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Darbà J, Ascanio M. Incidence and medical costs of chronic obstructive respiratory disease in Spanish hospitals: a retrospective database analysis. J Med Econ 2023; 26:335-341. [PMID: 36800217 DOI: 10.1080/13696998.2023.2182092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE This study aimed to assess the comorbidity profile, use of health care resources and medical costs of patients with chronic obstructive pulmonary disease (COPD) treated at the hospital level in Spain. METHODS Admission records of patients with COPD and at least two admissions registered between January 2016 and December 2020 were obtained from a Spanish hospital discharge database and analyzed in a retrospective multicenter study. RESULTS 95,140 patients met the inclusion criteria; 69.1% were males with a median age of 75 years. Mean Charlson comorbidity index (CCI) was 1.9 in the index admission, increasing to 2.1 during the follow-up period. An acute exacerbation of COPD was registered in 93.6% of patients in the index admission; other secondary diagnoses included respiratory failure (56.8%), essential hypertension (36.9%), hypercholesterolemia (26.7%) and diabetes (26.3%). The age-adjusted incidence rate of COPD was 22.6 per 10,000 persons over the study period, decreasing significantly in the year 2020. Mortality rate was 4.1% for COPD patients, increasing to 6.6% in the year 2020. The year 2020, 191 patients registered a COVID-19 infection, with a mortality rate of 23.0%. Length of hospital stay, and intensive care unit (ICU) stay increased in the follow-up period versus the index admission, similar to admission costs. Mean admission cost was €3212 in the index admission, with cost increases being associated with age, length of stay, ICU stay and CCI. CONCLUSIONS Patients' condition worsened significantly over the follow-up period, in terms of comorbidity and dependence on respirator, with an increased mortality rate and higher admission costs.
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Affiliation(s)
- Josep Darbà
- Department of Economics, Universitat de Barcelona, Barcelona, Spain
| | - Meritxell Ascanio
- Department of Health Economics, BCN Health Economics & Outcomes Research S.L, Barcelona, Spain
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Chen Y, Gong X, Zhou M, Xu Y, Fan F, Xiao J, Liu L, Shi K, Li S, Zhuo J, Chen Z, Yu X, Fan L, Chen Y, Wu L, Lin L. Treatment with JianPiYiFei II granules for patients with moderate to very severe chronic obstructive pulmonary disease: A 52-week randomised, double-blinded, placebo-controlled, multicentre trial. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 100:154057. [PMID: 35349835 DOI: 10.1016/j.phymed.2022.154057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/10/2022] [Accepted: 03/13/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Complementary and alternative therapy is widely used to treat chronic obstructive pulmonary disease (COPD). A Chinese herbal medicine, JianPiYiFei (JPYF) II granules, have been shown to improve COPD patients' quality of life, however long-term effectiveness has not been examined. PURPOSE To investigate whether long-term treatment with JPYF II granules is effective and safe for patients with stable, moderate to very severe COPD. STUDY DESIGN AND METHODS A multicentre, randomised, double-blinded, placebo-controlled trial was conducted. Eligible participants from six hospitals were randomly assigned 1:1 to receive either JPYF II granules or placebo for 52 weeks. The primary outcome was the change in St. George's Respiratory Questionnaire (SGRQ) score during treatment. Secondary outcomes included the frequency of acute exacerbations during treatment, COPD Assessment Test (CAT), 6-minute walking test (6MWT), lung function, body mass index, airflow obstruction, dyspnoea, exercise capacity (BODE) index, and peripheral capillary oxygen saturation (SpO2) at the end of treatment. RESULTS A total of 276 patients (138 in each group) were included in the analysis. JPYF II granules led to a significantly greater reduction in SGRQ score (-7.33 points, 95% CI -10.59 to -4.07; p < 0.0001) which reflects improved quality of life. JPYF II granules improved CAT (-3.49 points, 95% CI -5.12 to -1.86; p < 0.0001) and 6MWT (45.61 metres, 95% CI 20.26 to 70.95; p = 0.0005), compared with placebo. Acute exacerbations were less frequent with JPYF II granules than with placebo (0.87 vs. 1.34 events per patient; p = 0.0043). There were no significant differences between the groups in lung function, BODE index and SpO2. JPYF II granules were well tolerated and no significant adverse effects were noted. CONCLUSIONS Long-term treatment with JPYF II granules is effective in moderate to very severe COPD, improving quality of life and exercise capacity, decreasing the risk of acute exacerbation, and relieving symptoms.
