Abstract：【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-acting β2 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.
王韶, 曾玉琴, 宋庆, 蒋云, 双庆翠, 肖小翠, 周爱媛, 邓玎玎. 稳定期慢性阻塞性肺疾病患者初始药物治疗现状分析[J]. 医学临床研究, 2022, 39(10): 1441-1444.
WANG Shao, ZENG Yu-qin, SONG Qing, et al. Current Status of Inhaled Treatments in Patients with Stable Chronic Obstructive Pulmonary Disease. JOURNAL OF CLINICAL RESEARCH, 2022, 39(10): 1441-1444.
[1] DE MATTEIS S,JARVIS D,DARNTON A,et al. The occupations at increased risk of COPD:analysis of lifetime job-histories in the population-based UK Biobank Cohort[J].Eur Respir J,2019,54(1):1900186.
[2] WANG C,XU J,YANG L,et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study):a national cross-sectional study[J].Lancet,2018,391(10131):1706-1717.
[3] HALBERT R J,ISONAKA S,GEORGE D,et al. Interpreting COPD prevalence estimates:what is the true burden of disease?[J].Chest,2003,123(5):1684-1692.
[4] 任晓彤. 慢性阻塞性肺疾病患者稳定期的常用药物治疗[J].首都食品与医药, 2017,24(21):70.
[5] CAZZOLA M,MOLIMARD M. The scientific rationale for combining long-acting beta2-agonists and muscarinic antagonists in COPD[J].Pulm Pharmacol Ther,2010,23(4):257-267.
[6] MIRAVITLLES M. Guidelines versus clinical practice in the treatment of chronic obstructive pulmonary disease[J].Eur Respir J,2002,20(1):243-244.
[7] RIARIO-SFORZA G G,INCORVAIA C,PRAVETTONI C,et al. Guidelines versus clinical practice in the treatment of COPD:a reappraisal [J].Eur Respir J,2006,27(3):656.
[8] CORRADO A,ROSSI A. How far is real life from COPD therapy guide lines? An Italian observational study[J].Respir Med,2012,106(7):989-997.
[9] ZENG Y Q,CAI S,CHEN Y,et al. Current status of the treatment of COPD in China:A multicenter prospective observational study[J].Int J Chronic Obstr,2020,15:3227-3237.
[10] TURAN O,EMRE JC,DENIZ S,et al. Adherence to current COPD guidelines in Turkey[J].Expert Opin Pharmaco,2016,17(2):153-158.
[11] SUISSA S,PATENAUDE V,LAPI F,et al. Inhaled corticosteroids in COPD and the risk of serious pneumonia [J].Thorax,2013,68(11):1029-1036.
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