Investigation On The Causes Of Inhaled Drug Therapy For COPD Patients And Analysis Of Factors Related To Admission Frequency In One Year In A Tertiary Hospital In Yancheng

Part One:Pulmonary function examination of chronic bronchitis,obstructive emphysema and COPD inhaled drug therapy in stable stage and its influencing factorsPurpose:To study the status of pulmonary function examination in patients with acute exacerbation of chronic bronchitis and obstructive emphysema,and to analyze the influencing factors of inhaled drug therapy in patients with chronic obstructive pulmonary disease(COPD).Method:To collect the clinical data of patients with acute exacerbation of chronic bronchitis and obstructive emphysema hospitalized in Grade 3A Hospital of Yancheng Jiangsu Province from January 2016 to December 2017.The status of pulmonary function examination and its influencing factors were analyzed.The questionnaire was used to select COPD patients discharged from hospital during the period.To understand the current status of inhaled drug therapy during stable period.The database was established by SPSS21.0 and Excel software.Statistical analysis.Single factor analysis was used by x2 analysis(Fisher test was used for those who did not accord with x2 condition,and Logistic regression analysis was used for multivariate analysis.Result:A total of 1332 inpatients were screened,49 of whom were diagnosed as COPD.Inpatient period,All patients have received repeated medical education.The 49 patients completed questionnaire survey.49 discharged patients inhaled drug treatment status:6 patients have been regularly used after discharge,and 37 patients stopped using drugs after discharge.The main factors affecting inhalation therapy include:not knowing that inhaled drugs should be used for a long time in 1 Analysis of factors related to the frequency of acute exacerbation of admission to COPD patients within one year6 cases,fear side effects of drugs and adverse reactions(pharynx discomfort,10 cases of oral fungal infection.After continuous inhalation for a period of time,the symptom control was not ideal and the drug was not effective in 28 cases(57.1%).In 14 cases with no symptoms and no need to take medicine regularly,the operation was troublesome,and 12 cases(25.0%)could not fully master the correct use method of the inhaled drug device.The cost of inhaled drugs was high in 37 cases(75.6%),inconvenient drug purchase in 37 cases(75.6%),non-reimbursement of drugs in outpatient clinics(38 cases)or inpatient period(77.6%),and no need for the use of inhaled drugs in 15 cases(30.6%).ConclusionPatients with acute exacerbation of chronic bronchitis and obstructive emphysema are at high risk of examination and medical education due to inadequate medical staff.The low rate of pulmonary function examination and the low compliance of inhaled drugs in COPD patients during stable period were related to insufficient medical education,side effects and adverse reactions of fear drugs,poor economic conditions and so on.Part Two:Analysis of factors related to the frequency of acute exacerbation of admission to COPD patients within one yearPurpose:The acute exacerbations of COPD patients were divided into three groups:one episode within one year,two exacerbations within one year,and more than two occurrences within one year.The differences between the three groups were compared between the basic data of patients and the indicators of routine blood test.Furthermore,factors affecting acute exacerbation in patients with different characteristics of COPD were also evaluated.Methods:Sample SourcesFrom January 2016 to December 2016,the clinical diagnosis of respiratory inpatients were COPD acute exacerbation in Grade 3 A Hospital of Yancheng Jiangsu Province;The criteria for enrollment were as follows:1)Patients with pulmonary function tests,according to pulmonary function results,consistent with chronic obstructive pulmonary disease Diagnostic criteria for disease;2)Patients with no pulmonary function tests required several conditions,such as:a.Male,age>65 years,long-term smoking;b.Cough,cough,or asthma,lasting 3 months per year for more than two consecutive years;c.Imaging data suggest emphysema or pulmonary bullae;3)patients with respiratory symptoms worsen beyond the daily variation range,and need to change the drug treatment plan;4)and follow-up after discharge for more than 1 year.Exclusion criteria:(1)combined with lung cancer;(2)with asthma;(3)combined with expansion;(4)with tuberculosis;(5)with interstitial lung disease;(6)with severe heart,brain,kidney,vascular disease,tumor,blood system and immune system diseases or other serious physical illnesses.General information about patients(Eosinophil percentage,hemoglobin,prealbumin,albumin,creatinine,annual household income)were collected and the number of hospitalizations due to acute exacerbations was followed up within one year.All included patients and their families were informed and informed consent was obtained.Statistical AnalysisAccording to the collected basic data of patients and the routine blood test indicators,different expression methods were adopted according to the continuous variables and classification variables.The continuity variable was tested according to the normality of data distribution and the homogeneity of variance.The expressions of the continuity variable included mean(standard deviation),median(quartile spacing),maximum and minimum.Variance analysis or nonparametric rank sum test were used for comparison of baseline data