结合GOLD指南新变化分析1例慢性阻塞性肺疾病的用药监护

Analysis of Medication Supervision for One Case of COPD According to the New Changes in GOLD Guide

目的:通过对1例慢性阻塞性肺病(COPD)长期维持治疗却效果不佳的病例分析,结合COPD全球创议(GOLD)2016年版治疗理念的改变,引发对COPD治疗原则变化的关注。方法:剖析1例COPD患者的治疗方案,解读GOLD2016版的变化,观察患者吸入剂使用情况,总结分析长期治疗疗效不佳的原因。结果:发现影响患者疗效的重要原因之一是患者对自身疾病的认识不足,缺乏疾病相关知识,吸入剂的使用技巧未掌握,不遵从医嘱而自行减药或停药的现象频现。尤其是错误的使用含有激素类的吸入剂既增加患者医疗成本更使得不良反应频现。结论:COPD的治疗不仅要关注患者病情给予个体化的治疗方案,同时要重视医患沟通和用药教育。随着医学认知的发展及时更换治疗理念。在遵循传统与改变治疗方案间的选择,也是对临床药师用药指导工作的新挑战。

Objective： To analyze a COPD patient with long-term unsatisfactory maintenance treatment, and compare the new changes in the global initiative for chronic obstructive lung disease （GOLD） guide in 2016 in order to attract attention to the therapeutic principle for COPD. Methods： The treatment regimen for one case of COPD was analyzed, the changes in GOLD guide in 2016 were interpreted, the inhalant use in the patient was observed and the reasons for the unsatisfactory treatment were summarized. Results： The main reasons for the unsatisfactory treatment included the COPD knowledge lack of the patient, lack of the inhalant use skills, self dosage reduction or drug withdrawal beyond doctor＇ s advice. To be worse, the wrong way in the use of inhalant containing hormone could increase the medical cost and adverse reactions of the patient. Conclusion： COPD treatment should not only pay attention to individual treatment regimen according to the conditions of patients, but also emphasize the communication between doctors and patients and medical education. With the development of medicine, the concept of treatment should be timely updated. How to choose rationally between the traditional treatment and the changes in treatment regimen is a new challenge for clinical pharmacists to perform drug use guidance.