Clinical Survey on Drug Use in Patients with Chronic Obstructive Pulmonary Disease Outside the Hospital_West China Medical Journal

Authors：

WANG Ke , MIN Jie , FAN Tao , ZHONG Yunqing

Department of Traditional and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

Keywords：

慢性阻塞性肺疾病; 非准字号药物; 糖皮质激素; 真菌感染; 糖皮质激素不良反应

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【摘要】　目的　总结慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）患者院外用药情况，并分析其院外用药情况、痰真菌检出率以及激素不良反应发生率的变化。　方法　调查2011年1-6月住院的161 例COPD 患者院外用药情况，将其分为遵医嘱使用糖皮质激素组（A组，包括口服和吸入激素）、使用非准字号药物组（B组）和未使用以上两种药物组（C组），对各组的痰真菌检出率进行统计学分析，并对A、B组激素不良反应的发生率进行分析。再将现阶段的调查结果与2006年同样研究结果进行比较。　结果　 161例患者中使用口服糖皮质激素6例，使用吸入激素29例，使用非准字号药物32例，未使用以上两种药物94例。痰真菌检出率情况:B组检出率为62.5%，明显高于A组的17.14%、C组的27.66%；组间比较有统计学意义（P lt;0.001）。B组的药物不良反应发生率为37.5%；A组中口服激素发生率为50%，而使用吸入激素发生率为0%。与2006年同样研究结果比较，B组患者的比例明显下降，A组患者明显增多。　结论　使用非准字号药物的患者，真菌感染的危险性及激素不良反应的发生率较高，健康教育对于减少这些不良现象的发生发挥了重要作用。
【Abstract】　Objective　 To investigate the use of drugs in patients with chronic obstructive pulmonary disease (COPD) outside the hospital, and analyze the detection rate of fungus and the side effects of glucocorticosteroids (GCs), and their changes.　Methods　 We investigated the drugs used outside the hospital in 161 patients with stable COPD between January and June 2011, who were divided into prescribed medication GCs group (group A, including oral GCs group and inhaled GCs group), drugs without authorization by SFDA (DWAS) group (group B) and other drugs group (group C). Then we made a statistical analysis on the detection rate of fungus, and the incidence rate of the side effects of GCs in the three groups. Finally we compared the present findings with the similar studies five years ago.　Results　 Among the 161 patients, 6 took oral GCs, 29 used inhaled GCs, 32 used DWAS, and 94 used other drugs. The detection rate of fungus in group B was 62.5%, obviously higher than the other groups (17.14% in group A, and 27.66% in group B, P lt;0.05). The rate of side effects of GCs in group B was 37.5%, and 50% in oral GCs group, while no side effects of GCs was found in the inhaled GCs group. Compared with the similar study five years ago, the use of DWAS decreased, and the use of prescribed medication GCs among the patients increased significantly.　Conclusions　 Patients taking DWAS have a high incidence rate of mycotic infection and side effects of GCs. Health education plays an important role in reducing the occurrences of these undesirable phenomena.

Citation： WANG Ke,MIN Jie,FAN Tao,ZHONG Yunqing. Clinical Survey on Drug Use in Patients with Chronic Obstructive Pulmonary Disease Outside the Hospital. West China Medical Journal, 2011, 26(10): 1484-1487. doi: Copy

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1. 　Zhong N, Wang C, Yao W, et al. Prevalence of chronic obstructivepulmonary disease in China: a large, population-based survey[J]. Am J Respir Crit Care Med, 2007, 176(8): 753-760.
2. 　Brines R, Thorne M. Clinical consensus on COPD[J]. Respir Med: COPD Update, 2007, 3(2): 42-48.
3. 　贺正一. 慢性阻塞性肺疾病稳定期的治疗[J]. 现代实用医学, 2003, 15(11): 664-666.
4. 　Barr RG, Bourbeau J, Camargo CA, et al. Tiotropium for stablechronic obstructive pulmonary disease: a meta-analysis[J]. Thorax, 2006, 61(10): 854-862.
5. 　中华医学会呼吸病学会阻塞性疾病学组. 慢性阻塞性肺疾病诊治指南[J]. 中华结核和呼吸杂志, 2007, 1(30): 8-17.
6. 　Vestbo J, TORCH Study Group. The TORCH (towards a revolution in COPD health) survival study protocol[J]. Eur Respir J, 2004, 24(2): 206-210.
7. 　McGarvey LP, John M, Anderson JA, et al. TORCH Clinical Endpoint Committee Ascertainment of cause-specific mortality in COPD: operations of the TORCH Clinical Endpoint Committee[J]. Thorax, 2007, 62(5): 411-415.
8. 　Calverley PM, Anderson JA, Celli B, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease [J]. N Engl J Med, 2007, 35(6): 775-789.
9. 　于丽萍, 毕轶平. 慢性阻塞性肺疾病(COPD) 患者应用皮质类固醇激素后出现骨折或骨质疏松的风险分析[J]. 黑龙江医药科学, 2010, 33(6): 103.
10. 　闵婕, 毛兵. 慢性阻塞性肺疾病稳定期患者院外药物使用情况的调查研究[J]. 华西医学, 2008, 23(4): 745-747.
11. 　黄水平. 多个样本率间的两两比较方法[J]. 徐州医学院学报, 2002, 22(4): 291-294.
12. 　葛向旌, 陈庆锋, 乔永莉. 吸入舒利迭治疗稳定期 COPD 的临床研究[J]. 临床肺科杂志, 2010, 15(7): 937-939.
13. 　邓锐. 吸入糖皮质激素治疗稳定期 COPD疗效观察[J]. 四川医学, 2011, 32(1): 58-60.
14. 　漆波, 余巍, 罗明兴, 等. 二级甲等医院医生对COPD 诊治指南知晓度调查[J]. 西部医学, 2010, 22(12): 2363-2365.
15. 　陈莉. 影响 COPD 患者健康教育效果的病人因素分析及对策[J]. 中国社区医师·医学专业, 2011, 16(13): 273.
16. 　郑泽辉. 社区慢性呼吸系统疾病的防治策略[J]. 医学与社会, 2008, 21(12): 15-16.

West China Medical Journal

Clinical Survey on Drug Use in Patients with Chronic Obstructive Pulmonary Disease Outside the Hospital

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