and routine blood test indicators between groups.Categorical variables were expressed in terms of number of occurrence(percentage),and chi-square test was used to compare the normal medication after discharge between different groups.Univariate and multivariate Logistic regression were used to explore the risk factors affecting the frequency of acute exacerbation in COPD patients.The test level was bidirectional and<0.05 was considered significant.All statistical analyses in this study were performed using SPSS 19.0 software.ResultsUnivariate logistic regression indicated age(OR:0.940;95%Cl:0.9040.978;P=0.0024),albumin(OR:0.826;95%Cl:0.753 0.907;P<0.0001),creatinine(OR:1.069;95%CI:1.049 1.089;(OR:1312.601;95%CI:100.888 17077.57;P<0.0001),and hemoglobin(OR:0.918;95%CI:0.896 0.940;All were significantly associated with the frequency of acute exacerbation in COPD patients.The results of multivariate analysis indicated that increase in age(OR:0.939;95%CI:0.902 0.977;P=0.0021),increased albumin level(OR:0.818;95%CI:0.725 0.923;P=0.0011),increased hemoglobin level(OR:0.917;95%CI:0.896 0.940;P<0.0001)was significantly associated with a lower frequency of acute exacerbation of COPD.In contrast,creatinine levels reduce(OR:1.069;95%CI:1.049 1.089;(OR:1379.036;95%CI:105.494 18026.94;P<0.0001)can significantly increase the frequency of acute exacerbation of COPD.However,there was no significant association between the patient’s income level and the frequency of acute exacerbations in COPD patients.For male COPD patients over 75 years old,univariate logistic regression indicated whether it was normal to creatinine(OR:1.049;95%CI:1.025-1.074);(OR:1104.352:95%CI:27.197 44843.08;P=0.0002),and hemoglobin(OR:0.877;95%CI:0.839-0.916;P<0.0001)had significant effects on the frequency of acute exacerbation in COPD patients.Multivariate logistic regression results indicated creatinine(O^R:1.049;95%CI:1.023 1.075;P=0.0001),eosinophil(OR:1227.470;95%CI:29.60250898.69;P=0.0002),and hemoglobin(OR:0.876;95%CI:0.839 0.915;There was a significant association between P<0.0001)and the frequency of acute exacerbation in COPD patients.For patients with COPD younger than 75 years old,univariate logistic regression indicated albumin(OR:0.853;95%CI:0.747 0.975;P=0.0194),creatinine(OR:1.101;95%CI:1.066 1.137;(OR:2186.962;95%CI:47.269 101183.6;P<0.0001),and hemoglobin(OR:0.945;95%CI:0.916 0.975;P=0.0004)was significantly associated with the frequency of acute exacerbation in COPD patients.MultipIe logistic regression results indicated creatinine(OR:1.101;95%CI:1.065 1.137;(OR:2272.750:95%CI:46.505111071.6;P<0.0001),and hemoglobin level(OR:0.945;95%Cl:0.916 0.975;The association between P=0.0004)and the frequency of acute exacerbation in COPD patients was statistically significant.For male COPD patients with an annual income of more than 5.0 million yuan,univariate logistic regression indicated albumin(OR:0.877;95%CI:0.7760.992;P=0.0363),creatinine(OR:1.053;95%CI:1.030 1.077;(OR:688.041;95%CI:28.523 16596,89;P<0.0001),and hemoglobin(OR:0.923;95%Cl:0.895 0.952;There was a significant association between P<0.001)and the frequency of acute exacerbation in COPD patients.Multivariate logistic regression results found creatinine(OR:1.055;95%Cl:1.031 1.079;(P<0.0001),eosinophil(OR:446.530;95%CI:17.37211477.32;P=0.0002),and hemoglobin(OR:0.925;95%CI:0.897 0.954;There was a significant association between P<0.001)and the frequency of acute exacerbation in COPD patients.For male COPD patients with an annual income of less than 50,000 yuan,univariate logistic regression indicated age(OR:0.883;95%CI:0.819 0.952;P=0.0012),albumin(OR:0.750;95%CI:0.641 0.878;P=0.0003),creatinine(OR:1.095;95%CI:1.0581.133;(OR:10869.49;95%CI:118.949 993247.2;P<0.0001),and hemoglobin(OR:0.907;95%CI:0.871 0.943;There was a significant association between P<0.001)and the frequency of acute exacerbation in COPD patients.Multivariate logistic regression results found age(OR:0.886;95%CI:0.822 0.956;P=0.0018),albumin(OR:0.725;95%CI:0.608 0.865;P=0.0003),creatinine(OR:1.096;95%CI:1.059 1.135;(OR:11236.54;95%CI:119.633-1055390;P<0.0001),and hemoglobin(OR:0.904;95%CI:0.868 0.942;There was a significant association between P<0.0001)and the frequency of acute exacerbation in COPD patients.ConclusionsAfter discharge,there was significant correlation between normal medication,increased age,increased albumin,increased hemoglobin level and lower frequency of acute exacerbation of COPD.There was significant correlation between reduce of creatinine level and the increase of eosinophil and the increased frequency of acute exacerbation in patients with COPD.The association between patients’ income level,prealbumin level,and the frequency of acute exacerbations in COPD patients was statistically significant.There was a significant correlation between creatinine,eosinophil,and hemoglobin after discharge and the frequency of acute exacerbation in COPD patients over 75 years old;The association between creatinine,eosinophil,and hemoglobin levels after discharge and the frequency of acute exacerbation in men under 75 years of age was statistically significant.There was a significant correlation between creatinine,eosinophil,and hemoglobin after discharge and the frequency of acute exacerbation in COPD patients with an annual income of more than rmb50,000;After discharge,there was a significant correlation between age,albumin,creatinine,eosinophil,and hemoglobin,and the frequency of acute exacerbation in COPD patients with an annual income of less than rmb50,000.