接受長效型吸入劑藥物治療慢性阻塞性肺病病人之成效分析

Analysis of efficacy of treatment with long active inhaled combination agents in chronic obstructive pulmonary disease patients

侯堅(hou chine)

指導教授 ： 劉見祥 ； 葉玲玲

亞洲大學/健康學院/健康產業管理學系健康管理組/碩士(2010年)

摘要

慢性阻塞性肺病是引起呼吸道之慢性發炎，且疾病的進展是緩慢發展而造成氣道阻塞，使之造成的肺臟及肺功能逐漸惡化，且傷害大多是不可逆性。在先進國家中，慢性阻塞性肺病在死亡原因中的第四位，根據世界衛生組織於1990年預估，2020年它將會成為人類死亡原因第三位。台灣40歲以上成人，平均每六人就有一人罹患中重度的慢性阻塞性肺病，盛行率達16%。由於慢性阻塞性肺病患者數眾多、其死亡率高，治療慢性阻塞性肺病健保每年花費約13億元，造成社會經濟負擔，盛行率及耗用的醫療資源都逐年上升，現已成為一個重要的公共衛生問題。根據2007年慢性阻塞性肺病診治指引，依嚴重度逐漸增加治療(step-up) 之策略，將疾病嚴重度分成四級，依據不同的病情變化給予適當之藥物治療；近年來，以長效型吸入劑藥物 用來治療COPD為主流。故，藉此瞭解使用口服藥物與使用長效型吸劑之病人兩者做比較，是否因肺功能障礙而減緩肺功能衰退，進而增加門診使用次數、急診使用次數、延長住院天數。
本研究收案時間為已以收集2008年09月至2009年08月，共十二個月之門診慢性阻塞性肺病病人，並排除標準為氣喘病患和死亡病人。以接受長效型吸入劑治療與使用口服藥物之對照組病患兩組，比較疾病嚴重度輕度、中度、重度、極重度、肺活量 FEV1（用力呼氣一秒量）百分比之差異，對醫療利用累積住院日數、急診次數、急性發作之影響。統計部分採用 SPSS 12.0 版套裝軟體，以描述性、推論性分析及強迫進入複迴歸分析預測變項進行分析。
研究結果顯示，使用吸劑病人中在用藥前後肺功能之差異裡，比使用口服藥病人較佳。在使用口服藥控制COPD之個案中，其疾病嚴重度為極重度個案中會影響累積住院日數情況；故，其功能較差者日常生活活動受限，其住院天數就愈多天。由此可見使用長效型吸入劑病人，當提升會提高肺功能指標，對於 COPD疾病的控制是有利的，並帶給病人生活品質。有效的疾病管理會降低COPD病人再住院率，並提升醫療品質，以獲得更大成效。

關鍵字

慢性阻塞性肺病 ； 疾病嚴重度 ； 肺活量 ； 長效型吸入劑 ； 醫療利用

並列摘要

Chronic Obstruction Pulmonary Disease (i.e. COPD) is a preventable and treatable disease with some significant extra-pulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterised by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases. The World Health Organization predicts COPD to be the top three diseases in Year 2020.Adult over 40 years of age， the prevalence rate was 16% and the average one in six people suffered from moderate to severe COPD. The health insurance costs about 1.3 billion per year and resulting in increase socio-economic burden、consumption of medical resources year by year , and also has become an important public health problem in Taiwan. According to the 2007 Taiwan GOLD guidelines ,
treatment of COPD is based on disease severity and to step-up strategy.
This study collected from September 2008 to August 2009 , a total of 12 months of outpatients with chronic obstructive pulmonary disease and exclusion criteria for the asthma patient and the patient died.SPSS 12.0 statistical software and using descriptive, inferential analysis and prediction of forced entry multiple regression analysis . We analyzed efficacy of treatment with long-acting inhaled combination in chronic obstructive pulmonary disease patient and compared disease severity stage(GOLD stage) and FEV1 ( forced expiratory volume one second). We also focused on the effects of medical utilization patterns (reduction in out-patients、lower general ward admission and intensive care unit admission、decrease acute exacerbations、visit emergency room), and that whether health care costs decrease or not.
The research outcome shown as follows: (1).The efficacy of long-acting inhaled combination agents in patients with chronic obstructive pulmonary disease is well documented .(2)In inhaled group，lung function is better than oral medication group.(3)In inhaled group
, reduction in medical utilization patterns (out-patients、general ward admission and intensive care unit admission、acute exacerbations rate、emergency room）.Based on the higher COPD prevalence rate and medical consumption , appropriate treatment can have an important impact on many facets of the disease.
This study provides the evidence of reducing the health care expenditure by treat with long-acting inhaled combination agents .It will improve the lung function in chronic obstructive pulmonary disease patient and quality of life. Effective disease management will reduce the re-hospitalization rate .With more understandings of factors affecting medical utilization patterns, we can improve the health care delivery and reduce health insurance payment in the future.

並列關鍵字

COPD ； disease severity ； FEV1 ； medical utilization patterns

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