2023年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33119658_2988231.docx

亚洲大学 健康产业管理学系 硕 士 论 文 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 long active inhaled combination agents in chronic obstructive pulmonary disease patients 研 究 生：侯  坚 指导教授：刘见祥 教授 叶玲玲 副教授 中 华 民  国 九十九年 六 月 i 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 慢开展而造成气道阻塞，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，2023 年它将会成为人类死 亡原因第三位。台湾 40 岁以上成人，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 2023 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以收集 2023 年 09 月至 2023 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。统计局部采用 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 iv Abstract Chronic Obstruction Pulmonary Disease (i.e. COPD) is a preventable and treatable disease with some significant extra-pulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterised by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases. The World Health Organization predicts COPD to be the top three diseases in Year 2023.Adult over 40 years of age， the prevalence rate was 16% and the average one in six people suffered from moderate to severe COPD. The health insurance costs about 1.3 billion per year and resulting in increase socio-economic burden、consumption of medical resources year by year , and also has become an important public health problem in Taiwan. According to the 2023 Taiwan GOLD guidelines , treatment of COPD is based on disease severity and to step-up strategy. This study collected from September 2023 to August 2023 , a total of 12 months of outpatients with chronic obstructive pulmonary disease 12.0 statistical software and using descriptive, inferential analysis and prediction of forced entry multiple regression analysis . We analyzed efficacy of treatment with long-acting inhaled combination in chronic obstructive pulmonary disease patient and compared disease severity stage(GOLD stage) and FEV1 ( forced expiratory volume one second). v We also focused on the effects of medical utilization patterns (reduction in out-patients、lower general ward admission and intensive care unit admission、decrease acute exacerbations、visit emergency room), and that whether health care costs decrease or not. The research outcome shown as follows: (1).The efficacy of long-acting inhaled combination agents in patients with chronic obstructive pulmonary disease is well documented .(2)In inhaled group， lung function is better than oral medication group.(3)In inhaled group , reduction in medical utilization patterns (out-patients、general ward admission and intensive care unit admission、acute exacerbations rate、 emergency room）.Based on the higher COPD prevalence rate and medical consumption , appropriate treatment can have an important impact on many facets of the disease. This study provides the evidence of reducing the health care expenditure by treat with long-acting inhaled combination agents .It will improve the lung function in chronic obstructive pulmonary disease patient and quality of life. Effective disease management will reduce the re-hospitalization rate .With more understandings of factors affecting medical utilization patterns, we can improve the health care delivery and reduce health insurance payment in the future. Key word：COPD、disease severity、FEV1、medical utilization patterns vi 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