Lars Dijk, Yoran H Gerritsma, Thys Van der Molen, Ian Pavord, Ronald J Meijer, Huib Kerstjens, Janwillem Kocks
{"title":"在一个完善的哮喘/慢性阻塞性肺病初级保健服务中,阻塞性肺病患者的可治疗特征","authors":"Lars Dijk, Yoran H Gerritsma, Thys Van der Molen, Ian Pavord, Ronald J Meijer, Huib Kerstjens, Janwillem Kocks","doi":"10.2147/COPD.S508281","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>The primary objective of this study was to assess the prevalence of treatable traits (TTs) in patients with obstructive lung diseases in a primary care setting and how these TTs co-occur. The secondary objective was to assess the stability of TTs and the effect of management advice on changes in traits and health outcomes.</p><p><strong>Patients and methods: </strong>Data from the Dutch asthma/COPD service (2007-2023) were studied retrospectively. Patients ≥18 years with asthma, COPD, or Asthma-COPD overlap (ACO) were included. The prevalence of eight TTs were assessed: 1) insufficient inhaler technique, 2) poor medication adherence, 3) blood eosinophilia, 4) smoking, 5) obesity, 6) physical inactivity, 7) reversible airflow limitation, and 8) anxiety and/or depression. The effect of management advice on TTs was evaluated for patients with a follow-up visit scheduled within 1-2 years.</p><p><strong>Results: </strong>In total, 15246 patients (COPD n=4822; ACO n=1761, asthma n=8663) were included. The highest proportions of TTs were insufficient inhaler technique: 43.6% (95% CI: 42.9-44.4), followed by poor medication adherence: 40.3% (95% CI: 39.2-41.4) and blood eosinophilia: 36.9% (95% CI: 35.8-38.1). Overall, 83.3% of patients had ≥ 1 TTs, and 48.9% of patients ≥ 2 TTs. Among patients with blood eosinophilia, a significant reduction of the trait at follow-up (OR: 0.61, 95% CI: 0.39; 0.96) and improved health status were observed when the pulmonologist advised the general practitioner to initiate or increase the dose of ICS. No significant association was found between management advice and the exacerbation rate at follow-up.</p><p><strong>Conclusion: </strong>The TTs assessed in this study are common in primary care patients, with nearly half of the patients showing a combination of at least two TTs. These TTs coexist in many different combinations. A personalized approach targeting these traits may be effective in achieving better control of these heterogeneous diseases.</p>","PeriodicalId":48818,"journal":{"name":"International Journal of Chronic Obstructive Pulmonary Disease","volume":"20 ","pages":"1189-1201"},"PeriodicalIF":2.7000,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12034284/pdf/","citationCount":"0","resultStr":"{\"title\":\"Treatable Traits in Patients with Obstructive Lung Diseases in a Well-Established Asthma/COPD Service for Primary Care.\",\"authors\":\"Lars Dijk, Yoran H Gerritsma, Thys Van der Molen, Ian Pavord, Ronald J Meijer, Huib Kerstjens, Janwillem Kocks\",\"doi\":\"10.2147/COPD.S508281\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>The primary objective of this study was to assess the prevalence of treatable traits (TTs) in patients with obstructive lung diseases in a primary care setting and how these TTs co-occur. The secondary objective was to assess the stability of TTs and the effect of management advice on changes in traits and health outcomes.</p><p><strong>Patients and methods: </strong>Data from the Dutch asthma/COPD service (2007-2023) were studied retrospectively. Patients ≥18 years with asthma, COPD, or Asthma-COPD overlap (ACO) were included. The prevalence of eight TTs were assessed: 1) insufficient inhaler technique, 2) poor medication adherence, 3) blood eosinophilia, 4) smoking, 5) obesity, 6) physical inactivity, 7) reversible airflow limitation, and 8) anxiety and/or depression. The effect of management advice on TTs was evaluated for patients with a follow-up visit scheduled within 1-2 years.</p><p><strong>Results: </strong>In total, 15246 patients (COPD n=4822; ACO n=1761, asthma n=8663) were included. The highest proportions of TTs were insufficient inhaler technique: 43.6% (95% CI: 42.9-44.4), followed by poor medication adherence: 40.3% (95% CI: 39.2-41.4) and blood eosinophilia: 36.9% (95% CI: 35.8-38.1). Overall, 83.3% of patients had ≥ 1 TTs, and 48.9% of patients ≥ 2 TTs. Among patients with blood eosinophilia, a significant reduction of the trait at follow-up (OR: 0.61, 95% CI: 0.39; 0.96) and improved health status were observed when the pulmonologist advised the general practitioner to initiate or increase the dose of ICS. No significant association was found between management advice and the exacerbation rate at follow-up.</p><p><strong>Conclusion: </strong>The TTs assessed in this study are common in primary care patients, with nearly half of the patients showing a combination of at least two TTs. These TTs coexist in many different combinations. A personalized approach targeting these traits may be effective in achieving better control of these heterogeneous diseases.</p>\",\"PeriodicalId\":48818,\"journal\":{\"name\":\"International Journal of Chronic Obstructive Pulmonary Disease\",\"volume\":\"20 \",\"pages\":\"1189-1201\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2025-04-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12034284/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Chronic Obstructive Pulmonary Disease\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2147/COPD.S508281\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"RESPIRATORY SYSTEM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Chronic Obstructive Pulmonary Disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2147/COPD.S508281","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
Treatable Traits in Patients with Obstructive Lung Diseases in a Well-Established Asthma/COPD Service for Primary Care.
Purpose: The primary objective of this study was to assess the prevalence of treatable traits (TTs) in patients with obstructive lung diseases in a primary care setting and how these TTs co-occur. The secondary objective was to assess the stability of TTs and the effect of management advice on changes in traits and health outcomes.
Patients and methods: Data from the Dutch asthma/COPD service (2007-2023) were studied retrospectively. Patients ≥18 years with asthma, COPD, or Asthma-COPD overlap (ACO) were included. The prevalence of eight TTs were assessed: 1) insufficient inhaler technique, 2) poor medication adherence, 3) blood eosinophilia, 4) smoking, 5) obesity, 6) physical inactivity, 7) reversible airflow limitation, and 8) anxiety and/or depression. The effect of management advice on TTs was evaluated for patients with a follow-up visit scheduled within 1-2 years.
Results: In total, 15246 patients (COPD n=4822; ACO n=1761, asthma n=8663) were included. The highest proportions of TTs were insufficient inhaler technique: 43.6% (95% CI: 42.9-44.4), followed by poor medication adherence: 40.3% (95% CI: 39.2-41.4) and blood eosinophilia: 36.9% (95% CI: 35.8-38.1). Overall, 83.3% of patients had ≥ 1 TTs, and 48.9% of patients ≥ 2 TTs. Among patients with blood eosinophilia, a significant reduction of the trait at follow-up (OR: 0.61, 95% CI: 0.39; 0.96) and improved health status were observed when the pulmonologist advised the general practitioner to initiate or increase the dose of ICS. No significant association was found between management advice and the exacerbation rate at follow-up.
Conclusion: The TTs assessed in this study are common in primary care patients, with nearly half of the patients showing a combination of at least two TTs. These TTs coexist in many different combinations. A personalized approach targeting these traits may be effective in achieving better control of these heterogeneous diseases.
期刊介绍:
An international, peer-reviewed journal of therapeutics and pharmacology focusing on concise rapid reporting of clinical studies and reviews in COPD. Special focus will be given to the pathophysiological processes underlying the disease, intervention programs, patient focused education, and self management protocols. This journal is directed at specialists and healthcare professionals