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Affiliation(s)
- Yuanbin Chen
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China; Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou, China; State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiao Gong
- Department of Biostatistics, Guangzhou Jeeyor Medical Research Co., Ltd, Guangzhou, China
| | - Mingjuan Zhou
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Yinji Xu
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Feiting Fan
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China; Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou, China
| | - Jingmin Xiao
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China; Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou, China
| | - Liangji Liu
- Department of Respiratory Medicine, Jiangxi Provincial Hospital of Chinese Medicine, Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang, China
| | - Kehua Shi
- Department of Respiratory Medicine, Shanghai Hospital of Chinese Medicine, Shanghai, China
| | - Suyun Li
- Department of Respiratory Medicine, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Jinsheng Zhuo
- Department of Respiratory Medicine, Hainan Provincial Hospital of Chinese Medicine, Haikou, China
| | - Zhibin Chen
- Department of Respiratory Medicine, The Second Affiliated Hospital to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Xuhua Yu
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China; Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou, China; State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Long Fan
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China; Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou, China; State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yaolong Chen
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Lei Wu
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China; Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou, China; State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Lin Lin
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China; Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou, China; State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
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Valls Martínez MDC, Ramírez-Orellana A, Grasso MS. Health Investment Management and Healthcare Quality in the Public System: A Gender Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052304. [PMID: 33652724 PMCID: PMC7967670 DOI: 10.3390/ijerph18052304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/18/2021] [Accepted: 02/21/2021] [Indexed: 11/29/2022]
Abstract
The aim of this empirical research was to provide useful information for health system managers on the costs and investments involved in improving the quality of the National Health Service (NHS) based on patient assessments and from a gender perspective, i.e., without assuming that the perceived experience is identical for men and women. A cross-sectional study of 31 variables was applied using partial least squares structural equation modeling (PLS-SEM) as a research tool. The data were obtained from the Spanish Ministry of Health, Consumption, and Social Welfare for the entire Spanish territory between 2005 and 2018. The influence of expenditure, resource allocation, and mortality was hypothesized with regard to patient satisfaction according to disconfirmation theory. Patient satisfaction reflects clinical effectiveness, and therefore is a measure of health system quality. The results show that women are more sensitive to public investment in health than men, i.e., an increase in the level of spending and resources increases satisfaction more in women. In both sexes, the level of expenditure has a direct influence on patient satisfaction, and therefore on the quality of the healthcare system. It is important to increase spending on primary care, especially on specialized medical care and diagnostic equipment. However, reducing the use of drugs in favor of alternative treatments or therapies is considered to be positive. Likewise, spending has an impact on available resources, and these, in turn, have a positive influence on the level of use and a negative impact on mortality. Resources, especially healthcare staff, nuclear magnetic resonance equipment, and the number of posts in day hospitals, increase patients’ positive perception of the NHS.
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Dal Negro RW, Carone M, Cuttitta G, Gallelli L, Pistolesi M, Privitera S, Ceriana P, Pirina P, Balbi B, Vancheri C, Gallo FM, Chetta A, Turco P. Prevalence and clinical features of most frequent phenotypes in the Italian COPD population: the CLIMA Study. Multidiscip Respir Med 2021; 16:790. [PMID: 34733506 PMCID: PMC8506204 DOI: 10.4081/mrm.2021.790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/16/2021] [Indexed: 01/12/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a complex, progressive respiratory condition characterized by heterogeneous clinical presentations (phenotypes). The aim of this study was to assess the prevalence of the main COPD phenotypes and match of each phenotype to the most fitting clinical and lung function profile. Methods the CLIMA (Clinical Phenotypes in Actual Clinical Practice) study was an observational, cross-sectional investigation involving twenty-four sites evenly distributed throughout Italy. Patients were tentatively grouped based on their history and claimed prevailing symptoms at recruitment: chronic cough (CB, suggesting chronic bronchitis); dyspnoea (possible emphysema components, E); recurrent wheezing (presuming asthma components, A). Variables collected were: anagraphics; smoking habit; history of asthma; claim of >1 exacerbations in the previous year; blood eosinophil count; total blood IgE and alpha1 anti-trypsin (α1-AT) levels; complete lung function, and the chest X-ray report. mMRC, CAT, BCS, EQ5d-5L were also used. The association between variables and phenotypes were checked by Chi-square test and multinomial logistic regression. Results The CB phenotype was prevalent (48.3%), followed by the E and the A phenotypes (38.8% and 12.8%, respectively). When dyspnoea was the prevailing symptom, the probability of belonging to the COPD-E phenotype was 3.40 times higher. Recurrent wheezing was mostly related to the COPD-A phenotype. Lung function proved more preserved in the COPD-CB phenotype. Smoke; n. exacerbations/year; VR, and BODE index were positively correlated with the COPD-E phenotype, while SpO2, FEV1/FVC, FEV1/VC, and FEV1 reversibility were negatively correlated. Lower DLco values were highly probative for the COPD-E phenotype (p<0.001). Conversely, smoke, wheezing, plasma eosinophils, FEV1 reversibility, and DLco were positively correlated with the COPD-A phenotype. The probability of belonging to the COPD-A phenotype raised by 2.71 times for any increase of one unit in % plasma eosinophils (p<0.001). Also multiparametrical scores contributed to discriminate the three phenotypes. Conclusion The recognition of the main phenotypes of COPD can be effectively pursued by means of a few clinical and instrumental parameters, easy to obtain also in current daily practice. The phenotypical approach is crucial in the management of COPD as it allows to individualize the therapeutic strategy and to obtain more effective clinical outcomes.
