慢性阻塞性肺疾病与哮喘患者因切换装置吸入性错误：重要的健康和经济问题
2016/05/31
摘要
背景：吸入装置的不同主要是使用的技术不同。在慢性阻塞性肺疾病（COPD）和哮喘患者切换装置时未经培训可能与吸入技术不佳有关，由此，可能导致治疗依从性下降和疾病控制欠佳。这一分析的目的是评估潜在的经济影响与患者切换装置时未经培训所导致的吸入性错误之间的关系。
方法：一项在COPD和哮喘患者中进行的意大利真实世界研究显示，吸入器的错误使用可导致相关的医疗资源消耗增加。特别是观察到住院率、急诊访视率、以及药物治疗（类固醇和抗生素）率明显增高。在本文的分析中，考虑意大利国家卫生服务（INHS）的视角，这些资源消费的差异均货币化表示。
结果：将假想的队列比较100例至少有一个严重的吸入错误的COPD患者，与100例吸入无误的COPD患者进行比较，发现前一组患者每年超出后者11.5例住院，13例急诊，19.5例抗生素治疗，47剂糖皮质激素治疗。用同样的方法，考察100例至少有一个严重的吸入错误的哮喘患者与100例吸入无误的哮喘患者，前者每年超出后者19例住院，26.5例急诊，4.5例抗生素治疗，21.5例糖皮质激素治疗。
这些资源消耗的差异可能与吸入错误导致INHS医疗保健支出的增加有关：对于所考查的100个病人队列来说，COPD病人每年增加44,104欧元、哮喘病人每年增加23,444欧元。
结论：这份评估凸显了由于培训不充分或者吸入药物切换不顺畅导致的吸入设备的错误使用与疾病控制的降低和医疗资源消耗和成本增加有关。
（杨冬 审校）
Int J Chron Obstruct Pulmon Dis. 2016 Mar 21;11:597-602. doi: 10.2147/COPD.S103335. eCollection 2016.
Inhalation errors due to device switch in patients with chronic obstructive pulmonary disease and asthma: critical health and economic issues.
Roggeri A1, Micheletto C2, Roggeri DP1.
Author information
Abstract
BACKGROUND:Different inhalation devices are characterized by different techniques of use. The untrained switching of device in chronic obstructive pulmonary disease (COPD) and asthma patients may be associated with inadequate inhalation technique and, consequently, could lead to a reduction in adherence to treatment and limit control of the disease. The aim of this analysis was to estimate the potential economic impact related to errors in inhalation in patients switching device without adequate training.
METHODS:An Italian real-practice study conducted in patients affected by COPD and asthma has shown an increase in health care resource consumption associated with misuse of inhalers. Particularly, significantly higher rates of hospitalizations, emergency room visits (ER), and pharmacological treatments (steroids and antimicrobials) were observed. In this analysis, those differences in resource consumption were monetized considering the Italian National Health Service (INHS) perspective.
RESULTS:Comparing a hypothetical cohort of 100 COPD patients with at least a critical error in inhalation vs 100 COPD patients without errors in inhalation, a yearly excess of 11.5 hospitalizations, 13 ER visits, 19.5 antimicrobial courses, and 47 corticosteroid courses for the first population were revealed. In the same way, considering 100 asthma patients with at least a critical error in inhalation vs 100 asthma patients without errors in inhalation, the first population is associated with a yearly excess of 19 hospitalizations, 26.5 ER visits, 4.5 antimicrobial courses, and 21.5 corticosteroid courses. These differences in resource consumption could be associated with an increase in health care expenditure for INHS, due to inhalation errors, of €23,444/yr in COPD and €44,104/yr in asthma for the considered cohorts of 100 patients.
CONCLUSION:This evaluation highlights that misuse of inhaler devices, due to inadequate training or nonconsented switch of inhaled medications, is associated with a decrease in disease control and an increase in health care resource consumption and costs.
KEYWORDS:COPD; asthma; costs; devices; errors; inhalers; switch; training
Int J Chron Obstruct Pulmon Dis. 2016 Mar 21;11:597-602. doi: 10.2147/COPD.S103335. eCollection 2016.
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重度持续性过敏性哮喘患者温度控制层流治疗的经济分析
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在控制良好的哮喘患者上使用沙美特罗/丙酸氟替卡松联合疗法进行降阶梯治疗
