稳定期慢性阻塞性肺疾病患者初始药物治疗现状分析  

Current Status of Inhaled Treatments in Patients with Stable Chronic Obstructive Pulmonary Disease

作　　者：王韶 曾玉琴[2] 宋庆 蒋云 双庆翠 肖小翠 周爱媛 邓玎玎 WANG Shao;ZENG Yu-qin;SONG Qing(Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Shaoyang University,Shaoyang Hunan 422000)

机构地区：[1]邵阳学院附属第一医院呼吸与危重医学科,湖南邵阳422000 [2]中南大学湘雅二医院呼吸与危重医学科,湖南长沙410011

出　　处：《医学临床研究》2022年第10期1441-1444,共4页Journal of Clinical Research

基　　金：国家自然科学基金(No:81970044,81770046);2021年湖南省教育厅一般项目(No.21C0606);2018年湖南省科技创新项目(No.S2018SFYFSF0272);湘雅名医(2013)。

摘　　要：【目的】探讨稳定期慢性阻塞性肺疾病(Chronic Obstructive Pulmonary Disease,COPD)患者初始吸入药物治疗现状。【方法】收集2016年12月至2021年3月在我国湖南及广西境内13家医院呼吸科门诊就诊的稳定期COPD患者的人口学资料、肺功能指标、吸入药物治疗处方及COPD评估测试(CAT)及改良英国医学研究委员会呼吸困难量表(mMRC)评分。依据2017年COPD全球倡议(GOLD)指南分为A组、B组、C组和D组,吸入药物处方与2017年GOLD指南推荐不一致者,则视为不适当治疗。以2020年1月1日为时间节点,分析各组患者两个时间段吸入治疗处方的差异。【结果】共纳入5434例COPD患者,主要的吸入处方分别是长效抗胆碱能药(LAMA)、吸入性糖皮质激素(ICS)+长效β2受体激动剂(LABA)+LAMA、LABA/ICS,分别占比38.7%、36.9%、12.8%。A组、B组、C组和D组中分别有44.4%、58.4%、26.7%和5.97%的患者接受了不适当治疗,尤其是过度使用ICS。与2020年1月1日前对比,2020年1月1日后患者的两联支气管扩张剂(双支扩剂)使用率均有所增加(P<0.05),而三联药物治疗处方比例明显下降(P<0.001)。【结论】COPD患者的吸入药物处方与2017年GOLD指南推荐处方有差异,尤其是ICS的使用。双支扩剂上市后,三联药物治疗比例明显降低,改善了ICS的过度使用。【Objective】To investigate the current status of initial treatments in patients with stable chronic obstructive pulmonary disease(COPD).【Methods】Patients with COPD were enrolled to the Department of Respiratory Disease in 13 hospitals of Hunan and Guangxi from December 2016 to March 2021.Demographic data,pulmonary function,inhaled drug treatment prescriptions,and COPD assessment test(CAT),symptom score and Medical Research Council Dyspnea Scale(mMRC)score were collected.According to the 2017 COPD Global Initiative(GOLD)guidelines,patients were divided into groups A,B,C,and D.Patients'inhaled prescriptions were compared with the recommendations of the Global Initiative for COPD(GOLD,2017)guidelines.Inhaled drug prescriptions that were inconsistent with the 2017 GOLD guidelines are considered inappropriate treatment.The difference of inhalation in patients with COPD before and after January 1,2020 was compared.【Results】A total of 5434 patients with COPD were analyzed.The most commonly used inhaled bronchodilators were long-acting Anticholinergic(LAMA),triple therapy[inhaled glucocorticoids(ICS)+long-actingβ2 receptor agonists(LABA)+LAMA]and LABA/ICS,accounting for 38.7%,36.9%and 12.8%,respectively.We found that 44.4%of patients in the Group A,58.4%in Group B,26.7%in Group C,and 5.97%in Group D received inappropriate treatment,particularly the overuse of ICS.After January 1,2020,the use rate of dual bronchodilators(double bronchodilators)increased(P<0.05),while the proportion of triple drug therapy prescriptions decreased significantly(P<0.001),when compared with before January 1,2020.【Conclusion】In clinical practice,inhaled therapy in patients with stable COPD differs from the GOLD recommendations of 2017,particularly the overuse of ICS.After the launch and application of the double-bronchodilator(LABA/LAMA),the use of ICS has a certain trend of decline,but there is still unreasonable use.

关 键 词：肺疾病 慢性阻塞性 药物疗法 治疗 临床研究性 

分 类 号：R563[医药卫生—呼吸系统]