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Affiliation(s)
- Roberto W Dal Negro
- National Center for Respiratory Pharmacoeconomics and Pharmacoepidemiology, Verona
| | | | - Giuseppina Cuttitta
- Institute of Biomedicine and Molecular Immunology, National Research Council, Palermo
| | - Luca Gallelli
- Pharmacology Operative Unit, University Hospital Authority "Mater Domini", Catanzaro
| | - Massimo Pistolesi
- Pneumologia e Fisiopatologia Toraco-Polmonare, Azienda Ospedaliera Universitaria Careggi, Firenze
| | | | - Piero Ceriana
- Occupational Health and Rehabilitation Clinic, ICS Maugeri IRCCS, Pavia
| | - Pietro Pirina
- Pneumology Operative Unit, University Hospital Authority, Sassari
| | - Bruno Balbi
- Pneumology Rehabilitation Unit, ICS Maugeri IRCCS, Veruno (NO)
| | - Carlo Vancheri
- Pneumology Rehabilitation Unit, University Hospital Authority, Policlinico Vittorio Emanuele, Catania
| | - Franca M Gallo
- Departmental Structure for Territorial Pneumology, Local Health Authority, Matera
| | - Alfredo Chetta
- Pneumology Clinic, University Hospital Authority, Hospital "G. Rasori", Parma
| | - Paola Turco
- Research and Clinical Governance, Verona, Italy
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Li CL, Lin MH, Chen PS, Tsai YC, Shen LS, Kuo HC, Liu SF. Using the BODE Index and Comorbidities to Predict Health Utilization Resources in Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2020; 15:389-395. [PMID: 32110007 PMCID: PMC7036670 DOI: 10.2147/copd.s234363] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/05/2020] [Indexed: 12/04/2022] Open
Abstract
Background and Objective Chronic Obstructive Pulmonary Disease (COPD) is a common chronic respiratory disease that in the long term may develop into respiratory failure or even cause death and may coexist with other diseases. Over time, it may incur huge medical expenses, resulting in a heavy socio-economy burden. The BODE (Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity) index is a predictor of the number and severity of acute exacerbations of COPD. This study focused on the correlation between the BODE index, comorbidity, and healthcare resource utilization in COPD. Patients and Methods This is a retrospective study of clinical outcomes of COPD patients with complete BODE index data in our hospital from January 2015 to December 2016. Based on the patients’ medical records in our hospital’s electronic database from January 1, 2015 to August 31, 2017, we analyzed the correlation between BODE index, Charlson comorbidity index (CCI), and medical resources. Results Of the 396 patients with COPD who met the inclusion criteria, 382 (96.5%) were male, with an average age of 71.3 ± 8.4 years. Healthcare resource utilization was positively correlated with the BODE index during the 32 months of retrospective clinical outcomes. The study found a significant association between the BODE index and the CCI of COPD patients (p < 0.001). In-hospitalization expenses were positively correlated with CCI (p < 0.001). Under the same CCI, the higher the quartile, the higher the hospitalization expenses. BODE quartiles were positively correlated with number of hospitalizations (p < 0.001), hospitalization days (p < 0.001), hospitalization expenses (p = 0.005), and total medical expenses (p = 0.024). Conclusion This study demonstrates the value of examining the BODE index and comorbidities that can predict healthcare resource utilization in COPD.
