有变化。
