上海市某医院COPD急性加重住院患者用药模式及合并心血管疾病对其影响OA

AIM To analyze medication patterns and annual trends in acute exacerbation of chronic obstructive pulmonary disease(AECOPD)inpatients(2021-2024)in a hospital in Shanghai,and quantify cardiovascular disease(CVD)comorbidity's impact on specific drug selections.METHODS Medical records of AECOPD inpatients(n=2 398)in a hospital in Shanghai were retrospectively included.Demographic characteristics,hospitalization details,and prescription information for 10 commonly used medication categories were collected.Based on the International Classification of Diseases 10th Revision(ICD-10),patients were categorized into CVD group(n=1 888)and non-CVD group(n=510).Logistic regression and chi-square test were respectively used to compare the differences in the usage proportions of various drugs and combined drugs between 2 groups.The Cochran-Armitage trend test was used to analyze the changing trends of drug usage proportions in different years and the impact of combined CVD.RESULTS The average age of enrolled patients was(77.66±8.97)years.The majority(86.2％)were male.The average hospital stay was(12.36±8.73)days.Nearly half(48.3％)had been hospitalized more than 2 times due to AECOPD.The CVD group was characterized by the significantly older age,higher proportion of females,and longer hospital stays compared with the non-CVD group,with all differences being statistically significant(P＜0.05).The top three medications by usage rate were mucolytics(78.9％),inhaled corticosteroids(ICS,70.1％),and methylxanthines(65.4％),while more ICS(OR=1.35,95％CI:1.09-1.68)and methylxanthines(OR=1.26,95％CI:1.03-1.56)were used in the CVD group.Also,combination therapies including methylxanthines+ICS(51.1％vs 43.5％),long-acting β2-adrenoceptor agonist+long-acting muscarinic antagonist(LABA+LAMA)(40.0％vs 35.5％),and triple therapy(LABA+LAMA+ICS,38.0％vs 32.6％)were more prevalent in the CVD group(P＜0.05).Annual trends(2021-2024)revealed statistically significant increases in LABA,LAMA,ICS,and mucolytics but a decrease in methylxanthines overall or in the CVD group(P＜0.05).CONCLUSION The overall medication trend of AECOPD inpatients in the hospital has shown a positive change consistent with the direction of the Global Initiative for Chronic Obstructive Lung Disease(COLD).However,for the population with CVD,the continuous high usage rate of methylxanthines is contrary to the cardiovascular risk warnings in the guidelines.It is recommended to optimize the treatment strategy through establishing individualized medication paths for CVD patients,improving the relevant medication monitoring and evaluation system,and strengthening multidisciplinary collaboration and clinical doctor education.