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

IF 2.7 3区 医学 Q2 RESPIRATORY SYSTEM
Lars Dijk, Yoran H Gerritsma, Thys Van der Molen, Ian Pavord, Ronald J Meijer, Huib Kerstjens, Janwillem Kocks
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引用次数: 0

摘要

目的:本研究的主要目的是评估初级保健机构中阻塞性肺疾病患者可治疗特征(TTs)的患病率以及这些TTs如何共同发生。次要目的是评估TTs的稳定性以及管理建议对性状和健康结果变化的影响。患者和方法:回顾性研究荷兰哮喘/慢性阻塞性肺病服务(2007-2023)的数据。≥18岁的哮喘、COPD或哮喘-COPD重叠(ACO)患者纳入研究。评估了8种TTs的患病率:1)吸入器技术不足,2)药物依从性差,3)血嗜酸性粒细胞增多,4)吸烟,5)肥胖,6)缺乏运动,7)可逆性气流受限,8)焦虑和/或抑郁。对1-2年内随访的患者评估管理建议对TTs的影响。结果:共15246例患者(COPD n=4822;ACO =1761例,asthma =8663例。TTs比例最高的是吸入器技术不足:43.6% (95% CI: 42.9 ~ 44.4),其次是药物依从性差:40.3% (95% CI: 39.2 ~ 41.4)和血嗜酸性粒细胞增多:36.9% (95% CI: 35.8 ~ 38.1)。总体而言,83.3%的患者有≥1次TTs, 48.9%的患者有≥2次TTs。在嗜酸性血友病患者中,随访时该特征显著降低(OR: 0.61, 95% CI: 0.39;当肺科医生建议全科医生开始或增加ICS剂量时,观察到健康状况的改善。随访时未发现管理建议与病情恶化率之间存在显著关联。结论:本研究中评估的TTs在初级保健患者中很常见,近一半的患者表现出至少两种TTs的组合。这些tt以许多不同的组合共存。针对这些特征的个性化方法可能有效地实现对这些异质性疾病的更好控制。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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.

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来源期刊
CiteScore
4.80
自引率
10.70%
发文量
372
审稿时长
16 weeks
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
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