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Affiliation(s)
- Chin-Ling Li
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.,Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Mei-Hsin Lin
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Pei-Shiuan Chen
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Yuh-Chyn Tsai
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.,Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Lien-Shi Shen
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.,Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Ho-Chang Kuo
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.,Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shih-Feng Liu
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
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Dal Negro RW. COPD: The Annual Cost-Of-Illness during the Last Two Decades in Italy, and Its Mortality Predictivity Power. Healthcare (Basel) 2019; 7:E35. [PMID: 30832210 PMCID: PMC6473855 DOI: 10.3390/healthcare7010035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 11/16/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive pathological condition characterized by a huge epidemiological and socioeconomic impact worldwide. In Italy, the actual annual cost of COPD was assessed for the first time in 2002: the mean cost per patient per year was €1801 and ranged from €1500 to €3912, depending on COPD severity. In 2008, the mean annual cost per patient was €2723.7, ranging from €1830.6 in mild COPD up to €5451.7 in severe COPD. In 2015, it was €3291, which is 20.8% and 82.7% higher compared to the costs estimated in 2008 and 2002, respectively. In all these studies, the major cost component was direct costs, in particular hospitalization costs due to exacerbations, which corresponded to 59.9% of the total cost and 67.2% of direct costs, respectively. When the annual healthcare expenditure per patient is related to the length of survival by means of the PRO-BODE Index (PBI, which is the implementation of the well-known BODE Index with costs due to annual exacerbations and/or hospitalizations), the annual cost of care proved much more strictly and inversely proportional to patients' survival at three years, with the highest regression coefficient (r = -0.58) of all the multidimensional indices presently available, including the BODE Index (r = -021). In Italy, even though tobacco smoking has progressively declined by up to 21% in the general population, the economic impact of COPD has shown relentless progression over the last two decades, confirming that the present national health system organization is still insufficient for facing the issue of chronic diseases, in particular COPD, effectively. The periodic assessment of costs is an effective instrument for care providers in predicting COPD mortality, and for decision makers for updating and planning their social, economic, and political strategies.
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Affiliation(s)
- Roberto W Dal Negro
- National Centre for Respiratory Pharmacoeconomics and Pharmacoepidemiology, 37124 Verona, Italy.
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Zhao D, Ling C, Guo Q, Jin J, Xu H. Efficacy and safety of tiotropium bromide combined with budesonide/formoterol in the treatment of moderate to severe chronic obstructive pulmonary disease. Exp Ther Med 2018; 16:4578-4584. [PMID: 30542407 PMCID: PMC6257237 DOI: 10.3892/etm.2018.6773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 07/20/2018] [Indexed: 12/14/2022] Open
Abstract
With the increase of environmental pollution, chronic obstructive pulmonary disease (COPD) has become a serious health threat. In the present study, the efficacy and safety of inhalation therapy of tiotropium bromide combined with budesonide/formoterol were assessed in 180 patients with moderate to severe COPD (clinical trial registry no. ChiCTR1800017584). Patients were treated by inhalation of budesonide/formoterol (control group) or inhalation of tiotropium bromide combined with budesonide/formoterol (intervention group). The results indicated that after the treatment, the forced expiratory volume in 1 sec, the modified Medical Research Council scale, the 6-min walking distance and the St. George's Respiratory Questionnaire scores for quality of life were significantly improved in the two groups, while the improvements in the intervention group were more significant (all P<0.05). There was no significant difference in body mass indices between the two groups during the course of the treatment (P=0.302). The difference in the risk of an acute exacerbation between the two groups was also not significant (P=0.238). The median time to the first acute exacerbation from the start of treatment in the intervention group (53 days; 25% quartile, 50 days; 75% quartile, 62 days) was significantly longer than that in the control group (37 days; 25% quartile, 23 days; 75% quartile, 39 days; P=0.042). The adverse reaction rates in the intervention and control groups were 14.4 and 10.0%, respectively, without any significant difference. In conclusion, inhalation treatment of tiotropium bromide combined with budesonide/formoterol significantly improves pulmonary function, exercise capacity and quality of life of patients with COPD compared with budesonide/formoterol inhalation alone, while the effect of reducing the acute attack risk requires further evaluation.
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Affiliation(s)
- Daguo Zhao
- Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Chunhua Ling
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Qiang Guo
- Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Jun Jin
- Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Hua Xu
- Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
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