基于真实世界数据的重度哮喘患者药物治疗现状实证研究  

Real-world medication treatment status in patients with severe asthma

作　　者：张可[1] 贺小宁 吴晶[1] ZHANG Ke;HE Xiaoning;WU Jing(School of Pharmaceutical Science and Technology,Faculty of Medicine,Tianjin University,Tianjin 300072,China)

机构地区：[1]天津大学医学部药物科学与技术学院,天津300072

出　　处：《中国医院药学杂志》2025年第5期489-494,共6页Chinese Journal of Hospital Pharmacy

基　　金：天津市自然科学基金项目(编号:21JCQNJC00660)。

摘　　要：目的:评估我国重度哮喘患者药物治疗现状,为优化重度哮喘患者药物治疗模式与提升合理用药水平提供循证证据支持。方法:该研究基于天津市2018—2020年区域医疗大数据,对重度哮喘患者进行为期1年的随访。在1年基线期内有至少2次伴有哮喘诊断的中高剂量吸入性糖皮质激素处方,并联用其他控制药物的哮喘患者被识别为重度哮喘患者。研究描述入组患者在整个随访期的各类治疗药物的使用比例,对长期控制方案的依从性[以药品覆盖天数比例(proportion of medica⁃tion,PDC)计],口服糖皮质激素(specific use of oral corticosteroids,OCS)的具体使用情况,以及不同类型急性发作期间各类药物使用频率。结果:研究共识别到2418名重度哮喘患者,平均年龄为56.15岁,查尔森合并症指数为2.55。在一年随访期间,93.51%的重度哮喘患者使用过吸入性糖皮质激素和长效β2受体激动剂的复方制剂,10.75%的患者使用过OCS。患者对哮喘长期控制方案的平均依从性为0.439,仅17.78%的患者依从性良好(PDC≥0.8)。在使用过OCS的患者中,OCS平均使用天数为82.73 d,平均日剂量为15.68 mg。在接受住院治疗的急性发作期间,患者对绝大部分药物的使用频率远高于在其他类型急性发作期间的使用频率。结论:当前哮喘治疗药物的选择较符合国内防治指南规范,患者对OCS的使用相对较少,在急诊患者的控制治疗和患者的依从性管理上可能存在不足,需要进一步改善哮喘的治疗和管理模式以提高重度哮喘患者健康水平。OBJECTIVE To evaluate the medication treatment status of severe asthma patients in China and to provide evidence-based support for optimizing medication treatment mode and improving rational medication use in severe asthma patients.METHODS Using regional medical big data from Tianjin(2018—2020),severe asthma patients were followed for one year.Severe asthma was determined by at least 2 prescriptions for medium-to-high doses of inhaled corticosteroids with an asthma diag⁃nosis,combined with other control medications during the one-year baseline period.The study described proportion of medication use throughout the follow-up period,patients’adherence to long-term control regimens estimated by proportion of days covered(PDC),specific use of oral corticosteroids(OCS),and the frequency of medication use during different types of exacerbations.RESULTS The study included 2418 severe asthma patients with a mean age of 56.15 years and a Charlson comorbidity index of 2.55.During the one-year follow-up,93.51%of patients with severe asthma were medicated by inhaled corticosteroids combined with long-actingβ2 agonist,and OCS was given to 10.75%of them.The average adherence to asthma control treatment was 0.439,and only 17.78%of patients showing good adherence(PDC≥0.8).OCS was used with an average of 82.73 days,with an average daily dose of 15.68 mg.During the acute attacks that require hospitalization,patients had higher usage frequencies of most medications compared to other types of exacerbations.CONCLUSION Current selection of asthma treatment medications largely aligns with domestic guidelines,with the use of OCS being relatively limited.However,there may be deficiencies in the control and treatment of emergency patients,as well as in managing patient compliance.Further improvements in asthma treat⁃ment and management are needed to enhance the health outcomes for severe asthma patients.

关 键 词：重度哮喘 真实世界 治疗现状 依从性 急性发作 

分 类 号：R969.3[医药卫生—药理学]