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首页> 外文期刊>Journal of managed care pharmacy : >Chronic obstructive pulmonary disease: prevalence, characteristics, and pharmacologic treatment in nursing home residents with cognitive impairment.
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Chronic obstructive pulmonary disease: prevalence, characteristics, and pharmacologic treatment in nursing home residents with cognitive impairment.

机译：慢性阻塞性肺疾病：患有认知障碍的疗养院居民的患病率，特征和药物治疗。

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Chronic obstructive pulmonary disease (COPD) is prevalent in nursing home residents. National and international guidelines exist for management of COPD; however, little is known about "real-world" management of COPD in this population. Nursing home patients with significant cognitive impairment may have difficulty utilizing handheld device (HHD) formulations of respiratory medications and may be clinically appropriate candidates for nebulized therapy.To determine (a) the prevalence, clinical characteristics, and treatment of patients with a diagnosis of "emphysema/COPD" per Minimum Data Set (MDS) version 2.0 records in U.S. nursing homes and (b) the relationship of nebulized versus HHD formulations of medication to prevalence of shortness of breath in a cohort of cognitively impaired nursing home residents.In a descriptive, retrospective analysis of a large data repository of skilled nursing home residents with COPD, prescription claims and MDS data from October 1, 2009, through September 30, 2010, were extracted, linked, and de-identified. Measures included medications, diagnoses, and selected outcome parameters from the MDS. Cognitive impairment was defined as a score of 3-6 on the Cognitive Performance Scale derived from MDS records. A proxy of ≤ 14-day courses of respiratory antibiotics, oral corticosteroids, or both was used to identify COPD exacerbations. Shortness of breath (SOB) in the last 7 days was captured from Section J1.l. of the MDS.The total number of unique patients with at least 1 MDS record during the study period was 126,121. Of those, 27,106 (21.5%) had COPD. The prevalence rates of diagnoses concurrent with COPD were as follows: asthma = 8.6%, Alzheimer's disease or other dementia = 37.2%, congestive heart failure = 37.5%, anxiety disorder = 23%, depression = 50.1%, pneumonia = 21.2%, and respiratory infection = 9%. 58% of patients with COPD were white females aged 75 years or older. According to the MDS, 62% of COPD patients had a short-term memory problem, while 43.3% of patients had moderately or severely impaired cognitive skills for daily decision making. 83% of COPD patients with pharmacy claims (17,395/27,106) received at least 1 medication used to treat COPD; 9,711 (17.1%) received no respiratory medications. Use of beta-agonists (53.9%), anticholinergic medications (41.2%), long-acting beta-agonist/corticosteroid (LABA/ICS) combinations (28%) in HHD, and nebulized beta-agonist/anticholinergic combinations (26.6%) was prevalent. Inhaled LABA/ICS and long-acting anticholinergic therapy was received by 28% and 22% residents, respectively. 22% (n = 5,085) of patients exhibited at least 2 exacerbations of COPD, and 33% were noted to have SOB. Monotherapy with short-acting beta-agonists (SABA) was evident in 48.7% of cognitively impaired COPD patients. SOB within the previous 7 days was noted in 39.1% of cognitively impaired COPD patients treated with nebulized SABA monotherapy. 38% of these patients exhibited 2 or more COPD exacerbations, and 57.9% were hospitalized at least once during the 12-month period. LABA monotherapy or combined LABA/SABA use represented ≤ 1% of beta-agonist use for unique COPD patients with cognitive impairment.In this retrospective analysis of administrative data, 21.5% of nursing home residents had a diagnosis of COPD, and 17% of these residents received no respiratory medications. These residents had significant cognitive and functional impairment and concurrent diagnoses. 22% of residents experienced at least 2 exacerbations of COPD during the 12 months of study. As many as 60% were not receiving inhaled LABA/ICS or inhaled tiotropium, and 33% exhibited SOB. There is significant use of nebulized SABA monotherapy, which may be contributing to SOB and exacerbations or hospitalizations in nursing home residents with COPD.
机译：慢性阻塞性肺疾病（COPD）在养老院居民中普遍存在。存在关于COPD管理的国家和国际准则;然而，对于这种人群的COPD“现实”管理知之甚少。患有严重认知障碍的疗养院患者可能难以使用呼吸道药物的手持设备（HHD）配方，并且可能是临床上适合雾化治疗的候选人。为了确定（a）诊断为“肺气肿/ COPD”在美国养老院中的最低数据集（MDS）版本2.0记录，以及（b）一组认知障碍的养老院居民中雾化与HHD药物配方与呼吸急促患病率之间的关系。提取，链接和取消标识自2009年10月1日至2010年9月30日的具有COPD，处方索赔和MDS数据的熟练护理院居民的大型数据库的回顾性分析。措施包括药物，诊断和MDS中选定的结果参数。认知障碍定义为根据MDS记录得出的认知表现量表的3-6分。 ≤14天疗程的呼吸道抗生素，口服皮质类固醇或两者同时使用，可用于确定COPD恶化。从第J1.1节中捕获了最近7天的呼吸急促（SOB）。在研究期间，至少有1个MDS记录的独特患者总数为126121。在这些患者中，有27,106名（21.5％）患有COPD。合并COPD的诊断患病率如下：哮喘= 8.6％，阿尔茨海默氏病或​​其他痴呆= 37.2％，充血性心力衰竭= 37.5％，焦虑症= 23％，抑郁症= 50.1％，肺炎= 21.2％，呼吸道感染= 9％。 58％的COPD患者是75岁以上的白人女性。根据MDS，62％的COPD患者存在短期记忆问题，而43.3％的患者的日常决策认知能力中度或重度受损。有药理要求的COPD患者中有83％（17,395 / 27,106）至少接受了一种用于治疗COPD的药物; 9,711（17.1％）没有接受呼吸道药物治疗。在HHD中使用β-激动剂（53.9％），抗胆碱能药物（41.2％），长效β-激动剂/皮质类固醇（LABA / ICS）组合（28％）和雾化的β-激动剂/抗胆碱能组合（26.6％）很普遍。分别有28％和22％的居民接受了吸入LABA / ICS和长效抗胆碱能治疗。 22％（n = 5,085）的患者表现出COPD恶化至少2次，而33％的患者患有SOB。在48.7％的认知障碍COPD患者中，短效β受体激动剂（SABA）的单药治疗明显。使用雾化SABA单一疗法治疗的认知障碍COPD患者中，有39.1％的患者在过去7天内发现了SOB。这些患者中有38％表现出2次或更多次COPD加重，并且57.9％的患者在12个月内至少住院了一次。 LABA单药治疗或LABA / SABA联合使用占单独的认知功能障碍COPD患者的β-激动剂的比例≤1％。在对行政数据的回顾性分析中，有21.5％的疗养院居民诊断为COPD，其中17％居民没有接受呼吸道药物。这些居民有明显的认知和功能障碍，并发诊断。在研究的12个月中，有22％的居民经历了至少2次COPD恶化。多达60％的人没有吸入LABA / ICS或噻托溴铵，而33％的人表现出SOB。雾化的SABA单一疗法的大量使用，可能会导致SOB以及COPD疗养院居民的病情恶化或住院。

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