Drug Utilization Research For Patients Hospitalized For Acute Exacerbations Of Chronic Obstructive Pulmonary Disease

Background Chronic obstructive pulmonary disease（COPD）is a common respiratorycondition. It causes serious harm to the patients’ physical and mental health. Appropriatepharmacologic therapy in COPD is used to relieve symptoms, reduce the frequency andseverity of exacerbations, and improve exercise tolerance and health status. Rationalselection and use of drugs has important significance in the treatment of COPD.Objective The purpose of this research is to explore the characteristics and regulationof medication treating acute exacerbations of COPD (AECOPD). With reference to" Guidelines: global strategy for the diagnosis, management,and prevention of COPD "," Diagnosis and treatment standard of COPD" and "Clinical pathway of COPD ", drugutilization of patients hospitalized for AECOPD in a large tertiary hospital in Shanghaifrom2004to2011was analyzed. The sputum culture results of these patients were alsoexplored to promote rational use of drugs for patients hospitalized for AECOPD.Methods By a retrospective retrieval of clinical epidemiology, we collected theinformation of patients hospitalized in a large tertiary hospital in Shanghai from January2004to December2011to establish Oracle database based on hospital information system.Patients were included in our analysis if they were40years of age and older, had aprincipal diagnosis of AECOPD. Patients were excluded if they had a secondary diagnosisof pneumonia. Variety, cost, mode of administration, consumption, use density of commondrugs for AECOPD were analyzed by Excel2003and SPAW18. Four common classes ofmedications in our research were bronchodilators, corticosteroids, systemic antimicrobialagents, mucolytics. The relationship between systemic antimicrobial agents and sputumculture results was also discussed.Results (1) The usage rates of four classes of AECOPD medications were high.Systemic antimicrobial agents accounted for the largest proportion of the drug costs. Butthis proportion declined from2004to2011. The proportions of other three types ofAECOPD drugs increased. In particular, mucolytics increased significantly. Drug usedensity of mucolytics also increased dramatically.(2) The usage rates of three types ofbronchodilators were similar. Doxofylline injection was used widely as a kind of xanthinedrugs.(3) Systemic application was still a main mode of administration for glucocorticoidfrom2004to2011. But the usage of its inhalation mode increased. Budesonide inhalation became an important treatment mode of treatment.(4)β2-adrenergic agonists andglucocorticoids compound preparations salmeterol and fluticasone propionate inhalationpowder became an important variety of AECOPD drugs.(5)High-dose use of ambroxolinjection was the primary means of mucolytics application recently.(6) Fluoroquinolonesand third-generation cephalosporins were the primary classes of systemic antibacterialsapplication. The usages of third-generation cephalosporins and carbapenems increased, butthe usage of second generation cephalosporins decreased. Fluconazole injection was takenas an kind of fundamental antifungals.(7)Sputum culture results indicated detection ratesof Gram-negative pathogens were much larger than Gram-positive pathogens. Thedetection rates of Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonasmaltophilia increased in Gram-negative bacterias. The detection rates of Candida glabrata,Aspergillus fumigatus, Penicillium increased in fungus.Conclusion (1) From2004to2011, there were some apparent changes in variety, useintensity, the mode of drug application for AECOPD medications. It is suggested weshould give full consideration to safety, effectiveness, and economy in the selection andapplication of AECOPD medications.(2) The choice of antimicrobial agents wasconsistent with the shift of pathogens discovered discovered in sputum culture. But theproportion of bacterial resistance was increasing.(3) The hospital should take rational useof antimicrobial agents and mucolytics as a focus in controlling drug expenditure ofpatients hospitalized for AECOPD.