| Summary: | 碩士 === 中國醫藥大學 === 藥學系碩士班 === 102 === Background：Upon 2009, 2011 and 2013 guidelines of Global Initiative for Chronic Obstructive Lung Disease (GOLD), the inhaled corticosteroids (ICS) were added whenever patients were diagnosed with severe or very severe Chronic Obstructive Pulmonary Diseases (COPDs). In the real practice, some physicians prescribed combination therapies with ICS toward moderate COPD patients. However, up to now, there is lack of evidence to support earlier use of ICS toward moderate COPD patients.
Aims：To explore the differences of disease severity, medication prescriptions patterns (including medication use, medication possession ratio, medication adherence and persistence, medication switch), number of patients and events of disease exacerbations and medical expenditure (including ER costs, hospitalization costs and medications costs) between single therapy group (i.e., used long-acting bronchodilators only) and combo therapy group (i.e., used combined with ICS) among moderate COPD patients during study period.
Methods：We conducted a restrospective cohort study. The databases and electronic medical records in China Medical University Hospital were utilized. Upon pre-specfied criteria, 2009 GOLD guideline and patients’ lung function findings, the moderate COPD patients were identified. Those who were prescribed with long-acting bronchodilators only (i.e., single theray group) and combined with ICS (i.e., combo therapy group) were compared with their demographic data, disease severity, prescriptions patterns, number of exacerbation events, medical expenditure using chi-square test, t test or Mann-Whitney test. As for the medical expenditures, the medication costs were retrieved based on the reimbursed prices provided by National Health Insurance Administration. The ER costs and hospitalization costs of disease exacerbation due to COPD were adapted based on the data published in an article conducted in Taiwan.
Result：Of 175 moderate COPD patients, 98 and 77 patients (44%) were grouped into single therapy and combo therapy group, respectively. 57.14% of combo therapy group were diagnosed with severe COPD upon physicians’ records. Those patients in combo therapy group tended to use more medications, had higher medication possession ratio, higher adherence and persistence for both rescue and maintainance medications. The patterns of medication switch among two groups were different. Further, more occurrences of COPD exacerbation, and higher costs of ER, hospitalization and medication use in the combo therapy group patients were observed than that of single therapy group.
Conclusion：Those moderate COPD patients who were prescribed with combo therapy tended to have more severe disease statuses. As results, they were prescribed with more types of medications, had higher medication possession ratio and medication adherence, but they also consumed more medical expenditure. Indeed, as the updated guideline indicated that the COPD disease severity cannot be differentiated base upon lung function test findings only. It might be necessary for those moderate COPD patients (upon their lung function findings) with severe symptoms to use ICS to control their disease progressions. However, more researches are needed to explore their symptoms, exacerbation history and its outcomes in the future.
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