1、接受长效型吸入剂药物治疗慢性阻塞性肺病病人之成效分析Analysis of efficacy of treatment with longactive inhaled combination agents in chronicobstructive pulmonary disease patients中 文 摘 要慢性阻塞性肺病是引起呼吸道之慢性发炎，且疾病的进展是缓慢发展而造成气道阻塞，使之造成的肺脏及肺功能逐渐恶化，且伤害大多是不可逆性。在先进国家中，慢性阻塞性肺病在死亡原因中的第四位，根据世界卫生组织于 1990 年预估，2020 年它将会成为人类死亡原因第三位。台湾 40 岁以上成人，
2、平均每六人就有一人罹患中重度的慢性阻塞性肺病，盛行率达 16%。由于慢性阻塞性肺病患者数众多、其死亡率高，治疗慢性阻塞性肺病健保每年花费约 13 亿元，造成社会经济负担，盛行率及耗用的医疗资源都逐年上升，现已成为一个重要的公共卫生问题。根据 2007 年慢性阻塞性肺病诊治指引，依严重度逐渐增加治疗(step-up) 之策略，将疾病严重度分成四级，依据不同的病情变化给予适当之药物治疗；近年来，以长效型吸入剂药物用来治疗 COPD 为主流。故，藉此了解使用口服药物与使用长效型吸剂之病人两者做比较，是否因肺功能障碍而减缓肺功能衰退，进而增加门诊使用次数、急诊使用次数、延长住院天数。本研究收案时间为已
3、以收集 2008 年 09 月至 2009 年 08 月，共十二个月之门诊慢性阻塞性肺病病人，并排除标准为气喘病患和死亡病人。以接受长效型吸入剂治疗与使用口服药物之对照组病患两组，iii比较疾病严重度轻度、中度、重度、极重度、肺活量 FEV1（用力呼气一秒量）百分比之差异，对医疗利用累积住院日数、急诊次数、急性发作之影响。统计部分采用 SPSS 12.0 版套装软件，以描述性、推论性分析及强迫进入复回归分析预测变项进行分析。研究结果显示，使用吸剂病人中在用药前后肺功能之差异里，比使用口服药病人较佳。在使用口服药控制 COPD 之个案中，其疾病严重度为极重度个案中会影响累积住院日数情况；故，其功
4、能较差者日常生活活动受限，其住院天数就愈多天。由此可见使用长效型吸入剂病人，当提升会提高肺功能指标，对于 COPD 疾病的控制是有利的，并带给病人生活质量。有效的疾病管理会降低 COPD 病人再住院率，并提升医疗质量，以获得更大成效。关键字：慢性阻塞性肺病、疾病严重度、肺活量、长效型吸入剂、医疗利用ivAbstractChronic Obstruction Pulmonary Disease (i.e. COPD) is a preventableand treatable disease with some significant extra-pulmonary effects thatma
5、y contribute to the severity in individual patients. Its pulmonarycomponent is characterised by airflow limitation that is not fullyreversible. The airflow limitation is usually progressive and associatedwith an abnormal inflammatory response of the lung to noxious particlesor gases. The World Healt
6、h Organization predicts COPD to be the topthree diseases in Year 2020.Adult over 40 years of age， the prevalencerate was 16% and the average one in six people suffered from moderate tosevere COPD. The health insurance costs about 1.3 billion per year andresulting in increase socio-economic burden、co
7、nsumption of medicalresources year by year , and also has become an important public healthproblem 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 of12 mo
8、nths of outpatients with chronic obstructive pulmonary diseaseand exclusion criteria for the asthma patient and the patient died.SPSS12.0 statistical software and using descriptive, inferential analysis andprediction of forced entry multiple regression analysis . We analyzedefficacy of treatment wit
9、h long-acting inhaled combination in chronicobstructive pulmonary disease patient and compared disease severitystage(GOLD stage) and FEV1 ( forced expiratory volume one second).vWe also focused on the effects of medical utilization patterns (reduction inout-patients、lower general ward admission and
10、intensive care unitadmission、decrease acute exacerbations、visit emergency room), and thatwhether health care costs decrease or not.The research outcome shown as follows: (1).The efficacy oflong-acting inhaled combination agents in patients with chronicobstructive pulmonary disease is well documented
11、 .(2)In inhaled group，lung function is better than oral medication group.(3)In inhaled group, reduction in medical utilization patterns (out-patients、general wardadmission and intensive care unit admission、acute exacerbations rate、emergency room）.Based on the higher COPD prevalence rate andmedical c
12、onsumption , appropriate treatment can have an importantimpact on many facets of the disease.This study provides the evidence of reducing the health careexpenditure by treat with long-acting inhaled combination agents .It willimprove the lung function in chronic obstructive pulmonary diseasepatient
13、and quality of life. Effective disease management will reduce there-hospitalization rate .With more understandings of factors affectingmedical utilization patterns, we can improve the health care delivery andreduce health insurance payment in the future.Key word：COPD、disease severity、FEV1、medical ut
14、ilization patternsvi志谢工作了八年之后，能再回到学校，亚大有一流名师的教导，丰富了我的人生，且在忙碌的度过两年研究生生活。论文得以顺利完成，首先要感谢师长们的教导，首先要感谢我的指导教授 刘见祥老师、叶玲玲老师，在论文指导期间，无论是研究方向的指引与思想观念的导正，均给予最大的协助与耐心指导。由于老师的博学与平易近人，使学生在论文的撰写上给于莫大的空间受益良多，谨向恩师们致上最深的敬意与。再者，感谢医院病历室众多美丽的同仁，在病历收集和整理期间给予的协助。感谢一起奋斗的懿莹、佳俞、宏琛、文姬。要感谢的人真的很多，感谢这段日子所有关心我的朋友，最后要感谢我的太太以及一对儿女，感谢他们这一些日子以来的支持与鼓励，让我无后顾之忧，论文才能如期的完成。侯 坚谨识vii民国九九 年 六 月目