探討慢性阻塞性肺病病患使用「鎮咳祛痰藥理類」藥品之用藥型態與急診就醫之相關性

Investigation of the Drug Use Pattern of the 「Pharmacology Category of Antitussive and Expectorant Drugs」 in Chronic Obstructive Pulmonary Disease patients associated with Emergence Visit

陳怡璇(Yi-Shyuan Chen)

指導教授 ： 詹道明

高雄醫學大學/藥學院/藥學研究所碩士在職專班/碩士(2006年)

https://doi.org/10.6832/KMU.2006.00118

摘要

本研究針對慢性阻塞性肺疾病（COPD）病患及非COPD病患，因併發肺炎急診就醫之原因，評估是否因鎮咳劑、鎮咳祛痰劑、祛痰劑的用藥差異性所引起。相關研究以某家醫院92至94年健保申報資料庫及SPSS統計軟體進行分析。
門診研究對象主要係ICD-9-CM為單純496者的COPD病患，取樣以對照研究法(case match)分為三個實驗組及一個控制組，實驗組使用「鎮咳祛痰藥理類」藥品，控制組則未使用，並且以非COPD病患做進一步對照分析比較。而急診研究資料則以ICD-9-CM為480至486之肺炎病患。
實驗組為COPD病患之鎮咳劑組、鎮咳袪痰劑組及袪痰劑組，控制組為COPD病患且未使用上述三種藥品，分別與急診資料配對分析，經由檢視審查方式(spss files review)，以門診研究對象取得「鎮咳祛痰藥理類」藥品後一個月內，因肺炎至急診就醫作為結果認定之標準，並計算其勝算比(Odds Ratio)及95 %信賴區間（Confidence Interval）。
研究結果顯示，COPD病患使用「鎮咳祛痰藥理類」藥品者，平均每年每人就醫5.29次。實驗組使用鎮咳劑與控制組比較急診就醫之勝算比（OR）為0.36（95 % CI，0.07至1.8）；使用鎮咳袪痰劑組為1.34（95 % CI，0.44至4.01）；使用袪痰劑組為1（95 % CI，0.31至3.19）。另外，COPD病患鎮咳袪痰劑組與袪痰劑組比較急診就醫之勝算比為1.34（95 % CI，0.44至4.01）。而非COPD病患使用「鎮咳祛痰藥理類」藥品者，平均每年每人就醫2.56次。非COPD病患使用鎮咳劑組並無急診就醫紀錄；使用鎮咳袪痰劑組與非COPD控制組比較急診就醫之勝算比為2.01（95 % CI，0.18至22.42）；使用袪痰劑組為8.24（95 % CI，1.01至67.36）。
結果在沒有使用任何「鎮咳祛痰藥理類」藥品情況下，與非COPD病患比較，COPD病患有較高併發肺炎至急診就醫之危險性。而COPD病患投予鎮咳劑者，有較低的併發肺炎急診就醫發生率，因此推測COPD病患咳嗽無痰液者可投予鎮咳劑。但COPD病患服用鎮咳袪痰劑者與使用袪痰劑者比較，則有較高併發肺炎急診就醫的發生率，故推測COPD病患咳嗽有痰液者應捨棄投予鎮咳袪痰劑，單獨投予袪痰劑即可。同樣情況，非COPD病患單獨投予袪痰劑者併發肺炎至急診就醫的發生率比服用鎮咳袪痰劑者高，由此推測當病患咳嗽有痰液時，對COPD病患和非COPD病患的治療方式應不同。另外，COPD病患不論有無服用袪痰劑，都不影響併發肺炎急診就醫發生率，所以推測袪痰劑可為COPD病患的症狀治療。

關鍵字

慢性阻塞性肺病 ； 鎮咳劑 ； 肺炎 ； 用藥型態

並列摘要

This research, was to investigate the consequences of Chronic Obstructive Pulmonary Disease (COPD) Patient and Non-COPD patients, who suffered pneumonia that visit Emergency Room (ER) for further treatment, that resulted from using anti-cough, mucolytic drug and/or the combination of these two medications. Relevant research database were collected from a southern medication center from 2003 to 2005 and used SPSS version 13.0 for windows to complete the statistical work of analysis.
The research objects were COPD patients with the diagnosis code, ICD-9-CM 496. This comparative study (case-match study) used three experiment groups and one control group, experiment groups using the pharmacological group of all anti-cough and mucolytic medications whereas the control group did not use such medicines. Moreover, the patients who were not suffering from COPD were also used as comparative group for further evaluation. Pneumonia patient having a diagnosis code of ICD-9-CM as 480 to 486 from the ER were studied as a consequence.
The three experiment groups, in which the patients were using the anti-cough medications and the patients were using the mucolytics and the last group were using the combination of these two medications respectively. Control group was COPD patients and not used the three kinds of above-mentioned medications. Matching and analysis with the emergency cases were performed via studying over the Spss files. The ER pneumonia cases were accepted if the study object had taken the medication within the previous month. The consequences were measured using the Odds Ratio and its 95 % Confidence Interval.
The result showed that the COPD patients, with the use of such medications, having an outpatient clinic visit for 5.29 times each person every year. The experiment group using anti-cough medications had an OR=0.36 (95 % CI, 0.07 to 1.8) in comparison with the control group; whereas with the use of combinations OR=1.34 (95 % CI, 0.44 to 4.01); whereas with the use of mucolytics OR=1 (95 % CI, 0.31 to 3.19). In addition, in comparison with the use of conbinations to the mucolytic group, an OR=1.34 (95 % CI, 0.44 to 4.01) was found.
For the non-COPD group, with the use of such medications, had an outpatient clinic visit for 2.56 times each person every year. There was no ER visit noted for the non-COPD patient with the use of the anti-cough medications. For the experimental group with the combinations had an OR=2.01 (95 % CI, 0.18 to 22.42) as compared with the non-COPD control group; whereas, an OR=8.24 (95 % CI, 1.01 to 67.36) for the mucolytics.
As a result, the COPD group, who did not take any kind of such medications, had a higher risk for ER visit with pneumonia than the Non-COPD group. For the COPD patients who have taken anti-cough medication had a lower risk for ER visit because of pneumonia such that the anti-cough medication is appropriate for the patient without sputum. In comparison with the use of the combinations and the use of mucolytics only, the former had a high risk for the ER visit. Therefore, mucolytics is suggested for the COPD patients that have both the symptoms of cough and sputum. In conclusion, the treatment for the Non-COPD patient is different from the COPD patients. Besides, for the COPD patients with or without the use of mucolytics did not infer the ER visit of pneumonia; therefore, the mucolytics could be safe and a drug of choice for the COPD patients.

並列關鍵字

Chronic obstructive pulmonary disease ； Antitussive ； pneumonia ； Drug Use Pattern

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