慢性阻塞性肺疾病患者初始应用LABA/LAMA与ICS/LABA的依从性以及急性加重情况比较

Comparison of adherence and acute exacerbation between initial application of LABA/LAMA and ICS/LABA in patients with chronic obstructive pulmonary disease

目的探究慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)患者首次开始使用长效β_(2)受体激动剂/长效M胆碱受体拮抗剂(Long-acting beta-2 agonist/long-acting antimuscarinic agent,LABA/LAMA)和吸入皮质类固醇(Inhaled corticosteroid,ICS)/LABA单吸入器的依从性及对COPD急性加重的影响。方法选择2019月7月至2022年7月就诊于中国医科大学附属盛京医院的首次接受LABA/LAMA或ICS/LABA治疗的COPD患者为研究对象,采用倾向性评分对两组患者基线特征进行平衡,比较两组患者药物治疗后12个月的依从性、首次中重度COPD急性加重的情况以及升级至ICS/LABA/LAMA治疗的情况。结果共纳入275例符合条件的患者,LABA/LAMA组105例,ICS/LABA组170例。倾向性评分后两组患者基线资料均达到平衡(P>0.05)。治疗12个月后,LABA/LAMA组患者依从性显著高于ICS/LABA组(HR=1.897,95%CI:1.130~3.186,P=0.019)。与ICS/LABA组相比,接受LABA/LAMA组患者中重度急性加重率更低(HR=0.510,95%CI:0.321~0.835,P=0.007),需要ICS/LABA/LAMA治疗更少(HR=0.455,95%CI:0.232~0.890,P=0.021)。结论与首次开始应用ICS/LABA的患者相比,接受LABA/LAMA治疗的COPD患者用药依从性更高,中重度急性加重风险更低。

Objective To investigate the effects of first-time use of single-inhaler therapy with long-acting beta-2 agonist/long-acting antimuscarinic agent(LABA/LAMA)and inhaled corticosteroids(ICS)/LABA on adherence and exacerbations in patients with chronic obstructive pulmonary disease(COPD).Methods The COPD patients who received LABA/LAMA or ICS/LABA for the first time from July 2019 to July 2022 in Shengjing Hospital of China Medical University were selected.The baseline characteristics of the two groups were balanced by propensity scoring,and the adherence of the two groups at 12 months after drug treatment,the first acute exacerbation of moderate to severe COPD,and the upgrade to ICS/LABA/LAMA therapy were compared.Results A total of 275 patients were included,105 in the LABA/LAMA group and 170 in the ICS/LABA group.After the propensity scoring,the baseline data of the two groups reached equilibrium(P>0.05).After 12 months of treatment,the adherence in LABA/LAMA group was significantly higher than that in ICS/LABA group(HR=1.897,95%CI:1.130~3.186,P=0.019).Patients in the LABA/LAMA group had a lower rate of moderate to severe acute exacerbations than those in the ICS/LABA group(HR=0.510,95%CI:0.321~0.835,P=0.007)and need fewer ICS/LABA/LAMA treatments(HR=0.455,95%CI:0.232~0.890,P=0.021).Conclusion COPD patients treated with LABA/LAMA have higher medication adherence and a lower risk of moderate to severe exacerbations than those with initial treatment of ICS/LABA.