关键词: 慢性阻塞性肺疾病, 急性加重, 糖皮质激素, 嗜酸性粒细胞, 药物利用

Abstract:

AIM: To analyze the application situation of systemic glucocorticoids in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) diagnosed with different eosinophil levels in peripheral blood in order to guide clinical rational drug use. METHODS: A retrospective research method was adopted; the latest published AECOPD management recommendations issued by the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) were taken as evaluation criterion. According to the percentage of eosinophils (EOS) in peripheral blood, all patients were divided into two groups: patients with EOS≥2.0% as EOS observation group and patients with EOS<2.0% as EOS control group. SPSS 19.0 statistical analysis software was used for data processing; the differences in the proportion of systemic glucocorticoids used and the length of hospital stay between the two groups were compared, so was the difference of forced expiratory volume in 1s (FEV1) between the two groups before and after treatment. RESULTS: A total of 550 AECOPD patients were included in the study, of which there were 193 patients with EOS≥2.0%, accounting for 35.10%, and there were 357 patients with EOS<2.0%, accounting for 64.90%, there were 164 patients who used systemic glucocorticoids, accounting for 29.82%, there were 386 patients who used inhaled glucocorticoids, accounting for 70.18%. There were 45 patients out of the 164 patients who used systemic glucocorticoids in the EOS observation group, accounting for 27.44%; there were 119 patients who used systemic glucocorticoids in the EOS control group, accounting for 72.56%. Compared with the EOS control group, the average length of hospital stay in the EOS observation group was shorter; so the difference between the two groups was significant (P=0.04). FEV1 in EOS observation group was improved after using systemic glucocorticoid, and there was significant difference between before and after treatment (P=0.04). CONCLUSION: According to the latest AECOPD management recommendations as an evaluation criterion, systemic glucocorticoids are overused and underused in the treatment of AECOPD; clinical pharmacists should refer to the latest recommendations recognized by international professional pharmacists when guiding clinical drug use and conducting drug utilization evaluation in order to promote rational use of drugs together with clinicians.

Key words: COPD, acute exacerbation, glucocorticoid, eosinophils, drug utilization