General Situation Of Diagnosis And Treatment Of Stable Chronic Obstructive Pulmonary Disease In Changchun

Objective:Through investigating the general situation of diagnosis and treatment of stable chronic obstructive pulmonary disease(COPD)in Changchun,to understand the general situation of patients,and to explore the risk factors of the occurrence of acute exacerbation of stable COPD patients.At the same time,to further understand the use situation of COPD drugs,medication compliance for patients and economic burden related to COPD,and to provide useful guidance for the prevention and treatment of COPD in Changchun.Methods:400 patients with COPD in the stable stage who were treated the clinics of secondary hospitals(four)and tertiary hospitals(four)in Changchun were randomly included from March 2018 to March 2019.All enrolled patients met the inclusion and exclusion criteria set by this study.Each patient signed the informed consent form before the survey.Through the questionnaire of investigation,the clinical information of patients with COPD in the stable stage was collected: general data,drug use situation and economic burden in the past 1 year.Finally,data entry,sorting,and statistical analysis were performed uniformly.Results:1.Among the 400 patients with COPD in the stable stage who met the inclusion criteria,except for cases where some patients could not complete all the questions on the questionnaire due to personal reasons or uncertain reasons.In fact,306 patients provided a complete questionnaire for general data.Among them,there were 174males(56.86%)and 132 females(43.14%),the age was(67.08 ± 11.41)years old,and the BMI was(22.93 ± 4.09).229 people(74.84%)had a junior high school orbelow education degrees.Among 224 people(73.20%),there was at least one comorbidity patient.Among them,the first two comorbidities were 120 cases(39.22%)of ischemic heart disease and 84 cases(27.45%)of hypertension;in the past year,there were 3 patients(0.98%)each influenza and pneumococcal vaccines.There were 141 people(46.08%)with acute exacerbation and 165 people(53.92%)without acute exacerbation.2.For the comparison of general data of patients with COPD with or without acute exacerbation group,the differences were statistically significant in age,education,smoking history,disease course of COPD,number of comorbidities,and combined with ischemic heart disease aspects(P < 0.05);Logistic regression analysis showed that education,disease course of COPD,and combined with ischemic heart disease were the main risk factors that affected acute exacerbation.3.The CAT score was positively related to the number of acute exacerbation.4.A total of 329 patients with COPD in the stable stage provided a complete questionnaire on drug use situation and financial burden(average monthly medical expenses related to diagnosis and treatment of COPD)in the past 1 year.214 people(65.05%)used inhaled bronchodilators for treatment,and 213 people(64.74%)received inhaled corticosteroids or drugs containing corticosteroids for treatment;Of the two most commonly used drugs,149 people(69.63%)and 169 people(79.34%)each completed the questionnaire on whether to take medication regularly.Among them,20 people(13.42%)regularly used inhaled bronchodilators for treatment in the past 1 year,and 19 people(11.24%)regularly used inhaled corticosteroids or drugs containing corticosteroids for treatment.5.According to 2020 GOLD recommendations,329 patients with COPD in the stable stage were divided into four groups: A(27),B(190),C(2)and D(110).Among them,the number of group C was smaller,and its analysis was ignored.The two most commonly used drugs in each group were respectively inhaled bronchodilators and inhaled corticosteroids or drugs containing corticosteroids;9people(33.33%),62 people(32.63%),and 41 people(37.27%)in groups A,B,and D,respectively used oral corticosteroids;5 people(18.52%),57 people(30%),and56 people(50.91%)in the three groups used theophylline;in the untreated category,there were 14 people(51.85%)and 57 people(30%)in group A and group B and 3people(2.73%)in group D.From group A to group D,the proportion of people with average monthly medical expenses of more than 500 and 1,000 yuan for COPD diagnosis and treatment gradually increased.Conclusion:1.Age,education,smoking history,disease course of COPD,number of comorbidities,and combined with ischemic heart disease are risk factors suffering from acute exacerbation for patients with stable COPD in Changchun.Among them,education,disease course of COPD,and combined with ischemic heart disease are independent risk factors;2.The CAT score is positively related to the number of acute exacerbation,which means that CAT can be used as a helpful tool to predict the change of the condition for patients with COPD and become a beneficial clinical preventive intervention measure;3.The influenza and pneumococcal vaccination rates for patients with COPD in Changchun are low,the medication adherence with inhaled drugs is poor,the use of some drugs is not standardized,and cognitive importance degrees for patients with COPD is low;4.In terms of patients,the main sources of economic burden associated with COPD are acute exacerbation and increased the number of hospitalization.