A simple rule to identify patients with chronic obstructive pulmonary disease who may need treatment reevaluation

作者：Sharafkhaneh Amir^*; Altan Aylin E; Colice Gene L; Hanania Nicola A; Donohue James F; Kurlander Jonathan L; Rodriguez Roisin Roberto; Altman Pablo R

来源：Respiratory Medicine, 2014, 108(9): 1310-1320.

DOI：10.1016/j.rmed.2014.07.002

• COPD
• Exacerbation
• SABA
• Maintenance therapy

Background: A simple rule based on short-acting inhaled beta(2)-agonist (SABA) use could identify patients with chronic obstructive pulmonary disease (COPD) at increased risk of exacerbations and signal the need for maintenance therapy change, similar to asthma %26quot;Rules of Two (R)%26quot;. %26lt;br%26gt;Methods: Associations between SABA use, COPD exacerbations, and health care costs over 1 year were examined retrospectively using de-identified patient data from the Optum Research Database (ORD; N = 56,581) and the Impact National Benchmark Database (IMPACT (TM); N = 9423). Nebulized and metered-dose inhaler (MDI) SABA doses were normalized to 2.5 mg and 90 mcg albuterol equivalents, respectively. %26lt;br%26gt;Results: The GOLD initiative establishes %26gt;= 2 exacerbations/year as indicative of increased risk in COPD. We identified a correlation (p %26lt; 0.0001) between 1.5 SABA doses/day and this frequency of exacerbations. In ORD, patients using %26gt;= 1.5 versus %26lt;1.5 SABA doses/day experienced significantly more exacerbations: 1.92 (95% confidence interval [CI], 1.89-1.96) versus 1.36 (95% CI, 1.34-1.38) per patient year (PPY). Above-threshold use was associated with higher average annual COPD-related costs (2010 $US): $21,868 (standard deviation [SD], $53,910) versus $11,686 (SD, $32,707) for nebulized SABA only, $9216 (SD, $30,710) versus $7334 (SD, $24,853) for MDI SABA only, and $15,806 (SD, $35,260) versus $11,233 (SD, $27,006) for both nebulized and MDI SABA. IMPACT (TM) validated these findings. %26lt;br%26gt;Conclusion: Patients with COPD using %26gt;= 1.5 SABA doses/day were at increased risk of exacerbations. Our results suggest a %26quot;Rule of 3-2%26quot;: SABA use %26gt;= 3 times in 2 days should be considered a clinical marker for needing treatment reevaluation.

• 出版日期2014-9